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BMC Infectious Diseases Jan 2023Encephalitis is an inflammation of the cerebral parenchyma manifested by acute symptoms such as fever, headaches, and other neurological disorders. Its etiology is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Encephalitis is an inflammation of the cerebral parenchyma manifested by acute symptoms such as fever, headaches, and other neurological disorders. Its etiology is mostly viral, with herpes simplex virus being a frequent etiological agent in children. The development of neurological sequelae is a serious outcome associated with this infection.
OBJECTIVE
To assess the general prevalence and types of neurological sequelae in children after a case of acute viral encephalitis caused by HSV.
METHODS
This systematic review and meta-analysis was developed following the PRISMA guidelines. The literature search was carried out in the MEDLINE, Embase, SciELO, LILACS, Cochrane, CINAHL, PsycINFO, and Web of Science databases. Studies were included of children with confirmed HSV infection and that presented a description of neurological sequelae associated with that infection. For the meta-analysis of general prevalence and of the types of neurological sequelae a random effects model was used.
RESULTS
Of the 2827 articles chosen in the initial search, nine studies were included in the systematic review and meta-analysis. The general prevalence of neurological sequelae was 50.7% (95% CI 39.2-62.2). The most frequent sequelae were related to mental disability, with a 42.1% prevalence (95% CI 30-55.2); on the other hand, the least frequent sequelae were those related with visual impairment, with a 5.9% prevalence (95% CI 2.2-14.6). The included studies presented regular quality and substantial heterogeneity.
CONCLUSION
Even with antiviral therapy, half of patients will develop some type of disability.
Topics: Humans; Child; Simplexvirus; Herpes Simplex; Encephalitis, Viral; Disease Progression; Encephalitis; Encephalitis, Herpes Simplex
PubMed: 36703115
DOI: 10.1186/s12879-023-08007-3 -
Yearbook of Medical Informatics Aug 2022Automated computational segmentation of the lung and its lobes and findings in X-Ray based computed tomography (CT) images is a challenging problem with important...
OBJECTIVES
Automated computational segmentation of the lung and its lobes and findings in X-Ray based computed tomography (CT) images is a challenging problem with important applications, including medical research, surgical planning, and diagnostic decision support. With the increase in large imaging cohorts and the need for fast and robust evaluation of normal and abnormal lungs and their lobes, several authors have proposed automated methods for lung assessment on CT images. In this paper we intend to provide a comprehensive summarization of these methods.
METHODS
We used a systematic approach to perform an extensive review of automated lung segmentation methods. We chose Scopus, PubMed, and Scopus to conduct our review and included methods that perform segmentation of the lung parenchyma, lobes or internal disease related findings. The review was not limited by date, but rather by only including methods providing quantitative evaluation.
RESULTS
We organized and classified all 234 included articles into various categories according to methodological similarities among them. We provide summarizations of quantitative evaluations, public datasets, evaluation metrics, and overall statistics indicating recent research directions of the field.
CONCLUSIONS
We noted the rise of data-driven models in the last decade, especially due to the deep learning trend, increasing the demand for high-quality data annotation. This has instigated an increase of semi-supervised and uncertainty guided works that try to be less dependent on human annotation. In addition, the question of how to evaluate the robustness of data-driven methods remains open, given that evaluations derived from specific datasets are not general.
Topics: Humans; Tomography, X-Ray Computed; Biomedical Research; Data Accuracy; Lung
PubMed: 36463886
DOI: 10.1055/s-0042-1742517 -
The Cochrane Database of Systematic... Nov 2022Large territory middle cerebral artery (MCA) ischaemic strokes account for around 10% of all ischaemic strokes and have a particularly devastating prognosis when... (Review)
Review
BACKGROUND
Large territory middle cerebral artery (MCA) ischaemic strokes account for around 10% of all ischaemic strokes and have a particularly devastating prognosis when associated with malignant oedema. Progressive cerebral oedema starts developing in the first 24 to 48 hours of stroke ictus with an associated rise in intracranial pressure. The rise in intracranial pressure may eventually overwhelm compensatory mechanisms leading to a cascading secondary damage to surrounding unaffected parenchyma. This downward spiral can rapidly progress to death or severe neurological disability. Early decompressive craniectomy to relieve intracranial pressure and associated tissue shift can help ameliorate this secondary damage and improve outcomes. Evidence has been accumulating of the benefit of early surgical decompression in stroke patients. Earlier studies have excluded people above the age of 60 due to associated poor outcomes; however, newer trials have included this patient subgroup. This review follows a Cochrane Review published in 2012.
OBJECTIVES
To assess the effectiveness of surgical decompression in people with malignant oedema after ischaemic stroke with regard to reduction in mortality and improved functional outcome. We also aimed to examine the adverse effects of surgical decompression in this patient cohort.
SEARCH METHODS
We searched the Cochrane Stroke Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL; 2022, Issue 7 of 12), MEDLINE Ovid, Embase Ovid, Web of Science Core Collection, Scopus databases, ClinicalTrials.gov, and the WHO ICTRP to July 2022. We also reviewed the reference lists of relevant articles.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) comparing decompressive craniectomy with medical management to best medical management alone for people with malignant cerebral oedema after MCA ischaemic stroke.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the search results, assessed study eligibility, performed risk of bias assessment, and extracted the data. The primary outcomes were death and death or severe disability (modified Rankin Scale (mRS) > 4) at 6 to 12 months follow-up. Other outcomes included death or moderate disability (mRS > 3), severe disability (mRS = 5), and adverse events. We assessed the certainty of the evidence using the GRADE approach, categorising it as high, moderate, low, or very low.
MAIN RESULTS
We included nine RCTs with a total of 513 participants included in the final analysis. Three studies included patients younger than 60 years of age; two trials accepted patients up to 80 years of age; and one trial only included patients 60 years or older. The majority of included trials (six) mandated a time from stroke ictus to treatment of < 48 hours, whilst in two of them this was < 96 hours. Surgical decompression was associated with a reduction in death (odds ratio (OR) 0.18, 95% confidence interval (CI) 0.12 to 0.27, 9 trials, 513 participants, P < 0.001; high-certainty evidence); death or severe disability (mRS > 4, OR 0.22, 95% CI 0.15 to 0.32, 9 trials, 513 participants, P < 0.001; high-certainty evidence); and death or moderate disability (mRS > 3, OR 0.34, 95% CI 0.22 to 0.52, 9 trials, 513 participants, P < 0.001; moderate-certainty evidence). Subgroup analysis did not reveal any significant effect on treatment outcomes when analysing age (< 60 years versus ≥ 60 years); time from stroke ictus to intervention (< 48 hours versus ≥ 48 hours); or dysphasia. There was a significant subgroup effect of time at follow-up (6 versus 12 months, P = 0.02) on death as well as death or severe disability (mRS > 4); however, the validity of this finding was affected by fewer participant numbers in the six-month follow-up subgroup. There was no consistent reporting of per-participant adverse event rates in any of the included studies, which prevented further analysis.
AUTHORS' CONCLUSIONS
Surgical decompression improves outcomes in the management of malignant oedema after acute ischaemic stroke, including a considerable reduction in death or severe disability (mRS > 4) and a reduction in death or moderate disability (mRS > 3). Whilst there is evidence that this positive treatment effect is present in patients > 60 years old, it is important to take into account that these patients have a poorer prospect of functional survival independent of this treatment effect. In interpreting these results it must also be considered that the data demonstrating benefit are drawn from a unique patient subset with profound neurological deficit, reduced level of consciousness, and no pre-morbid disability or severe comorbidity.
Topics: Humans; Middle Aged; Brain Edema; Ischemic Stroke; Stroke; Infarction, Middle Cerebral Artery; Decompression, Surgical; Edema
PubMed: 36385224
DOI: 10.1002/14651858.CD014989.pub2 -
Current Oncology (Toronto, Ont.) Sep 2022Resection of lung metastases with curative intention in selected patients is associated with prolonged survival. Laser-assisted resection of lung metastases results in... (Review)
Review
BACKGROUND
Resection of lung metastases with curative intention in selected patients is associated with prolonged survival. Laser-assisted resection of lung metastases results in complete resection of a high number of lung metastases, while preserving lung parenchyma. However, data concerning laser lung resections are scarce and contradictory. The aim of this study was to conduct a systematic review to evaluate the utility of laser-assisted pulmonary metastasectomy.
METHODS
An electronic search in MEDLINE (via PubMed), complemented by manual searches in article references, was conducted to identify eligible studies.
RESULTS
Fourteen studies with a total of 1196 patients were included in this metanalysis. Laser-assisted surgery (LAS) for lung metastases is a safe procedure with a postoperative morbidity up to 24.2% and almost zero mortality. LAS resulted in the resection of a high number of lung metastases with reduction of the lung parenchyma loss in comparison with conventional resection methods. Survival was similar between LAS and conventional resections.
CONCLUSION
LAS allows radical lung-parenchyma saving resection of a high number of lung metastases with similar survival to conventional methods.
Topics: Humans; Retrospective Studies; Metastasectomy; Laser Therapy; Lung; Lung Neoplasms
PubMed: 36290825
DOI: 10.3390/curroncol29100548 -
Strahlentherapie Und Onkologie : Organ... Feb 2023Chronic pulmonary aspergillosis (CPA) can manifest as fungus balls in preexisting cavities of lung parenchyma and recurrent hemoptysis is among the most frequent...
PURPOSE
Chronic pulmonary aspergillosis (CPA) can manifest as fungus balls in preexisting cavities of lung parenchyma and recurrent hemoptysis is among the most frequent complications. Radiotherapy can be considered for treatment-refractory aspergilloma and severe hemoptysis. To the best of our knowledge, we present the first application of stereotactic body radiotherapy (SBRT) for a pulmonary aspergilloma in a patient with limited functional lung capacity. The topic was further expanded on with a systematic review of the literature addressing the implementation of radiotherapy in CPA patients.
CASE REPORT
A 52-year-old man presented with recurring and treatment-refractory hemoptysis caused by chronic cavitary aspergillosis localized in the left lower lobe. We applied SBRT on two consecutive days with a total dose of 16 Gy. Hemoptysis frequency decreased to a clinically insignificant level.
SYSTEMATIC REVIEW
We performed a systematic search of the literature in line with the PRISMA statement. The initial PubMed search resulted in 230 articles, of which 9 were included.
RESULTS
The available literature contained 35 patients with CPA who received radiotherapy. Dose fractionation usually ranged from 2 to 4 Gy per fraction, applied almost exclusively in conventional two-dimensional (2D) techniques. There is no report of SBRT usage in such a scenario. Most cases report a positive treatment response after irradiation.
CONCLUSION
The presented case demonstrates long-term clinical stability after SBRT for recurrent hemoptysis due to pulmonary aspergilloma. The systematic literature search revealed that concept definition is still uncertain, and further work is necessary to establish radiotherapy in clinical practice.
Topics: Male; Humans; Middle Aged; Hemoptysis; Radiosurgery; Pulmonary Aspergillosis; Lung
PubMed: 36264357
DOI: 10.1007/s00066-022-02013-1 -
Frontiers in Oncology 2022There is a deep interrelation between the thyroid gland and the kidney parenchyma, with dysfunction of the first leading to significant changes in renal metabolism and ....
There is a deep interrelation between the thyroid gland and the kidney parenchyma, with dysfunction of the first leading to significant changes in renal metabolism and . Given the recognition of cancer as a systemic disease, the raise of thyroid tumors and the common association of several malignancies, such as breast cancer, prostate cancer, colorectal cancer, and other, with an increased risk of kidney disease, public health alert for these conditions is warranted. A systematic review of the current evidence on the bidirectional relationship between thyroid and renal cancers was conducted including 18 studies, highlighting patient's characteristics, histology, time for secondary malignancy to develop from the first diagnosis, treatment, and follow-up. A total of 776 patients were identified; median age was 64 years (range: 7-76 years). Obesity and family history were identified as the most common risk factors, and genetic susceptibility was suggested with a potential strong association with Cowden syndrome. Controversy on chemo and radiotherapy effects was found, as not all patients were previously exposed to these treatments. Men were more likely to develop kidney cancer after a primary thyroid malignancy, with 423/776 (54%) experiencing renal disease secondarily. Median time after the first malignancy was 5.2 years (range: 0-20 years). With the advancement of current oncological therapy, the prognosis for thyroid cancer patients has improved, although there has been a corresponding rise in the incidence of multiple secondary malignancy within the same population, particularly concerning the kidney. Surgery can achieve disease-free survival, if surveillance follow-up allows for an early localized form, where radical treatment is recommended.
PubMed: 36212468
DOI: 10.3389/fonc.2022.951976 -
Archivos Espanoles de Urologia Aug 2022Minimally invasive techniques for the treatment and diagnosis of kidney disease seek to preserve the greatest amount of parenchyma. Bleeding after these practices is...
UNLABELLED
Minimally invasive techniques for the treatment and diagnosis of kidney disease seek to preserve the greatest amount of parenchyma. Bleeding after these practices is rare, but must be treated quickly given its severity. Iatrogenic renal vascular injuries (IRVI) resulting from these procedures include active bleeding, arterial pseudoaneurysms, and arteriovenous fistulas. Renal artery embolization (RAE) is the main pillar in the treatment of this type of complications.
OBJECTIVE
To assess the results of RAE for the treatment of IRVI and its impact on the renal function of patients.
METHOD
Retrospective analysis of all patients who presented vascular complications after renal procedures and who were referred for management by RAE, between August 2012 and December 2020.
RESULTS
18 patients were included. 4 patients presented with pseudoaneurysm, 10 patients with active bleeding, and 1 patient with arteriovenous fistula; 2 patients had a combination of different IRVI; 1 patient did not present any findings at the time of renal angiography in dissonance with her computed tomography angiography. Technical and clinical success was achieved in all patients. One renal artery dissection was the only complication. No differences were found in serum creatinine ( = 0.51), urea ( = 0.37), hemoglobin ( = 0.26) and hematocrit ( = 0.24) after embolization.
CONCLUSION
EAR is a safe and effective method for the treatment of IRVI, achieving a very high technical and clinical success rate with a low incidence of complications and without significant repercussions on the renal function of patients.
Topics: Aneurysm, False; Arteriovenous Fistula; Creatinine; Embolization, Therapeutic; Endovascular Procedures; Female; Hemorrhage; Humans; Iatrogenic Disease; Kidney Diseases; Retrospective Studies; Treatment Outcome; Urea; Vascular System Injuries
PubMed: 36138501
DOI: 10.37554/es-j.arch.esp.urol-20210515-3507-27 -
Neurosurgical Review Oct 2022Traumatic brain injury (TBI) is a major cause of mortality and morbidity worldwide. There are currently no early biomarkers for prognosis in routine clinical use....
Traumatic brain injury (TBI) is a major cause of mortality and morbidity worldwide. There are currently no early biomarkers for prognosis in routine clinical use. Interleukin-6 (IL-6) is a potential biomarker in the context of the established role of neuroinflammation in TBI recovery. Therefore, a systematic review of the literature was performed to assess and summarise the evidence for IL-6 secretion representing a useful biomarker for clinical outcomes. A multi-database literature search between January 1946 and July 2021 was performed. Studies were included if they reported adult TBI patients with IL-6 concentration in serum, cerebrospinal fluid (CSF) and/or brain parenchyma analysed with respect to functional outcome and/or mortality. A synthesis without meta-analysis is reported. Fifteen studies were included, reporting 699 patients. Most patients were male (71.7%), and the pooled mean age was 40.8 years; 78.1% sustained severe TBI. Eleven studies reported IL-6 levels in serum, six in CSF and one in the parenchyma. Five studies on serum demonstrated higher IL-6 concentrations were associated with poorer outcomes, and five showed no signification association. In CSF studies, one found higher IL-6 levels were associated with poorer outcomes, one found them to predict better outcomes and three found no association. Greater parenchymal IL-6 was associated with better outcomes. Despite some inconsistency in findings, it appears that exaggerated IL-6 secretion predicts poor outcomes after TBI. Future efforts require standardisation of IL-6 measurement practices as well as assessment of the importance of IL-6 concentration dynamics with respect to clinical outcomes, ideally within large prospective studies. Prospero registration number: CRD42021271200.
Topics: Adult; Biomarkers; Brain Injuries, Traumatic; Female; Humans; Interleukin-6; Male; Prognosis; Prospective Studies
PubMed: 35790656
DOI: 10.1007/s10143-022-01827-y -
The Cochrane Database of Systematic... Jun 2022There are many accepted airway clearance techniques (ACTs) for managing the respiratory health of people with cystic fibrosis (CF); none of which demonstrate... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There are many accepted airway clearance techniques (ACTs) for managing the respiratory health of people with cystic fibrosis (CF); none of which demonstrate superiority. Other Cochrane Reviews have reported short-term effects related to mucus transport, but no evidence supporting long-term benefits. Exercise is an alternative ACT thought to produce shearing forces within the lung parenchyma, which enhances mucociliary clearance and the removal of viscous secretions. Recent evidence suggests that some people with CF are using exercise as a substitute for traditional ACTs, yet there is no agreed recommendation for this. Additionally, one of the top 10 research questions identified by people with CF is whether exercise can replace other ACTs. Systematically reviewing the evidence for exercise as a safe and effective ACT will help people with CF decide whether to incorporate this strategy into their treatment plans and potentially reduce their treatment burden. The timing of this review is especially pertinent given the shifting landscape of CF management with the advent of highly-effective small molecule therapies, which are changing the way people with CF are cared for.
OBJECTIVES
To compare the effect of exercise to other ACTs for improving respiratory function and other clinical outcomes in people with CF and to assess the potential adverse effects associated with this ACT.
SEARCH METHODS
On 28 February 2022, we searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews. We searched online clinical trial registries on 15 February 2022. We emailed authors of studies awaiting classification or potentially eligible abstracts for additional information on 1 February 2021.
SELECTION CRITERIA
We selected randomised controlled studies (RCTs) and quasi-RCTs comparing exercise to another ACT in people with CF for at least two treatment sessions.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data and assessed risk of bias for the included studies. They assessed the certainty of the evidence using GRADE. Review authors contacted investigators for further relevant information regarding their publications.
MAIN RESULTS
We included four RCTs. The 86 participants had a wide range of disease severity (forced expiratory volume in one second (FEV) ranged from 54% to 95%) and were 7 to 41 years old. Two RCTs were cross-over and two were parallel in design. Participants in one RCT were hospitalised with an acute respiratory exacerbation, whilst the participants in three RCTs were clinically stable. All four RCTs compared exercise either alone or in combination with another ACT, but these were too diverse to allow us to combine results. The certainty of the evidence was very low; we downgraded it due to low participant numbers and high or unclear risks of bias across all domains. Exercise versus active cycle of breathing technique (ACBT) One cross-over trial (18 participants) compared exercise alone to ACBT. There was no change from baseline in our primary outcome FEV, although it increased in the exercise group before returning to baseline after 30 minutes; we are unsure if exercise affected FEV as the evidence is very low-certainty. Similar results were seen for other measures of lung function. No adverse events occurred during the exercise sessions (very low-certainty evidence). We are unsure if ACBT was perceived to be more effective or was the preferred ACT (very low-certainty evidence). 24-hour sputum volume was less in the exercise group than with ACBT (secondary outcome). Exercise capacity, quality of life, adherence, hospitalisations and need for additional antibiotics were not reported. Exercise plus postural drainage and percussion (PD&P) versus PD&P only Two trials (55 participants) compared exercise and PD&P to PD&P alone. At two weeks, one trial narratively reported a greater increase in FEV % predicted with PD&P alone. At six months, the other trial reported a greater increase with exercise combined with PD&P, but did not provide data for the PD&P group. We are uncertain whether exercise with PD&P improves FEV as the certainty of evidence is very low. Other measures of lung function did not show clear evidence of effect. One trial reported no difference in exercise capacity (maximal work rate) after two weeks. No adverse events were reported (1 trial, 17 participants; very low-certainty evidence). Adherence was high, with all PD&P sessions and 96% of exercise sessions completed (1 trial, 17 participants; very low-certainty evidence). There was no difference between groups in 24-hour sputum volume or in the mean duration of hospitalisation, although the six-month trial reported fewer hospitalisations due to exacerbations in the exercise and PD&P group. Quality of life, ACT preference and need for antibiotics were not reported. Exercise versus underwater positive expiratory pressure (uPEP) One trial (13 participants) compared exercise to uPEP (also known as bubble PEP). No adverse events were recorded in either group (very low-certainty evidence). Trial investigators reported that participants perceived exercise as more fatiguing but also more enjoyable than bubble PEP (very low-certainty evidence). There were no differences found in the total weight of sputum collected during treatment sessions. The trial did not report the primary outcomes (FEV, quality of life, exercise capacity) or the secondary outcomes (other measures of lung function, adherence, need for antibiotics or hospitalisations).
AUTHORS' CONCLUSIONS
As one of the top 10 research questions identified by clinicians and people with CF, it is important to systematically review the literature regarding whether or not exercise is an acceptable and effective ACT, and whether it can replace traditional methods. We identified an insufficient number of trials to conclude whether or not exercise is a suitable alternative ACT, and the diverse design of included trials did not allow for meta-analysis of results. The evidence is very low-certainty, so we are uncertain about the effectiveness of exercise as an ACT. Longer studies examining outcomes that are important to people with CF are required to answer this question.
Topics: Adolescent; Adult; Anti-Bacterial Agents; Child; Cystic Fibrosis; Drainage, Postural; Forced Expiratory Volume; Humans; Mucociliary Clearance; Young Adult
PubMed: 35731672
DOI: 10.1002/14651858.CD013285.pub2 -
Medicina Oral, Patologia Oral Y Cirugia... Jul 2022Analysis of the tumor microenvironment has been proposed as a strategy for the treatment and prognosis of different neoplastic processes. A grading system based on the...
BACKGROUND
Analysis of the tumor microenvironment has been proposed as a strategy for the treatment and prognosis of different neoplastic processes. A grading system based on the tumor-stroma ratio (TSR), which evaluates the proportion of stroma in relation to neoplastic parenchyma at the invasion front, has shown a strong prognostic value in different neoplastic processes. The aim of the present systematic review was to understand the role of the TSR in head and neck squamous cell carcinoma (HNSCC), evaluating its correlation with clinical and prognostic parameters.
MATERIAL AND METHODS
An electronic search was performed in PubMed/Medline, Web of Science, Science Direct, Scopus, Embase, and the Cochrane Collaboration Library. Publications assessing the relationship between TSR and prognosis in cases of HNSCC were eligible. The quality of the studies was assessed independently by four evaluators using the Newcastle-Ottawa scale.
RESULTS
After application of the previously es+lished inclusion/exclusion criteria, nine articles were included in the qualitative synthesis. With regards to quality on the Newcastle-Ottawa scale, an overall value of 4.55 was obtained. This systematic review demonstrated a strong association between TSR and prognosis in esophageal and oral squamous cell carcinomas.
CONCLUSIONS
Histopathological analysis of the TSR can optimize the analysis of the prognosis of cases diagnosed with HNSSC. In addition, the TSR is a reliable and simple parameter that can be evaluated in hematoxylin/eosin-stained slides during routine laboratory examinations, showing high inter- and intraobserver agreement.
Topics: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Prognosis; Squamous Cell Carcinoma of Head and Neck; Stromal Cells; Tumor Microenvironment
PubMed: 35717622
DOI: 10.4317/medoral.24922