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Frontiers in Neurology 2024Post-stroke dysphagia (PSD) affects the efficacy and safety of swallowing, causing serious complications. Acupuncture is a promising and cost-effective treatment for...
BACKGROUND
Post-stroke dysphagia (PSD) affects the efficacy and safety of swallowing, causing serious complications. Acupuncture is a promising and cost-effective treatment for PSD; however, as the number of randomized controlled trials increases, scientific analysis of the parameters and acupoint prescription is required. Therefore, this study aimed to explore the effects of acupuncture on parameters related to post-stroke dysphagia (PSD).
METHODS
We searched the Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature, and Chongqing VIP Database for randomized controlled trials of acupuncture for PSD in the last 15 years and relevant parameters were analyzed using data mining techniques.
RESULTS
In total, 3,205 records were identified, of which 3,507 patients with PSD were included in 39 studies. The comprehensive analysis demonstrated that the closest parameter combinations of acupuncture on PSD were 0.25 mm × 40 mm needle size, 30 min retention time, five treatments per week, and a 4-week total course of treatment. Additionally, the gallbladder and nontraditional meridians, crossing points, and head and neck sites are the most commonly used acupoint parameters. The core acupoints identified were GB20, RN23, EX-HN14, Gongxue, MS6, SJ17, EX-HN12, EX-HN13, and the commonly used combination of EX-HN12, EX-HN13, GB20, and RN23.
CONCLUSION
This study analyzed the patterns of PSD-related needling and acupoint parameters to provide evidence-based guidelines for clinical acupuncturists in treating PSD, potentially benefitting affected patients.
PubMed: 38854959
DOI: 10.3389/fneur.2024.1394348 -
Digestive and Liver Disease : Official... Jun 2024The use of neuromodulators is prevalent in various functional gastrointestinal disease. However, data concerning the outcomes of these treatments in functional...
BACKGROUD
The use of neuromodulators is prevalent in various functional gastrointestinal disease. However, data concerning the outcomes of these treatments in functional esophageal disorders (FED) remains limited and inadequate.
AIMS
The aim of the present study is to examine the efficacy of central neuromodulators in FED.
METHODS
We searched PubMed, EMBASE, and the Cochrane library databases from inception to April 2023. Randomized controlled trials that compared the effects of neuromodulators and placebos on FED are included. Primary outcome is the symptom improvement, and Rome IV criteria is used to assess eligible studies.
RESULTS
Eleven randomized controlled studies (three for functional chest pain, four for reflux hypersensitivity/functional heartburn, three for globus, and one for functional dysphagia) were included in the final analysis. Neuromodulators reduced chest pain by 52%-71% in patients with functional chest pain, and alleviated symptom by 46%-75% in patients with globus (n = 3, Odds ratio 6.30, 95% confidence interval 4.17-9.50). However, the results were inconsistent for reflux hypersensitivity and functional heartburn. There was a lack of convincing evidence to support the use of neuromodulators for functional dysphagia. The use of neuromodulators did not have a significant impact on the quality of life.
CONCLUSIONS
Functional chest pain and globus may potentially benefit from the use of neuromodulators, but their effectiveness for functional dysphagia, functional heartburn and reflux hypersensitivity remains controversial. More controlled trials are needed to confirm the therapeutic effects on these conditions.
PubMed: 38851975
DOI: 10.1016/j.dld.2024.05.013 -
European Geriatric Medicine Jun 2024Numerous epidemiological studies have suggested a possible association between dysphagia and the risk of decline in Activities of daily living (ADL) among older adults.... (Review)
Review
PURPOSE
Numerous epidemiological studies have suggested a possible association between dysphagia and the risk of decline in Activities of daily living (ADL) among older adults. This systematic review and meta-analysis aimed to elucidate the relationship between dysphagia and ADL in older adults.
METHODS
PubMed, Web of Science, Cochrane Library, Embase, Ebsco, MEDLINE, Wiley, CINAHL, and Ovid databases were comprehensively examined for relevant studies published up to October 31, 2022. Quantitative studies published in English were included to explore the relationship between dysphagia and ADL in people aged 65 years and older. The NIH Quality Assessment Tool was used to assess the study quality. R software was used to draw forest plots and I was employed to indicate study heterogeneity. Sensitivity analysis was performed using the one-by-one exclusion method. Publication bias was measured using funnel plots and Egger's test.
RESULTS
A total of 3,498 studies were retrieved from the database, 22 of which were eventually included in the systematic evaluation, and 14 of which were subjected to meta-analysis. Data from nine studies were categorical variables, and meta-analysis results showed that swallowing disorders in older adults were associated with a lower ability to perform ADL (OR = 3.39, 95% CI: 2.55-4.50, p < 0.001), with moderate heterogeneity (I = 62%, p = 0.006). Data from seven studies were continuous variables, resulting in a negative association between the prevalence of dysphagia and ADLs in older adults (SMD = -0.80, 95% CI: -1.08 to -0.51, p < 0.001), with high heterogeneity (I = 94%, p < 0.001). Sensitivity analysis showed robust results, funnel plots and Egger's test indicated no publication bias.
CONCLUSION
Dysphagia is significantly associated with the capacity to perform ADL. Prevention and screening of dysphagia in older patients dependent on others for daily care are needed. Further long-term studies are needed in the future to prove causality.
PubMed: 38842653
DOI: 10.1007/s41999-024-00999-8 -
Langenbeck's Archives of Surgery Jun 2024The objective of this study is to compare the operative time, intraoperative complications, length of stay, readmission rates, overall complications, mortality, and cost... (Meta-Analysis)
Meta-Analysis Comparative Study
PURPOSE
The objective of this study is to compare the operative time, intraoperative complications, length of stay, readmission rates, overall complications, mortality, and cost associated with Robotic Surgery (RS) and Laparascopic Surgery (LS) in anti-reflux and hiatal hernia surgery.
METHODS
A comprehensive literature search was conducted using MEDLINE (via PubMed), Web of Science and Scopus databases. Studies comparing short-term outcomes and cost between RS and LS in patients with anti-reflux and hiatal hernia were included. Data on operative time, complications, length of stay, readmission rates, overall complications, mortality, and cost were extracted. Quality assessment of the included studies was performed using the MINORS scale.
RESULTS
Fourteen retrospective observational studies involving a total of 555,368 participants were included in the meta-analysis. The results showed no statistically significant difference in operative time, intraoperative complications, length of stay, readmission rates, overall complications, and mortality between RS and LS. However, LS was associated with lower costs compared to RS.
CONCLUSION
This systematic review and meta-analysis demonstrates that RS has non-inferior short-term outcomes in anti-reflux and hiatal hernia surgery, compared to LS. LS is more cost-effective, but RS offers potential benefits such as improved visualization and enhanced surgical techniques. Further research, including randomized controlled trials and long-term outcome studies, is needed to validate and refine these findings.
Topics: Humans; Hernia, Hiatal; Robotic Surgical Procedures; Laparoscopy; Gastroesophageal Reflux; Operative Time; Herniorrhaphy; Treatment Outcome; Length of Stay; Fundoplication; Patient Readmission; Postoperative Complications
PubMed: 38842610
DOI: 10.1007/s00423-024-03368-y -
World Neurosurgery May 2024This study examined clinical outcomes associated with 3 types of noncontiguous cervical surgeries - anterior cervical discectomy and fusion (ACDF), cervical disc... (Review)
Review
Clinical Outcomes and Complication Rates for Noncontiguous Anterior Cervical Discectomy and Fusion, Cervical Disc Arthroplasty, and Hybrid Cervical Surgery: A Systematic Review.
OBJECTIVE
This study examined clinical outcomes associated with 3 types of noncontiguous cervical surgeries - anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA), and hybrid cervical surgery (HCS) - to improve surgeon decision-making.
METHODS
A systematic review was performed using PubMed, CINAHL, MEDLINE, and Web of Science from database inception until June 6th, 2023. Inclusion criteria were studies that reported any type of clinical outcome, examined noncontiguous ACDF, noncontiguous CDA, and/or noncontiguous HCS.
RESULTS
Ten articles out of 523 articles initially retrieved were included. Patients (n = 388) had a mean age of 52 ± 5.1 years and a mean follow-up time of 33 ± 6.0 months. Overall, 119 patients underwent noncontiguous HCS, 65 underwent noncontiguous CDA, and 204 underwent noncontiguous ACDF. There appears to be no clinically meaningful difference in Neck Disability Index score, Japanese Orthopedic Association score, and improvement in pain based on surgery type. There were a total of 83 complications (21% of cases) with noncontiguous ACDF having a higher absolute rate of dysphagia (20%) as compared to noncontiguous HCS (6.7%) or noncontiguous CDA (6.2%). Noncontiguous ACDF had a higher absolute rate of adjacent segment degeneration anterior cervical discectomy and fusion as a reported complication (6.4%) as compared to noncontiguous HCS (1.7%) and noncontiguous CDA (0.0%).
CONCLUSIONS
There may be no clinically meaningful difference in many clinical outcomes for different noncontiguous surgical interventions for noncontiguous (cervical degenerative disc disease). However, complication rates, such as dysphagia and anterior cervical discectomy and fusion, appear higher for noncontiguous ACDF as compared to noncontiguous CDA or HCS.
PubMed: 38823447
DOI: 10.1016/j.wneu.2024.05.157 -
International Journal of Pediatric... Jun 2024The systematic review aimed to provide an overview of the state-of-art regarding the use of fiberoptic endoscopic evaluation of swallowing (FEES) in pediatrics,... (Review)
Review
OBJECTIVES
The systematic review aimed to provide an overview of the state-of-art regarding the use of fiberoptic endoscopic evaluation of swallowing (FEES) in pediatrics, specifically investigating FEES feasibility, safety, diagnostic accuracy, and protocols.
METHODS
Four electronic databases were searched for original studies on the pediatric population that instrumentally assessed swallowing function using FEES. A hand-search of the references of included studies was performed. Data on the population, feasibility of endoscope insertion and bolus trials, adverse events, sensitivity and specificity, and FEES equipment and protocol were extracted. The quality of the studies was assessed using the checklists of the Johanna Briggs Institute. Selection of the studies, data extraction, and quality appraisal were conducted by two independent researchers.
RESULTS
Eighty-two reports from 81 studies were included. The mean overall quality of the studies was 80 % (17-100 %). The feasibility of endoscope insertion was high (89%-100 %), while the feasibility of bolus trials varied from 40 % to 100 %. Adverse events were excessive crying (8 studies), irritability or agitation (4 studies), transitory oxygen desaturations (3 studies, 1.2-6.7 % of the patients), epistaxis (3 studies, 0.8-3.3 % of the patients), increased heart rate (1 study, 1 patient), vomiting (1 study, 1 patient), hypertonia (1 study), and hypersalivation (1 study). No major complications were reported. Using VFSS as the reference standard, FEES was generally found to be less sensitive (25-94 %) but more specific (75-100 %) for aspiration, whereas the reverse was true for penetration (sensitivity 76-100 %, specificity 44-83 %). FEES protocols were highly heterogeneous with poor reporting.
CONCLUSION
FEES is a safe, accurate, and generally feasible examination in the pediatric population with suspected dysphagia. However, a consensus on the best FEES protocol for clinical practice and research is currently lacking.
Topics: Humans; Deglutition Disorders; Child; Fiber Optic Technology; Deglutition; Endoscopy; Child, Preschool; Infant; Pediatrics; Sensitivity and Specificity
PubMed: 38796943
DOI: 10.1016/j.ijporl.2024.111983 -
Scientific Reports May 2024The Montreal consensus recognizes chronic cough as an extra-esophageal manifestation of gastroesophageal reflux disease. We performed a meta-analysis to assess the... (Meta-Analysis)
Meta-Analysis
The Montreal consensus recognizes chronic cough as an extra-esophageal manifestation of gastroesophageal reflux disease. We performed a meta-analysis to assess the effects of acid-suppressive medications in adults with non-specific chronic cough. The protocol was registered on PROSPERO (CRD42022368769). Placebo-controlled randomized trials evaluating the impact of acid-suppressive medications on persistent cough were included. The systematic search was performed on the 1st of November 2022 in three databases. A random-effects model was used for the calculations. The effect size was the standardized mean difference (SMD) with 95% confidence interval (CI). A total number of 11 double-blinded placebo-controlled randomized trials were included in the meta-analysis. Data showed that compared to placebo, PPIs decreased the severity of cough (SMD 0.33; CI 0.05; 0.61). Therapeutic response was not different in patients with non-specific chronic cough only, compared to those with laryngopharyngeal reflux. Prolonged treatment durations did not result in greater symptomatic improvement, with SMD 0.33 (CI - 0.22; 0.88), 0.31 (CI - 1.74; 2.35), 0.32 (CI - 0.29; 0.93) and 0.34 (CI - 0.16; 0.85), following 4, 6, 8 and 12 weeks of treatment, respectively. The pooled analysis of the improvement in quality of life with PPIs found an SMD of 0.39 (CI - 0.51; 1.29). PPIs mildly decrease the severity of non-specific chronic cough, irrespective of treatment duration.
Topics: Proton Pump Inhibitors; Cough; Humans; Chronic Disease; Gastroesophageal Reflux; Randomized Controlled Trials as Topic; Severity of Illness Index; Treatment Outcome; Chronic Cough
PubMed: 38796481
DOI: 10.1038/s41598-024-62640-9 -
Surgical Endoscopy Jul 2024Peroral endoscopic myotomy (POEM) is an emerging effective treatment for achalasia. However, a significant proportion of patients do not respond well to the treatment.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Peroral endoscopic myotomy (POEM) is an emerging effective treatment for achalasia. However, a significant proportion of patients do not respond well to the treatment. After over a decade of clinical practice, potential risk factors associated with POEM failure have been identified. This meta-analysis aimed to summarize the evidence of risk factors for POEM failure.
METHODS
A systematic literature search was conducted on PubMed, Embase, Web of Science, and Cochrane Library from inception to June 10th, 2022. We included English studies that reported POEM outcomes in achalasia patients and identified risk factors for POEM failure. Relevant information was extracted and analyzed using fixed- or randomized-effect models to pool the effect size.
RESULTS
A total of 27 studies comprising 9371 patients with achalasia were included in this review. The pooled failure rate was 8% (90% CI 7%-10%). We identified sigmoid esophagus (OR 1.90, 95% CI 1.45-2.47), type I achalasia (OR 1.30, 95% CI 1.04-1.63), and type III achalasia (OR 1.26, 95% CI 0.89-1.78) were associated with a worse clinical response. Conversely, type II achalasia was associated with a better response (OR 0.59, 95% CI 0.47-0.75). Prior treatment with Heller myotomy (OR 5.75, 95% CI 3.97-8.34) and prior balloon dilation (OR 1.18, 95% CI 1.07-1.29) were also associated with a higher risk of clinical failure.
CONCLUSION
Our meta-analysis results demonstrated that sigmoid esophagus, manometric achalasia subtype, and prior treatment were associated with POEM failure. This information could be used to guide treatment decisions and improve the success rate of POEM in achalasia patients.
Topics: Esophageal Achalasia; Humans; Natural Orifice Endoscopic Surgery; Myotomy; Risk Factors; Treatment Failure; Treatment Outcome; Esophagoscopy; Heller Myotomy
PubMed: 38782829
DOI: 10.1007/s00464-024-10862-3 -
PloS One 2024The aim of this systematic review was to describe the efficacy and acceptability of natural products in the management of oral mucositis caused by radiation. From the...
The aim of this systematic review was to describe the efficacy and acceptability of natural products in the management of oral mucositis caused by radiation. From the day it started to August 7, 2023, a thorough search for randomized controlled trials (RCTs) was carried out among seven databases: the Web of Science, PubMed, Embase, OVID, Scopus, the Cochrane Library and the CINAHL database. Only English-language articles were identified during the search. Using the revised Cochrane risk-of-bias tool, version 2, two researchers screened the articles, collected information on study characteristics, and appraised risks of bias. The data were analyzed and descriptively presented with a narrative synthesis methodology involving the Synthesis Without Meta-Analysis (SWiM) reporting element applied in detail. The PROSPERO registration number of this study is CRD42023476932. Thirty-six clinical trials were included in the study; the included studies included a variety of 20 types of natural products. Honey and Curcuma longa were the most commonly assessed natural products. A total of 2,400 participants reported taking part in therapy with natural products for oral mucositis. Natural products demonstrated substantial efficacy in terms of influencing intensity, incidence, pain score, quality of life, and symptoms such as xerostomia and dysphagia. Except for manuka honey, most natural products were well accepted. Regarding the clinical trials' risk of bias, 2 clinical trials (5.56%) had a high risk of bias, 17 studies (47.2%) had a low risk of bias, and 17 studies (47.2%) were rated with "some concern." Natural remedies work well as alternate treatments for managing oral mucositis caused by radiation therapy. However, additional clinical trials are still needed. The safety of these conventional medications as well as their effectiveness and safety when used in combination with other conventional or naturopathic therapies should be fully examined.
Topics: Humans; Stomatitis; Biological Products; Radiotherapy; Radiation Injuries; Quality of Life; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 38781255
DOI: 10.1371/journal.pone.0303988 -
Esophagus : Official Journal of the... Jul 2024There are various therapeutic options for achalasia. Nevertheless, peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy with fundoplication (LHM) are... (Meta-Analysis)
Meta-Analysis
There are various therapeutic options for achalasia. Nevertheless, peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy with fundoplication (LHM) are distinguished by their efficacy and low incidence of complications. Compare POEM and LHM regarding several outcomes in patients with achalasia. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An exhaustive literature search was performed using PubMed, Web of Science, and Cochrane Library databases. Studies comparing several outcomes between POEM and LHM in patients with achalasia were included. Data on clinical success, operative time, intraoperative complications, length of stay, reintervention rates, postoperative pain, overall complications, occurrence of GERD symptoms, use of proton bomb inhibitors and esophagitis were extracted. Quality assessment of the included studies was performed using the MINORS scale. We included 20 retrospective observational studies with a combined total of 5139 participants. The results demonstrated that there was no statistically significant difference in terms of intraoperative complications, postoperative complications, reintervention rate, occurrence of GERD symptoms, GERD HRQL, use of proton pump inhibitors, and esophagitis between POEM and LHM groups. Conversely, POEM was associated with higher clinical success and shorter operative time, length of stay, and postoperative pain. This meta-analysis concludes that both POEM and LHM, are effective and safe treatments for achalasia. However, POEM demonstrates better results regarding clinical success, operative time, length of stay, postoperative pain, and a tendency towards lower recurrence.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Esophageal Achalasia; Esophagitis; Fundoplication; Gastroesophageal Reflux; Heller Myotomy; Intraoperative Complications; Laparoscopy; Length of Stay; Natural Orifice Endoscopic Surgery; Operative Time; Pain, Postoperative; Postoperative Complications; Proton Pump Inhibitors; Retrospective Studies; Treatment Outcome
PubMed: 38775883
DOI: 10.1007/s10388-024-01063-x