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Polish Journal of Radiology 2023Colorectal cancer (CRC) is one of the most common malignancies in the world. Nowadays many treatments are available to help control CRC, including surgery, radiation... (Review)
Review
Colorectal cancer (CRC) is one of the most common malignancies in the world. Nowadays many treatments are available to help control CRC, including surgery, radiation therapy, interventional radiology, and drug treatments. A multidisciplinary approach and the role of radiologists is needed to assist the surgeon in the management thanks to emerging technology and strategies. The Response Evaluation Criteria in Solid Tumours (RECIST) has been created to objectify and standardize cancer response assessment. Thus, in this article specific presumptions and practical aspects of evaluating responses according to the RECIST 1.1 are discussed. Furthermore, examples of possible response to systemic treatment of colorectal liver metastases (CRLM), including tumour necrosis, apparent diffusion coefficient (ADC) values, tumour calcification, tumour fibrosis and intratumoural fat deposition observed on cross-sectional imaging, are described. Disappearing liver metastases (DLM) presents a therapeutic dilemma. The optimal management of DLM remains controversial due to the uncertainty of residual microscopic disease and effective long-term outcomes. The article provides an overview of the CRLM phenomenon and current possible assessment methods of the response to systemic treatment.
PubMed: 38125815
DOI: 10.5114/pjr.2023.132884 -
GeroScience Apr 2024In the context of a globally aging population, exploring interventions that counteract age-related cognitive decline and cerebral structural alterations is paramount.... (Meta-Analysis)
Meta-Analysis
In the context of a globally aging population, exploring interventions that counteract age-related cognitive decline and cerebral structural alterations is paramount. Among various strategies, physical exercise (PE) emerges as a prevalent activity routinely incorporated in many individuals' lives. This systematic review and meta-analysis aims to elucidate the impact of PE on white matter (WM) integrity and cognitive function in older adults. Data from 581 participants, 312 in the PE intervention group, and 269 in the control group were extracted from nine randomized controlled trials (RCTs) retrieved from databases including PubMed, Embase, Web of Science, and the Cochrane Library. The results indicated a significant improvement in white matter (WM) integrity in individuals engaged in PE, as evidenced by enhanced fractional anisotropy (FA) scores (SMD = 0.4, 95% confidence interval (CI) [0.05, 0.75], P = 0.024). The GRADE assessment revealed a moderate risk. However, no significant associations were found between PE and other metrics such as radial diffusivity (RD), mean diffusivity (MD), white matter volume (WMV), hippocampal volume (HV), and cognitive functions (executive function [EF], memory, processing speed). In conclusion, our study emphasizes the potential neurostructural and cognitive functional benefits of physical exercise for the brain health of older adults.
Topics: Humans; Aged; White Matter; Diffusion Tensor Imaging; Cognition; Brain; Exercise
PubMed: 38108993
DOI: 10.1007/s11357-023-01033-8 -
Frontiers in Immunology 2023Richter syndrome (RS) represents the clonal evolution of chronic lymphocytic leukemia with histological transformation into a high-grade B cell lymphoma (diffuse large B... (Meta-Analysis)
Meta-Analysis
INTRODUCTION AND AIMS
Richter syndrome (RS) represents the clonal evolution of chronic lymphocytic leukemia with histological transformation into a high-grade B cell lymphoma (diffuse large B cell lymphoma - DLBCL) or Hodgkin lymphoma. Considering that RS is an uncommon condition with poor prognosis, few high-quality evidence is available. To overcome this unmet need, this meta-analysis aimed to pool efficacy of early clinical trials in Richter syndrome (DLBCL subtype).
METHODS
MEDLINE, Scopus and Web of Science were searched up to May of 2023 to identify clinical trials decoying efficacy. The pooled complete response, objective response and intension-to-treat failure rates were calculated by pharmacological categories (classical chemotherapy, immunochemotherapy, immunotherapy, Bruton-tyrosine kinase inhibitors, targeted approaches, cell-based therapies and combinatorial regimens) using the Der-Simonian and Laird random-effects model. The Freeman-Tukey double arcsine method was used to estimate variance and confidence intervals. Heterogeneity was assessed using the I method.
RESULTS
Overall, from 1242 studies identified, 30 were included, pooling data from 509 patients. The higher efficacy rates when, cell-based therapies were excluded, were achieved by immunochemotherapeutic regimens followed by combinatorial regimens, with complete response rates of 21.54% (IC95%14.93-28.87) and 23.77% (IC95% 8.70-42.19), respectively. Bispecific antibodies (alone or coupled with a chemotherapy debulking strategy) overtook Bruton tyrosine kinase inhibitors response rates. The latter, although achieving objective response rates above average, presented scarce complete response rates. Checkpoint inhibitors alone usually do not lead to complete responses, but their effectiveness may improve when combined with other agents, unveiling the importance of immune microenvironmental modulation.
CONCLUSION
This is the first meta-analysis of early clinical trials assessing the impact of different therapeutics in RS. By analyzing the pooled efficacy estimates, our work suggests the role of a tailor-made bridging therapy for young patients with RS eligible for allogeneic hematopoietic stem cell transplantation (alloSCT), formally the only curative strategy.
Topics: Humans; Antineoplastic Combined Chemotherapy Protocols; Hodgkin Disease; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphoma, Large B-Cell, Diffuse; Tyrosine Kinase Inhibitors; Clinical Trials as Topic
PubMed: 38077330
DOI: 10.3389/fimmu.2023.1295293 -
Applied Bionics and Biomechanics 2023[This retracts the article DOI: 10.1155/2022/2042736.].
[This retracts the article DOI: 10.1155/2022/2042736.].
PubMed: 38075141
DOI: 10.1155/2023/9810302 -
Frontiers in Neurology 2023Relapsing polychondritis (RP) is a rare rheumatologic disorder that may affect the neurological system with various presentations. In this study, we present a case and...
BACKGROUND AND PURPOSE
Relapsing polychondritis (RP) is a rare rheumatologic disorder that may affect the neurological system with various presentations. In this study, we present a case and summarize the clinical characteristics of RP-associated meningoencephalitis.
CASE PRESENTATION
A 48-year-old man presented with first-ever seizures that were well controlled by valproate. Physical examination results were unremarkable, except for binaural deformation. The initial brain magnetic resonance imaging (MRI) without contrast and electroencephalogram (EEG) findings were normal. However, the patient subsequently developed recurrent fever, scleritis, headache, lethargy, and left arm paresis. Repeated brain MRI with contrast demonstrated increased enhancement of the pia mater and abnormal diffusion-weighted imaging (DWI) signals in the bilateral auricles. The cerebrospinal fluid (CSF) analysis showed 2 leukocytes/μL, 736.5 mg/L of protein, and no evidence of infectious disease or autoimmune encephalitis. Meningoencephalitis secondary to RP was considered. The patient's condition improved significantly and quickly with the administration of dexamethasone (10 mg per day). Oral methylprednisolone was continued, and the patient remained well without relapse during the 9-month follow-up period.
CONCLUSION
RP-associated meningoencephalitis is rare but fatal. Although symptoms vary, red or deformed ears remain the most common and suggestive features. Non-specific parenchymal changes and/or meningeal enhancement can be observed on brain MRI scans. CSF lymphocytic pleocytosis with mild protein elevation was observed in most patients.
PubMed: 38033767
DOI: 10.3389/fneur.2023.1265345 -
Clinical Medicine Insights. Oncology 2023Pulmonary toxicities caused by immune checkpoint inhibitors are a prominent concern for clinicians. Clinical Practice Guidelines (CPGs) are critical for managing these... (Review)
Review
A Systematic Review of Clinical Practice Guidelines for Managing Pulmonary Toxicities Caused by Immune Checkpoint Inhibitors: Quality of Treatment Recommendations and Differences in Management Strategies Between Guidelines.
BACKGROUND
Pulmonary toxicities caused by immune checkpoint inhibitors are a prominent concern for clinicians. Clinical Practice Guidelines (CPGs) are critical for managing these toxicities.
METHODS
A systematic search of CPGs on checkpoint-associated pulmonary toxicities (ca-PT) was conducted in October 2022. PubMed, Embase, Cochrane Library, CINAHL, and Web of Science were searched. AGREE II and AGREE-REX were used to appraise CPGs and recommendations quality, respectively. Descriptive statistics, intraclass correlation coefficient, Kruskal-Wallis (H) test, and Spearman's correlation were used for analyses. P-values < .05 were considered statistically significant. Matrices were used to determine recommendation differences between CPGs. The study's design was based on the PRISMA 2020 checklist for systematic reviews. Protocol registration number: CRD42022358435.
RESULTS
Eight CPGs (two high-quality, three moderate-quality, and three low-quality) were identified. All CPGs covered pneumonitis. One CPG covered pleural effusions and pneumonitis/SARs-CoV-2-infection. Three CPGs covered sarcoidosis-like-reactions. CPGs for pulmonary fibrosis, airway disease, bronchiolitis, and diffuse alveolar damage, were unavailable. No CPG recommendation was based on a prospective study, and none were appraised as high-quality. Also, recommendations were not specific to histopathologic subtypes. AGREE II's "rigor of development," the domain that evaluates a guideline's methodological approach and strategies in gathering scientific evidence, correlated strongly with AGREE-REX's "overall quality" pneumonitis recommendations, r = .952; P < .01. Approximately 73% of recommendations on pneumonitis were similar between high-quality CPGs. About 16% to 74% of low-quality CPGs were similar to those recommended by high-quality CPGs.
CONCLUSION
Prospectively designed research projects focusing on all types of ca-PT and their histopathologic subtypes are urgently needed. Due to the lack of high-quality recommendations in available CPGs, the disparities in treatment recommendations between high-quality CPGs, and the similarities in recommendations that exists between high-quality and low-quality CPGs, clinicians should thoroughly assess and responsibly appraise all available CPG recommendations in formulating treatment strategies for ca-PT.
PubMed: 38033741
DOI: 10.1177/11795549231203153 -
Shoulder & Elbow Dec 2023Many joint-preserving surgical interventions for cartilage defects of the knee have been adapted for use in the shoulder; however, there still exists no clear consensus... (Review)
Review
BACKGROUND
Many joint-preserving surgical interventions for cartilage defects of the knee have been adapted for use in the shoulder; however, there still exists no clear consensus for treatment. Thus, the purpose of this systematic review was to evaluate the outcomes of different interventions in patients with focal chondral lesions of the glenohumeral joint.
METHODS
A literature search was conducted using PubMed, Embase, and Medline. Patients who underwent a joint-preserving surgical procedure to treat a focal chondral defect of the glenoid, humeral head or both were included. Patients treated for diffuse cartilage defects or with shoulder arthroplasty were excluded.
RESULTS
Ten studies were included, with follow-up data available for 194 shoulders. Eight joint-preserving procedures were evaluated, with microfracture being the most common. One study evaluating microfracture reported significant improvements in patient-reported outcomes at short-term and long-term follow-up compared to preoperative scores. Across all studies, 32 patients underwent subsequent shoulder surgery, with 22 being arthroplasties.
CONCLUSIONS
We found improvements in patient-reported and functional outcomes across all studies. Although joint-preserving procedures have shown reasonable outcomes for focal chondral defects of the glenohumeral joint, long-term outcomes remain unknown, and the progression of osteoarthritis remains a concern. Higher quality evidence is required to make definitive recommendations.
LEVEL OF EVIDENCE
IV.
PubMed: 38028932
DOI: 10.1177/17585732221142610 -
Polish Journal of Radiology 2023This study aimed to assess the applicability of the apparent diffusion coefficient (ADC) for differentiating nasopharyngeal carcinoma (NPC) from lymphomas in the head... (Review)
Review
Differentiating nasopharyngeal carcinoma from lymphoma in the head and neck region using the apparent diffusion coefficient (ADC) value: a systematic review and meta-analysis.
PURPOSE
This study aimed to assess the applicability of the apparent diffusion coefficient (ADC) for differentiating nasopharyngeal carcinoma (NPC) from lymphomas in the head and neck region.
MATERIAL AND METHODS
Four databases, including PubMed, the Cochrane Library, EMBASE, and Web of Science, were searched systematically to find relevant literature. The search date was updated to 8 September 2022, with no starting time restriction. The methodological quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Firstly, a random-effects model was used in a meta-analysis of continuous variables with low heterogeneity to determine the overall effect size, which was reported as the standard mean difference (SMD). Then, bivariate random effects modelling was used to calculate the combined sensitivity and specificity. The area under the curve (AUC) for each diffusion parameter was calculated after constructing summary receiver operating characteristic curves. The presence of heterogeneity was evaluated using subgroup and meta-regression analysis.
RESULTS
Twelve studies involving 181 lymphoma and 449 NPC lesions ( = 630) in the head and neck region were included, of which 5 studies provided sufficient data for pooling diagnostic test accuracy. A meta-analysis of the 12 studies using a random-effects model yielded an SMD of 1.03 (CI = 0.76-1.30; = 0.00001), implying that NPC lesions had a significantly higher ADC value than lymphoma lesions. By pooling 5 standard DWI studies, the pooled sensitivity and specificity of ADC were 0.90 (95% CI: 0.82-0.95) and 0.63 (95% CI: 0.52-0.72), respectively. The area under the curve (AUC) calculated from the SROC curve was 0.74 (95% CI: 0.70-0.78).
CONCLUSIONS
According to this systematic review and meta-analysis, nasopharyngeal carcinoma has a significantly higher ADC value than lymphomas. Furthermore, while ADC has excellent sensitivity for distinguishing these 2 types of tumours, its specificity is relatively low, yielding a moderate diagnostic performance. Further investigations with larger sample sizes are required.
PubMed: 38020498
DOI: 10.5114/pjr.2023.132172 -
BMC Pulmonary Medicine Nov 2023Acute heart failure (AHF) is often associated with diffuse insufficiency and arterial hypoxemia, requiring respiratory support for rapid and effective correction. We... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Acute heart failure (AHF) is often associated with diffuse insufficiency and arterial hypoxemia, requiring respiratory support for rapid and effective correction. We aimed to compare the effects of high-flow nasal cannula(HFNC) with those of conventional oxygen therapy(COT) or non-invasive ventilation(NIV) on the prognosis of patients with AHF.
METHODS
We performed the search using PubMed, Embase, Web of Science, MEDLINE, the Cochrane Library, CNKI, Wanfang, and VIP databases from the inception to August 31, 2023 for relevant studies in English and Chinese. We included controlled studies comparing HFNC with COT or NIV in patients with AHF. Primary outcomes included the intubation rate, respiratory rate (RR), heart rate (HR), and oxygenation status.
RESULTS
From the 1288 original papers identified, 16 studies met the inclusion criteria, and 1333 patients were included. Compared with COT, HFNC reduced the intubation rate (odds ratio [OR]: 0.29, 95% CI: 0.14-0.58, P = 0.0005), RR (standardized mean difference [SMD]: -0.73 95% CI: -0.99 - -0.47, P < 0.00001) and HR (SMD: -0.88, 95% CI: -1.07 - -0.69, P < 0.00001), and hospital stay (SMD: -0.94, 95% CI: -1.76 - -0.12, P = 0.03), and increase arterial oxygen partial pressure (PaO), (SMD: 0.88, 95% CI: 0.70-1.06, P < 0.00001) and oxygen saturation (SpO [%], SMD: 0.70, 95% CI: 0.34-1.06, P = 0.0001).
CONCLUSIONS
There were no significant differences in intubation rate, RR, HR, arterial blood gas parameters, and dyspnea scores between the HFNC and NIV groups. Compared with COT, HFNC effectively reduced the intubation rate and provided greater clinical benefits to patients with AHF. However, there was no significant difference in the clinical prognosis of patients with AHF between the HFNC and NIV groups.
TRIAL REGISTRATION
PROSPERO (identifier: CRD42022365611).
Topics: Humans; Cannula; Oxygen; Oxygen Inhalation Therapy; Hypoxia; Noninvasive Ventilation; Heart Failure; Respiratory Insufficiency
PubMed: 38017474
DOI: 10.1186/s12890-023-02782-0 -
Healthcare (Basel, Switzerland) Nov 2023Idiopathic pulmonary fibrosis (IPF) is one of the most deleterious diseases of the pulmonary fibrosis spectrum. Its clinical presentation includes irreversible loss of... (Review)
Review
Effect of Chest Physiotherapy on Quality of Life, Exercise Capacity and Pulmonary Function in Patients with Idiopathic Pulmonary Fibrosis: A Systematic Review and Meta-Analysis.
BACKGROUND
Idiopathic pulmonary fibrosis (IPF) is one of the most deleterious diseases of the pulmonary fibrosis spectrum. Its clinical presentation includes irreversible loss of lung function, and increasing cough, dyspnea and impaired quality of life. Chest physiotherapy can improve ventilation capacity, gas exchange, dyspnea, exercise capacity and quality of life. The aim of this study was to review the evidence about chest physiotherapy in IPF, specifically meta-analyzing quality of life, exercise capacity and pulmonary function.
METHODS
A wide search was conducted in PubMed, Embase, Cochrane and Web of Science for articles included until October 2023. PROSPERO Identifier: CRD42022333496. The Downs and Black scale and the Cochrane tool were employed to evaluate quality assessments and to assess the risk of bias. Data were pooled, and a meta-analysis was conducted.
RESULTS
We selected 10 studies in which a chest physiotherapy program was performed with a total of 340 patients; of these, three articles were meta-analyzed. Significant effects in favor of chest physiotherapy were found for quality of life (MD = -8.60, 95% CI = -11.30, -5.90; < 0.00001; I = 24%), exercise capacity (MD = 37.62, 95% CI = 15.10, 60.13; = 0.001; I = 65%) and pulmonary function (MD = 7.86, 95% CI = 2.54, 13.17; = 0.004; I = 80%).
CONCLUSIONS
The systematic review showed significant results for the application of chest physiotherapy regarding pulmonary capacity, diffusion of gases and quality of life in IPF patients. The meta-analysis showed a significant improvement associated with applying chest physiotherapy in pulmonary function, exercise capacity and quality of life.
PubMed: 37998418
DOI: 10.3390/healthcare11222925