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Clinical and Translational Radiation... May 2022Thymic epithelial tumors (TETs) are rare thoracic tumors, often requiring multimodal approaches. Surgery represents the first step of the treatment, possibly followed by... (Review)
Review
Thymic epithelial tumors (TETs) are rare thoracic tumors, often requiring multimodal approaches. Surgery represents the first step of the treatment, possibly followed by adjuvant radiotherapy (RT) and, less frequently, chemotherapy. For unresectable tumors, a combination of chemotherapy and RT is often used. Currently, the optimal dose for patients undergoing radiation is not clearly defined. Current guidelines on RT are based on studies with a low level of evidence, where 2D RT was widely used. We aim to shed light on the optimal radiation dose for patients with TETs undergoing RT through a systematic review of the recent literature, including reports using modern RT techniques such as 3D-CRT, IMRT/VMAT, or proton-therapy. A comprehensive literature search of four databases was conducted following the PRISMA guidelines. Two investigators independently screened and reviewed the retrieved references. Reports with < 20 patients, 2D-RT use only, median follow-up time < 5 years, and reviews were excluded. Two studies fulfilled all the criteria and therefore were included. Loosening the follow-up time criteria to > 3 years, three additional studies could be evaluated. A total of 193 patients were analyzed, stratified for prognostic factors (histology, stage, and completeness of resection), and synthesized according to the synthesis without -analysis (SWIM) method. The paucity and heterogeneity of eligible studies led to controversial results. The optimal RT dose neither for postoperative, nor primary RT in the era of modern RT univocally emerged. Conversely, this overview can spark new evidence to define the optimal RT dose for each TETs category.
PubMed: 35360004
DOI: 10.1016/j.ctro.2022.03.005 -
Schizophrenia Bulletin Sep 2022Youth at clinical high-risk (CHR) for psychosis present with neuropsychological impairments relative to healthy controls (HC), but whether these impairments are... (Meta-Analysis)
Meta-Analysis
Neuropsychological Performance Among Individuals at Clinical High-Risk for Psychosis vs Putatively Low-Risk Peers With Other Psychopathology: A Systematic Review and Meta-Analysis.
BACKGROUND AND HYPOTHESIS
Youth at clinical high-risk (CHR) for psychosis present with neuropsychological impairments relative to healthy controls (HC), but whether these impairments are distinguishable from those seen among putatively lower risk peers with other psychopathology remains unknown. We hypothesized that any excess impairment among CHR cohorts beyond that seen in other clinical groups is minimal and accounted for by the proportion who transition to psychosis (CHR-T).
STUDY DESIGN
We performed a systematic review and meta-analysis of studies comparing cognitive performance among CHR youth to clinical comparators (CC) who either sought mental health services but did not meet CHR criteria or presented with verified nonpsychotic psychopathology.
STUDY RESULTS
Twenty-one studies were included representing nearly 4000 participants. Individuals at CHR showed substantial cognitive impairments relative to HC (eg, global cognition: g = -0.48 [-0.60, -0.34]), but minimal impairments relative to CC (eg, global cognition: g = -0.13 [-0.20, -0.06]). Any excess impairment among CHR was almost entirely attributable to CHR-T; impairment among youth at CHR without transition (CHR-NT) was typically indistinguishable from CC (eg, global cognition, CHR-T: g = -0.42 [-0.64, -0.19], CHR-NT: g = -0.09 [-0.18, 0.00]; processing speed, CHR-T: g = -0.59 [-0.82, -0.37], CHR-NT: g = -0.12 [-0.25, 0.07]; working memory, CHR-T: g = -0.42 [-0.62, -0.22], CHR-NT: g = -0.03 [-0.14, 0.08]).
CONCLUSIONS
Neurocognitive impairment in CHR cohorts should be interpreted cautiously when psychosis or even CHR status is the specific clinical syndrome of interest as these impairments most likely represent a transdiagnostic vs psychosis-specific vulnerability.
Topics: Adolescent; Cognition; Cognition Disorders; Humans; Neuropsychological Tests; Psychotic Disorders; Risk
PubMed: 35333372
DOI: 10.1093/schbul/sbac031 -
JAMA Psychiatry May 2022Socioeconomic factors are associated with the prevalence of depression, but their associations with prognosis are unknown. Understanding this association would aid in... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Socioeconomic factors are associated with the prevalence of depression, but their associations with prognosis are unknown. Understanding this association would aid in the clinical management of depression.
OBJECTIVE
To determine whether employment status, financial strain, housing status, and educational attainment inform prognosis for adults treated for depression in primary care, independent of treatment and after accounting for clinical prognostic factors.
DATA SOURCES
The Embase, International Pharmaceutical Abstracts, MEDLINE, PsycINFO, and Cochrane (CENTRAL) databases were searched from database inception to October 8, 2021.
STUDY SELECTION
Inclusion criteria were as follows: randomized clinical trials that used the Revised Clinical Interview Schedule (CIS-R; the most common comprehensive screening and diagnostic measure of depressive and anxiety symptoms in primary care randomized clinical trials), measured socioeconomic factors at baseline, and sampled patients with unipolar depression who sought treatment for depression from general physicians/practitioners or who scored 12 or more points on the CIS-R. Exclusion criteria included patients with depression secondary to a personality or psychotic disorder or neurologic condition, studies of bipolar or psychotic depression, studies that included children or adolescents, and feasibility studies. Studies were independently assessed against inclusion and exclusion criteria by 2 reviewers.
DATA EXTRACTION AND SYNTHESIS
Data were extracted and cleaned by data managers for each included study, further cleaned by multiple reviewers, and cross-checked by study chief investigators. Risk of bias and quality were assessed using the Quality in Prognosis Studies (QUIPS) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tools, respectively. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses-Individual Participant Data (PRISMA-IPD) reporting guidelines.
MAIN OUTCOMES AND MEASURES
Depressive symptoms at 3 to 4 months after baseline.
RESULTS
This systematic review and individual patient data meta-analysis identified 9 eligible studies that provided individual patient data for 4864 patients (mean [SD] age, 42.5 (14.0) years; 3279 women [67.4%]). The 2-stage random-effects meta-analysis end point depressive symptom scale scores were 28% (95% CI, 20%-36%) higher for unemployed patients than for employed patients and 18% (95% CI, 6%-30%) lower for patients who were homeowners than for patients living with family or friends, in hostels, or homeless, which were equivalent to 4.2 points (95% CI, 3.6-6.2 points) and 2.9 points (95% CI, 1.1-4.9 points) on the Beck Depression Inventory II, respectively. Financial strain and educational attainment were associated with prognosis independent of treatment, but unlike employment and housing status, there was little evidence of associations after adjusting for clinical prognostic factors.
CONCLUSIONS AND RELEVANCE
Results of this systematic review and meta-analysis revealed that unemployment was associated with a poor prognosis whereas home ownership was associated with improved prognosis. These differences were clinically important and independent of the type of treatment received. Interventions that address employment or housing difficulties could improve outcomes for patients with depression.
Topics: Adolescent; Adult; Anxiety; Child; Depression; Depressive Disorder, Major; Female; Humans; Male; Prognosis; Socioeconomic Factors
PubMed: 35262620
DOI: 10.1001/jamapsychiatry.2022.0100 -
Otology & Neurotology Open Mar 2022To describe outcomes after bilateral cochlear implantation (CI) in a patient with a pathologic variant associated with Noonan syndrome (NS) and Noonan syndrome with...
OBJECTIVES
To describe outcomes after bilateral cochlear implantation (CI) in a patient with a pathologic variant associated with Noonan syndrome (NS) and Noonan syndrome with multiple lentigines (NSML). Additionally, to assess the utility of CI in this specific population based on our outcome and previous reports.
STUDY DESIGN
Retrospective case report with literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
PATIENTS
A young boy with various multiorgan abnormalities, speech and language delay, and persistent hearing loss who was found to have a heterozygous gene mutation at age 2.
INTERVENTIONS
Bilateral tympanostomy tube placement, diagnostic imaging, and eventual staged bilateral CI.
MAIN OUTCOME MEASURES
Objective audiometric testing and developmental milestone attainment.
RESULTS
Bilateral CI was successfully completed over a 2-month period. The patient illustrated significant improvement in objective audiologic measurement. However, he continues to sign as his main form of communication without significant speech progression.
CONCLUSIONS
Early diagnostic and therapeutic intervention in patients with NS/NSML can help improve long-term audiologic and speech development. Given the heterogeneity of NS/NSML, a multidisciplinary approach is needed for optimal outcomes.
PubMed: 38515811
DOI: 10.1097/ONO.0000000000000009 -
Clinical and Translational Radiation... Mar 2022Prophylactic cranial irradiation (PCI) for limited-stage small-cell lung cancer (LS-SCLC) patients has become more controversial. Since the publication of the systematic... (Review)
Review
BACKGROUND
Prophylactic cranial irradiation (PCI) for limited-stage small-cell lung cancer (LS-SCLC) patients has become more controversial. Since the publication of the systematic review by Aupérin et al. in 1999, no randomized controlled trials regarding PCI in LS-SCLC have been completed. The aim of this study was to systematically review and meta-analyze the effect of PCI on overall survival (OS) in patients with LS-SCLC.
METHODS
A systematic search was conducted in the databases of MEDLINE (PubMed), Embase and the Cochrane library. Only studies that reported an adjusted hazard ratio (aHR), indicating the effect of PCI versus no PCI on OS (adjusted for confounders) in patients with LS-SCLC were included for critical appraisal and meta-analysis. A pooled aHR estimate was calculated using a random-effects model.
RESULTS
Pooling of 28 retrospective studies including a total of 18,575 patients demonstrated a significant beneficial effect of PCI versus no PCI on OS with a pooled aHR of 0.62 (95% CI: 0.57-0.69). Substantial heterogeneity of reported aHRs among studies was observed (I = 65.9%). Subgroup analyses revealed that this heterogeneity could partly be explained by study sample size. The pooled aHR among 7 versus 21 studies with a sample size of > 300 versus ≤ 300 patients was 0.79 (95% CI: 0.64-0.97) versus 0.56 (95% CI: 0.46-0.69; < 0.001), respectively.
CONCLUSIONS
This meta-analysis demonstrates a significant beneficial effect of PCI on OS in patients with LS-SCLC. Larger studies reported a milder beneficial effect, possibly due to a decreased risk of model overfitting. Serious risk of selection and confounding bias were of concern due to the lack of prospective trials. These results support the role of PCI in standard clinical practice in patients with LS-SCLC while awaiting results of prospective trials on alternative strategies.
PubMed: 35243025
DOI: 10.1016/j.ctro.2022.02.002 -
Clinical and Translational Radiation... Mar 2022To maximize the likelihood of positive outcome in non-small-cell lung cancer (NSCLC) survivors, potential benefits of treatment modalities have to be weighed against the... (Review)
Review
BACKGROUND
To maximize the likelihood of positive outcome in non-small-cell lung cancer (NSCLC) survivors, potential benefits of treatment modalities have to be weighed against the possibilities of damage to normal tissues, such as the heart. High-quality data-driven evidence regarding appropriate risk stratification strategies is still scarce. The aim of this review is to summarize and appraise available prediction models for treatment-induced cardiac events in patients with NSCLC.
METHODS
A systematic search of MEDLINE was performed using a Boolean combination of appropriate truncation and indexing terms related to "NSCLC", "prediction models", "cardiac toxicity", and "treatment modalities". The following exclusion criteria were applied: sample-size of less than 100, no significant predictors in multivariate analysis, lack of model specifications, and case-mix studies. The generic inverse variance method was used to pool the summary effect estimate for each predictor. The quality of the papers was assessed using the Prediction model Risk Of Bias Assessment Tool.
RESULTS
Of the 3,056 papers retrieved, 28 prediction models were identified, including seven for (chemo-)radiotherapy, one for immunotherapy, and 20 for surgical resection. Forty-one distinct predictors were entered in the prediction models. The pooled effect estimate of the mean heart dose (HR = 1.06, 95%CI:1.04-1.08) and history of cardiovascular diseases (HR = 3.1, 95%CI:1.8-5.36) were shown to significantly increase the risk of developing late cardiac toxicity after (chemo-)radiotherapy. Summary estimates of age (OR = 1.17, 95%CI:1.06-1.29), male gender (OR = 1.61, 95%CI:1.4-1.85), and advanced stage (OR = 1.34, 95%CI:1.06-1.69) were significantly associated with higher risk of acute cardiac events after surgery. Risk of bias varied across studies, but analysis was the most concerning domain where none of the studies were judged to be low risk.
CONCLUSION
This review highlights the need for a robust prediction model which can inform patients and clinicians about expected treatment-induced heart damage. Identified clues suggest incorporation of detailed cardiac metrics (substructures' volumes and doses).
PubMed: 35243024
DOI: 10.1016/j.ctro.2022.02.007 -
Internet Interventions Apr 2022College students face several sources of stress. Self-guided stress management interventions offer an excellent opportunity for scaling up evidence-based interventions... (Review)
Review
BACKGROUND
College students face several sources of stress. Self-guided stress management interventions offer an excellent opportunity for scaling up evidence-based interventions for self-management of these stresses. However, little is known about the overall effects of these interventions. Increasing this understanding is essential because self-guided stress management interventions might be a cost-effective and acceptable way of providing help to this important segment of the population during a critical life course stage.
METHODS
We carried out a systematic literature search of bibliographical databases (PubMed, PsycINFO, Embase, and Cochrane Library) for randomized controlled trials (RCTs) of self-guided stress management interventions published up through April 2020. We conducted two separate meta-analyses for perceived stress, depression, and anxiety. The first included interventions for general college student samples. The second included studies for students with high levels of perceived stress.
RESULTS
The first meta-analysis included 26 studies with 29 intervention-control comparisons based on a total of 4468 students. The pooled effect size was small but statistically significant ( = 0.19; 95% CI [0.10, 0.29]; < 0.001). Results showed moderate heterogeneity across studies [ = 48%; 95% CI (19, 66%)]. The second meta-analysis, included four studies based on a total of 491 students with high levels of stress. The pooled effect size was small but statistically significant ( = 0.34; 95% CI [0.16, 0.52]; < 0.001). Results showed no heterogeneity across studies ( = 0%; 95% CI [0, 79%]), but risk of bias was substantial.
DISCUSSION
Our results suggest that self-guided stress management programs may be effective when compared to control conditions, but with small average effects. These programs might be a useful element of a multi-component intervention system. Given the psychological barriers to treatment that exist among many college students, self-help interventions might be a good first step in facilitating subsequent help-seeking among students reluctant to engage in other types of treatment. More studies should be conducted to investigate these interventions, sample specifications, mediating effects, and individual-level heterogeneity of effects.
PubMed: 35242591
DOI: 10.1016/j.invent.2022.100503 -
American Journal of Preventive Medicine Mar 2022The rates of pediatric obesity in the U.S. are highest among Hispanics. There is no existing meta-analysis of the effects of obesity interventions among Hispanic youth.... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The rates of pediatric obesity in the U.S. are highest among Hispanics. There is no existing meta-analysis of the effects of obesity interventions among Hispanic youth. This systematic review and meta-analysis assesses the effects of obesity prevention and treatment interventions on Hispanic youth's weight status and lifestyle behaviors.
METHODS
PubMed, PsycINFO, and Scopus were searched between January 1, 2000 and October 30, 2020. Interventions with ≥50% Hispanic youth aged 0-18 years were included. Using a weighted inverse-variance procedure, fixed-effects and random-effects models were run for an overall effect size on the basis of the Q test statistic. Hedges' g was calculated for outcomes of interest between baseline and postintervention separately for studies with multiple versus single conditions. Continuous and categorical moderators were also examined.
RESULTS
A total of 1,103 articles were screened, of which 117 were included in the narrative synthesis and 105 in the meta-analysis (n=49,276 youth). The overall effects for RCT/quasi-experimental studies on BMI status (g= -0.15, SE=0.03, 95% CI= -0.20, -0.10), waist circumference (g= -0.15, SE=0.10, 95% CI= -0.35, -0.05), physical activity (g=0.12, SE=0.05, 95% CI=0.03, 0.22), fruit and vegetable intake (g=0.08, SE=0.02, 95% CI=0.03, 0.12), and sugar-sweetened beverage intake (g= -0.07, SE= 0.03, 95% CI= -0.13, -0.01) were small. Intervention effects varied by participant developmental stage, SES, study setting, and lifestyle behavior target.
DISCUSSION
Beyond developing more impactful interventions to address obesity among Hispanic youth, findings highlight the need for targeted policies and more easily disseminable interventions that can spread small effects across a population for maximal public health impact.
Topics: Adolescent; Child; Child, Preschool; Exercise; Fruit; Hispanic or Latino; Humans; Infant; Infant, Newborn; Life Style; Pediatric Obesity
PubMed: 35190103
DOI: 10.1016/j.amepre.2021.10.003 -
Journal of Medical Education and... 2021Heralded as a teaching, assessment and reflective tool, and increasingly as a longitudinal and holistic perspective of the educator's development, medical educator's... (Review)
Review
BACKGROUND
Heralded as a teaching, assessment and reflective tool, and increasingly as a longitudinal and holistic perspective of the educator's development, medical educator's portfolios (MEP)s are increasingly employed to evaluate progress, assess for promotions and career switches, used as a reflective tool and as a means of curating educational activities. However, despite its blossoming role, there is significant dissonance in the content and structure of MEPs. As such, a systematic scoping review (SSR) is proposed to identify what is known of MEPs and its contents.
METHODS
Krishna's Systematic Evidenced Based Approach (SEBA) was adopted to structure this SSR in SEBA of MEPs. SEBA's constructivist approach and relativist lens allow data from a variety of sources to be considered to paint a holistic picture of available information on MEPs.
RESULTS
From the 12 360 abstracts reviewed, 768 full text articles were evaluated, and 79 articles were included. Concurrent thematic and content analysis revealed similar themes and categories including: (1) , (2) , (3) and (4) .
DISCUSSION
This SSR in SEBA proffers a novel 5-staged evidence-based approach to constructing MEPs which allows for consistent application and assessment of MEPs. This 5-stage approach pivots on assessing and verifying the achievement of developmental milestones or 'micro-competencies' that facilitate micro-credentialling and effective evaluation of a medical educator's development and entrust-ability. This allows MEPs to be used as a reflective and collaborative tool and a basis for career planning.
PubMed: 35187262
DOI: 10.1177/23821205211000356 -
Cell Journal Jan 2022Gastric cancer (GC) is one of the leading causes of cancer-related deaths worldwide. The major problems of patients with GC are the lack of proper response to the... (Review)
Review
Gastric cancer (GC) is one of the leading causes of cancer-related deaths worldwide. The major problems of patients with GC are the lack of proper response to the treatment, drug resistance and metastasis attributed to the presence of a subpopulation of cells inside the tumour that are called cancer stem cells (CSCs). In addition, deregulation of microRNAs (miRNAs) has been reported in different stages of GC. The aim of the present study is to determine and introduce miRNAs that contribute to regulation of stemness, metastasis and drug resistance in GC. A systematic review, we conducted data mining of available datasets and a review of previous studies to select miRNAs that target stemness, epithelial-mesenchymal transition (EMT) and drug resistance. All selected miRNAs were analysed by R software to find a common miRNA target for all three processes. Then, the target prediction of miRNAs and their related signalling pathways were obtained by using bioinformatics tools, ONCO.IO and KEGG databases, respectively. We identified seven miRNAs (miR-34a, miR-23a, miR-27a, miR-30a, miR-19b, miR-107, miR-100) from our searching approach. These miRNAs regulate pathways that contribute to stemness, EMT and drug resistance in GC. Four (miR- 34a, miR-23a, miR-30a, and miR-100) had significant interactions with each other and 52 target genes among them, from which , and were involved in the regulation of several biological processes. These data suggest that the three significant properties can be regulated by common miRNAs (hsa-miR-34a, hsa-miR-23a, hsa-miR-30a and hsa-miR-100). Hence, targeting selected miRNAs or their targets might be helpful to stop tumour growth and metastasis development, and increase tumour sensitivity to chemotherapy agents. This signature can also be assumed for early detection of metastasis or drug resistance. However, there should be additional experimentation to validate these results.
PubMed: 35182058
DOI: 10.22074/cellj.2022.7173