scholarly journals Infiltration and Sealing for Managing Non-Cavitated Proximal Lesions: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Yuanyuan Chen ◽  
Dongru Chen ◽  
Huancai Lin

Abstract Background: Infiltration and sealing are micro-invasive treatments for arresting proximal non-cavitated caries lesions; however, their efficacies under different conditions remain unknown. This systematic review and meta-analysis aimed to evaluate the caries-arresting effectiveness of infiltration and sealing and to further analyse their efficacies across different dentition types and caries risk levels.Methods: Electronic databases (Cochrane Library, PubMed and Embase) were searched for published literature, and references were manually searched. Split-mouth randomized controlled trials (RCTs) to compare the effectiveness between infiltration/sealing and non-invasive treatments in proximal lesions were included. The primary outcome was obtained from radiographical readings. In total, 995 citations were identified, and 16 RCTs (21 articles) were included.Results: For subgroup analysis, infiltration and sealing reduced the odds of lesion progression (infiltration vs non-invasive: OR = 0.20, 95% CI: 0.15 to 0.29; sealing vs placebo: OR = 0.27, 95% CI: 0.18 to 0.41). For both primary and permanent dentitions, infiltration and sealing were more effective than non-invasive treatments (primary dentition: OR = 0.30, 95% CI: 0.20 to 0.45; permanent dentition: OR = 0.19, 95% CI: 0.13 to 0.27). The overall effects of infiltration and sealing were significantly different from the control effects based on different caries risk levels (OR = 0.19, 95% CI: 0.14 to 0.27). For patients with different risk levels, there were significant differences between micro-invasive and non-invasive treatments (low risk: OR = 0.23, 95% CI: 0.07 to 0.75; low to moderate risk: OR=0.38, 95% CI: 0.18 to 0.81; moderate to high risk: OR=0.17, 95% CI: 0.17 to 0.29; and high risk: OR=0.14, 95% CI: 0.07 to 0.26). Infiltration was superior to non-invasive treatments for patients at different caries risk levels (low risk: OR = 0.07, 95% CI: 0.02 to 0.22; low to moderate risk: OR=0.38, 95% CI: 0.18 to 0.81; moderate to high risk: OR=0.19, 95% CI: 0.09 to 0.38; and high risk: OR=0.14, 95% CI: 0.07 to 0.29).Conclusion: Infiltration and sealing were more efficacious than non-invasive treatments for halting non-cavitated proximal lesions.

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuanyuan Chen ◽  
Dongru Chen ◽  
Huancai Lin

Abstract Background Infiltration and sealing are micro-invasive treatments for arresting proximal non-cavitated caries lesions; however, their efficacies under different conditions remain unknown. This systematic review and meta-analysis aimed to evaluate the caries-arresting effectiveness of infiltration and sealing and to further analyse their efficacies across different dentition types and caries risk levels. Methods Six electronic databases were searched for published literature, and references were manually searched. Split-mouth randomised controlled trials (RCTs) to compare the effectiveness between infiltration/sealing and non-invasive treatments in proximal lesions were included. The primary outcome was obtained from radiographical readings. Results In total, 1033 citations were identified, and 17 RCTs (22 articles) were included. Infiltration and sealing reduced the odds of lesion progression (infiltration vs. non-invasive: OR = 0.21, 95% CI 0.15–0.30; sealing vs. placebo: OR = 0.27, 95% CI 0.18–0.42). For both the primary and permanent dentitions, infiltration and sealing were more effective than non-invasive treatments (primary dentition: OR = 0.30, 95% CI 0.20–0.45; permanent dentition: OR = 0.20, 95% CI 0.14–0.28). The overall effects of infiltration and sealing were significantly different from the control effects based on different caries risk levels (OR = 0.20, 95% CI 0.14–0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01–8.27), there were significant differences between micro-invasive and non-invasive treatments (low risk: OR = 0.24, 95% CI 0.08–0.72; low to moderate risk: OR = 0.38, 95% CI 0.18–0.81; moderate to high risk: OR = 0.17, 95% CI 0.10–0.29; and high risk: OR = 0.14, 95% CI 0.07–0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01–8.27), infiltration was superior (low risk: OR = 0.24, 95% CI 0.08–0.72; low to moderate risk: OR = 0.38, 95% CI 0.18–0.81; moderate to high risk: OR = 0.20, 95% CI 0.10–0.39; and high risk: OR = 0.14, 95% CI 0.05–0.37). Conclusion Infiltration and sealing were more efficacious than non-invasive treatments for halting non-cavitated proximal lesions.


2020 ◽  
Author(s):  
Yuanyuan Chen ◽  
Dongru Chen ◽  
Huan Cai Lin

Abstract Background: Infiltration and sealing are micro-invasive treatments for arresting proximal non-cavitated caries lesions; however, their efficacies under different conditions remain unknown. This systematic review and meta-analysis aimed to evaluate the caries-arresting effectiveness of infiltration and sealing and to further analyse their efficacies across different dentition types and caries risk levels.Methods: Six electronic databases were searched for published literature, and references were manually searched. Split-mouth randomised controlled trials (RCTs) to compare the effectiveness between infiltration/sealing and non-invasive treatments in proximal lesions were included. The primary outcome was obtained from radiographical readings.Results: In total, 1033 citations were identified, and 17 RCTs (22 articles) were included. Infiltration and sealing reduced the odds of lesion progression (infiltration vs non-invasive: OR = 0.21, 95% CI: 0.15 to 0.30; sealing vs placebo: OR = 0.27, 95% CI: 0.18 to 0.42). For both the primary and permanent dentitions, infiltration and sealing were more effective than non-invasive treatments (primary dentition: OR = 0.30, 95% CI: 0.20 to 0.45; permanent dentition: OR = 0.20, 95% CI: 0.14 to 0.28). The overall effects of infiltration and sealing were significantly different from the control effects based on different caries risk levels (OR = 0.20, 95% CI: 0.14 to 0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI: 0.01 to 8.27), there were significant differences between micro-invasive and non-invasive treatments (low risk: OR = 0.24, 95% CI: 0.08 to 0.72; low to moderate risk: OR=0.38, 95% CI: 0.18 to 0.81; moderate to high risk: OR = 0.17, 95% CI: 0.10 to 0.29; and high risk: OR = 0.14, 95% CI: 0.07 to 0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI: 0.01 to 8.27), infiltration was superior (low risk: OR = 0.24, 95% CI: 0.08 to 0.72; low to moderate risk: OR = 0.38, 95% CI: 0.18 to 0.81; moderate to high risk: OR = 0.20, 95% CI: 0.10 to 0.39; and high risk: OR = 0.14, 95% CI: 0.05 to 0.37).Conclusion: Infiltration and sealing were more efficacious than non-invasive treatments for halting non-cavitated proximal lesions.


2021 ◽  
pp. 1-10
Author(s):  
Andrea Kokorovic ◽  
Mary E. Westerman ◽  
Kate Krause ◽  
Mike Hernandez ◽  
Nathan Brooks ◽  
...  

BACKGROUND: The optimal management of non-invasive (mucosal and/or ductal) urothelial carcinoma of the prostate remains elusive and there is a paucity of data to guide treatment. OBJECTIVE: Our objective was to systematically review and synthesize treatment responses to conservative management of non-invasive prostatic urothelial carcinoma using intravesical therapy. METHODS: A systematic literature search using MEDLINE, EMBASE, Cochrane Library, SCOPUS, and Web of Science databases from inception to November 2019 was performed. Risk of bias assessment was performed using the Newcastle-Ottawa scale for non-randomised studies. Pooled estimates of complete response in the bladder and prostate and prostate only were performed using a random effects model. Pre-specified subgroup analyses were generated to assess differences in complete responses for: BCG therapy vs other agents, ductal vs mucosal involvement, CIS vs papillary tumors and TURP vs no TURP. RESULTS: Nine studies including 175 patients were identified for inclusion in the systematic review and meta-analysis. All were retrospective case series and most evaluated response to BCG therapy. The pooled global complete response rate for intravesical therapy was 60%(95%CI: 0.48, 0.72), and for prostate 88%(95%CI: 0.81, 0.96). Pre-specified analyses did not demonstrate statistically significant differences between subgroups of interest. CONCLUSIONS: Management of non-invasive prostatic urothelial carcinoma using intravesical therapy yields satisfactory results. Caution should be taken in treating patients with papillary tumors and ductal involvement, as data for these populations is limited. TURP may not improve efficacy, but is required for staging. Current recommendations are based on low quality evidence, and further research is warranted.


Author(s):  
Muhamad Bob Anthony

PT. RK is one of the major international steel producing companies. This study aims to determine the potential hazards and the value of the level of risk that is likely to occur in the new plant owned by PT. RK i.e. the gas cleaning system area which is currently in the process of entering 95% progress. This study uses the Hazard & Operability Study (HAZOPs) method in analyzing risks in the gas cleaning system area of PT. RK. The Hazard & Operability Study (HAZOPs) method was used in this study because this method is very suitable for a new plant to be used. Based on the identification of potential hazards and risk analysis that has been done in the area of gas cleaning system using the HAZOPs method, it was found that 11 deviations that might occur from all existing nodes, i.e. for extreme risk levels of 1 (one) deviation or 9%, level high risk of 2 (two) deviations or 18%, moderate risk level of 6 (six) deviations or 55% and low risk level of 2 (two) deviations or 18%.Keyword : Gas Cleaning System, HAZOPs, Potential of Hazard, Risk Levels PT. RK merupakan salah satu perusahaan manufaktur besar penghasil baja berskala internasional. Penelitian ini bertujuan untuk mengetahui potensi bahaya dan nilai level risiko yang kemungkinan terjadi di plant baru milik PT. RK yaitu area gas cleaning system yang saat ini proses pekerjaannya sudah memasuki progress 95%. Penelitian ini menggunakan metode Hazard & Operability Study (HAZOPs) dalam menganalisa risiko di area gas cleaning system  PT. RK.  Metode Hazard & Operability Study (HAZOPs) digunakan dalam penelitian ini dikarenakan metode ini sangat cocok untuk sebuah plant baru yang akan digunakan. Berdasarkan identifikasi potensi bahaya dan analisa risiko yang telah dilakukan di area gas cleaning system dengan menggunakan metode HAZOPs, didapatkan bahwa 11 penyimpangan yang kemungkinan terjadi dari semua node yang ada yaitu untuk level risiko extreme sebanyak 1 (satu) penyimpangan atau sebesar 9%, level risiko high risk sebanyak 2 (dua) penyimpangan atau sebesar 18%, level risiko moderate sebanyak 6 (enam) penyimpangan atau sebesar 55% dan level risiko low risk sebanyak 2 (dua) penyimpangan atau sebesar 18%.Kata Kunci: Gas Cleaning System, HAZOPs, Level Risiko, Potensi Bahaya


2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Shiren Sun ◽  
Wei Zhang ◽  
Ming Bai ◽  
Lijuan Zhao ◽  
Xiaolan Chen ◽  
...  

Abstract Background and Aims Continuous renal replacement therapy (CRRT) has been widely used in the critical care setting and anticoagulation is usually necessitated. However, critically ill patients are commonly at incremental risk of bleeding, which contributed to the hesitation of anticoagulant use for CRRT in clinical practice. The current guideline recommended CRRT proceed without anticoagulation in patients with contraindication to citrate and increased bleeding risk. Nevertheless, the efficacy of anticoagulation-free CRRT remains inconsistent. Therefore, the purpose of our present systematic review is to evaluate the efficacy and safety of anticoagulant-free CRRT based on the current literatures. Method We conducted a comprehensive search of PubMed (US National Library of Medicine, Bethesda, MD, USA), Cochrane Library databases and EMBASE from database inception to January 12, 2019 for potential candidate studies. Studies included adult critically ill (age > 18 years) patients with increased bleeding risk, and underwent CRRT without anticoagulation were considered for the inclusion. Results Finally, 17 observational studies and 3 randomized controlled trials with 1615 patients were included in our present meta-analysis. There was no significant difference in filter lifespan between the anticoagulation-free and systemic heparin group. The filter lifespan was significantly prolonged in the citrate (WMD -23.01, 95%CI [-28.62, -17.39], P < 0.001; I2 = 0%, P = 0.53) and nafamostat (WMD -8.4, 95%CI [-9.9, -6.9], P < 0.001; I2 = 33.7%, P = 0.21) groups, compared with anticoagulation-free group. The averaged filter lifespan of the anticoagulation-free CRRT ranged from 10.2 to 52.5 hours. Conclusion The filter lifespan in anticoagulation-free patients with increased bleeding risk was comparable to that in patients without increased bleeding risk underwent systemic heparin anticoagulation CRRT. Nafamostat was not recommended for CRRT anticoagulation due to its drawbacks. Currently, the optimal choice of anticoagulation strategy for critically ill patients without citrate contraindications at high risk of bleeding should be regional citrate anticoagulation. Further studies should focus on the special cut-off value of activated partial thromboplastin time (APTT), international normalized ratio (INR) and platelet (PLT) count, at which the anticoagulation-free CRRT would be beneficial.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
I Piras ◽  
G Murenu ◽  
G Piras ◽  
G Pia ◽  
A Azara ◽  
...  

Abstract Background Falls in hospital are adverse events with serious consequences for the patient. Fall risk assessment requires easy tools that are suitable for the specific clinical context. This is important to quickly identify preventing measures. The aim of the study is to identify an appropriate scale for assessing fall risk in patients from an emergency department. Methods For the fall risk assessment in the emergency department, three scales were identified in literature: Kinder 1, MEDFRAT, and Morse. MEDFRAT and Morse classify the patient in high, moderate, and low risk; Kinder 1 split patients “at risk” (also when there is only one positive item) and “non-risk” (in which all items are negative). The study was carried out in July 2019 in an Italian emergency department. Patients who arrived in triage were assessed for the fall risk using the three scales. Results On a sample of 318 patients, the used scales show different levels of fall risk. For Kinder 1, 83.02% is at risk and 16.98% is not at risk; for MEDFRAT, 14.78% is at high risk, 15.09% moderate, and 70.13% low risk; for Morse, 8.81% is at high risk, 35.53% moderate, and 56.66% low risk. As Kinder 1 implies as “high risk” that all items of the questionnaire are positive, to compare Kinder 1 to the other scales with three measurements, we assumed only one positive response as “moderate risk”, all negative responses as “low risk”. Thus, Kinder 1 shows no cases at high risk, 83.02% moderate risk, and 16.98% low risk. All the scales show that the moderate-high risk increases with age. MEDFRAT and Morse have concordant percentages for young (13.6%), elderly (61.2%), and long-lived (66.6%) people. Kinder 1, 59%, 96.7%, and 100%, respectively. Conclusions The comparison between scales shows inhomogeneity in identifying the level of risk. MEDFRAT and Morse appear more reliable and consistent. Key messages An appropriate assessment scale is important to identify the fall risk level. Identifying accurate fall risk levels allows for implementing specific prevention actions.


2021 ◽  
Vol 9 ◽  
Author(s):  
Li-Li Pang ◽  
Jin Mei ◽  
Ling-Xiu Fan ◽  
Ting-Ting Zhao ◽  
Ruo-Nan Li ◽  
...  

Objective: High-intensity focused ultrasound (HIFU) is an innovative non-invasive technology used for adenomyosis. Gonadotropin-releasing hormone agonist (GnRH-a) is a hormone commonly used for adenomyosis. We investigated and assessed the efficacy of HIFU combined with GnRH-a for adenomyosis.Methods: For this systematic review and meta-analysis, we searched Pubmed, Cochrane Library, Web of Science, Embase, CNKI, WanFang, and VIP databases for relevant articles published in Chinese or English that compared HIFU combined with GnRH-a vs. HIFU alone in patients with adenomyosis. The last literature search was completed on January 31, 2021. Two reviewers independently assessed study eligibility and assessed risk of bias. Another two reviewers extracted the data. The RevMan5.3 software was used for the data analysis. Changes in volume of the uterine and adenomyotic lesion were defined as the primary outcomes. The secondary outcomes were visual analog scale (VAS) scores for dysmenorrhea, menstrual volume scores, serum CA125 levels, and recurrence rate. This study is registered with PROSPERO (CRD42021234301).Results: Three hundred and ninety potentially relevant articles were screened. Nine studies with data for 766 patients were finally included. Compared with the HIFU alone group, the HIFU combined with GnRH-a group had a higher rate of uterine volume reduction (MD 7.51, 95% CI 5.84–9.17, p < 0.00001), smaller adenomyotic lesion volume (MD 4.11, 95% CI 2.93–5.30, p < 0.00001), lower VAS score for dysmenorrhea (MD 1.27, 95% CI 0.54–2.01, p = 0.0007) and menstrual volume score (MD 0.88, 95% CI 0.73–1.04, p < 0.00001), and lower CA125 level (SMD 0.31, 95% CI 0.05–0.56, p = 0.02) after the procedure. The recurrence rate in the HIFU combined with GnRH-a group was lower than that in the HIFU alone group (RR 0.28, 95% CI 0.10–0.82, p = 0.02).Conclusions: Compared with HIFU treatment alone, HIFU combined with GnRH-a for the treatment of adenomyosis has greater efficacy in decreasing the volumes of the uterine and adenomyotic lesions and alleviating symptoms. However, since the number of the included studies was too small and most of them were written in Chinese, this conclusion needs to be referenced with caution. And the long-term evidence of its efficacy is still insufficient.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/ identifier [CRD42021234].


Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3551-3551
Author(s):  
Maya Khalil ◽  
Tea Reljic ◽  
Jessica El-Asmar ◽  
Mehdi Hamadani ◽  
Taiga Nishihori ◽  
...  

Abstract Background: Despite availability of novel therapies, namely JAK inhibitors and immunomodulatory agents, for treatment of myelofibrosis, the disease remains incurable unless eligible patients are offered an allogeneic hematopoietic cell transplant (allo-HCT). Available data supporting allo-HCT in myelofibrosis are limited to single-arm prospective or retrospective studies (including data from registries) or single-center case series. No randomized controlled trial (RCT) has ever been conducted comparing the impact of dose-intensity of the conditioning regimen on post-transplant outcomes in patients with myelofibrosis. Accordingly, we performed a systematic review/meta-analysis of the published literature using PubMed and EMBASE from date of inception until 12/16/2015. We restricted inclusion criteria to studies published only as peer-reviewed manuscripts which included more than 10 patients. Patients and methods: Our search strategy identified 907 publications, but only 29 (n=2,128 patients) met our inclusion criteria. Data were collected on treatment benefits (overall response rate (ORR), complete (CR) or partial response (PR), overall survival (OS)) and harms (grade 2-4 acute graft-versus-host disease (GVHD), 3-4 acute GVHD, chronic GVHD, non-relapse mortality (NRM), and graft failure) whenever available. We also assessed outcomes based on disease-risk stratification whenever possible. For the purposes of our analysis, low-risk encompassed (low-risk Lille/Dupriez/DIPSS), intermediate-risk (intermediate-risk Lille/Dupriez/int-1 DIPSS), and high-risk (high-risk Lille/Dupriez/Int-2 or high-DIPSS). All results are reported as pooled proportions. Results: When using reduced-intensity conditioning (RIC) regimens, 7 prospective (n=281 patients) and 11 retrospective (n=532 patients) studies were identified. Pooled (rates) outcomes of RIC prospective studies were as follow: ORR=65% (95%CI=26-95%), CR=51% (95%CI=18-84%), OS= 69% (95%CI=58-80%), grade 2-4 acute GVHD= 37% (95%CI=27-48%), grade 3-4 acute GVHD= 22% (95%CI=7-44%), chronic GVHD= 38% (95%CI=22-55%), NRM= 23% (95%CI=12-37%), and graft failure= 6% (95%CI=1-12%). Pooled outcomes of RIC retrospective studies were as follow: ORR= 100% (95%CI=86-100%), CR=100% (95%CI=86-100%), OS= 51% (95%CI=43-58%), grade 2-4 acute GVHD= 35% (95%CI=30-39%), grade 3-4 acute GVHD=19% (95%CI=11-29%), chronic GVHD= 47% (95%CI=41-52%), NRM= 20% (95%CI=13-27%), and graft failure= 15% (95%CI=9-22%). For myeloablative conditioning (MAC) regimens, 0 prospective and 5 retrospective (n=132 patients) studies were identified. Outcomes were as follow: ORR= 40% (95%CI=21-61%), CR=40% (95%CI=21-61%), OS=56% (95%CI=42-70%), grade 2-4 acute GVHD= 46% (95%CI=26-66%), grade 3-4 acute GVHD=13% (95%CI=4-26%), chronic GVHD= 57% (95%CI=26-86%), NRM= 26% (95%CI=16-38%), and graft failure= 9% (95%CI=0-32%). Furthermore, Survival outcomes based on disease-risk stratification showed OS rates of 78% (95%CI=69-86%) for low-risk, 60% (95%CI=48-70%) for intermediate-risk, and 42% (95%CI=36-48%) for high-risk cases. Conclusions: Notwithstanding the need of a RCT to help better understand the effect of dose-intensity of allo-HCT regimens (RIC vs. MAC) on outcomes, this systematic review/meta-analysis highlights encouraging OS rates of 51-69% when using RIC regimens with resulting pooled NRM rates of 20-23%. Rates of grade 2-4 acute and chronic GVHD appear, unsurprisingly, lower with RIC regimens; but high rates of graft failure remain a serious concern in myelofibrosis regardless of the intensity of the conditioning regimen. Disclosures Hamadani: Janssen: Consultancy; Celgene: Honoraria, Research Funding; Takeda Pharmaceuticals: Research Funding. Nishihori:Signal Genetics: Research Funding; Novartis: Research Funding.


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