Acupuncture for Low Back Pain: Reevaluation of Systematic Reviews and Meta-analyses.

PURPOSE OF REVIEW: This overview aims to reevaluate the methodological quality, report quality, and evidence quality of systematic reviews (SRs)/meta-analyses (MAs) of acupuncture for low back pain to determine whether acupuncture effectively treats low back pain (LBP). RECENT FINDINGS: Twenty-three SRs/MAs were deemed eligible for the present overview. The AMSTAR 2 score showed that the methodological quality of one SR/MA was of medium quality, one was of low quality, and 21 were of critically low quality. Based on the results of the PRISMA evaluation, there are certain areas for improvement in the quality of reporting of SRs/MAs. There were some reporting flaws in the topic of search strategy (8/23, 34.78%), certainty assessment (4/23, 17.39%), the certainty of evidence (4/23, 17.39%), registration and protocol (3/23, 13.04%), and availability of data, code, and other material (1/23, 4.35%). Results from the GRADE evaluation indicated that 13 of 255 outcomes were rated as moderate, 88 were low, and 154 were very low. Acupuncture effectively treated LBP in the SRs/MAs included in the reevaluation. However, the methodological, report, and evidence-based quality of the SRs/MAs on acupuncture for LBP was low. Therefore, further rigorous and comprehensive studies are warranted to improve the quality of SRs/MAs in this field.

Corrective effects of maternal extreme flexure and hip abduction combined with contralateral side-lying on persistent foetal occipito-posterior position.

AIMS: To observe the corrective effects of maternal extreme flexure and hip abduction combined with contralateral side-lying on persistent foetal occipito-posterior position. BACKGROUND: Digital rotation and other methods are used for correction of a persistent foetal occipito-posterior position. However, digital rotation readily causes damage to mother and foetus, and the correction rates of other methods are low. DESIGN: In this observational study, pregnant women were randomly divided into 2 groups according to different postures and their outcomes were compared. METHODS: A total of 238 women with persistent foetal occipito-posterior position gave birth in our hospital between January 2015 and June 2017. Of these 238 cases, 12 women declined to participate. The 226 pregnant women were divided into study group (maternal extreme flexure and hip abduction combined with contralateral side-lying, n = 114) and control group (contralateral side-lying alone, n = 112). RESULTS: The correction and spontaneous labour rates were higher in the study group than in the control group (P < .05). The duration between initial and successful correction and birth process were shorter in the study group than in the control group (P < .05). CONCLUSION: Maternal extreme flexure and hip abduction combined with contralateral side-lying has better correction effect on persistent foetal occipito-posterior position.

Factors influencing the incidence of sinusitis in nasopharyngeal carcinoma patients after intensity-modulated radiation therapy.

The aim of the study was to investigate the incidence of sinusitis in nasopharyngeal carcinoma (NPC) patients before and after intensity-modulated radiation therapy (IMRT) and to analyze factors associated with the incidence of sinusitis following IMRT. We retrospectively analyzed 283 NPC patients who received IMRT in our hospital from March 2009 to May 2011. The diagnostic criteria for sinusitis are based on computed tomography (CT) or magnetic resonance imaging (MRI) findings. CT or MRI scans were performed before and after IMRT to evaluate the incidence of sinusitis. Factors influencing the incidence of sinusitis were analyzed by log-rank univariate and logistic multivariate analyses. Among the 283 NPC patients, 128 (45.2 %) suffered from sinusitis before radiotherapy. The incidence rates of sinusitis in patients with T1, T2, T3, and T4 NPC before radiotherapy were 22.6, 37.5, 46.8, and 61.3 %, respectively (χ 2 = 14.548, p = 0.002). Among the 155 NPC patients without sinusitis before radiotherapy, the incidence rates of sinusitis at the end of radiotherapy and at 1, 3, 6, 9, 12, and 18 months after radiotherapy were 32.9, 43.2, 61.3, 68.4, 73.5, 69.7, and 61.3 %, respectively (χ 2 = 86.461, p < 0.001). Univariate analysis showed that T stage, invasion of the nasal cavity, nasal irrigation, and radiation dose to the nasopharynx were associated with the incidence of sinusitis in NPC patients after IMRT (p = 0.003, 0.006, 0.002, and 0.020). Multivariate analysis showed that T stage, invasion of the nasal cavity, and nasal irrigation were influential factors for the incidence of sinusitis in NPC patients after IMRT (p = 0.002, 0.002, and 0.000). There was a higher incidence of sinusitis with higher T stage among NPC patients before radiotherapy, and the incidence of sinusitis in NPC patients after IMRT was high (45.2 %). The incidence of sinusitis increased rapidly within the first 3 months after IMRT, and the number of sinusitis cases peaked at 6-9 months after IMRT and showed a trend toward stabilization after 1 year. Advanced T stage, invasion of the nasal cavity, and nasal irrigation were positively associated with the incidence of sinusitis in NPC patients after IMRT.

[Significance of dual-time-point 18F-FDG PET imaging in evaluation of hilar and mediastinal lymph node metastasis in non-small-cell lung cancer].

OBJECTIVE: To explore the diagnostic value of dual-time-point 18F-FDG PET-CT imaging in detecting hilar and mediastinal lymph node metastasis in non-small-cell lung cancer (NSCLC). METHODS: Forty-six patients with NSCLC underwent standard whole body single-time 18F-FDG PET-CT scans and a delayed imaging for the thorax alone before surgery, meanwhile, the standard uptake value (SUV) and retention index (RI) were calculated. RESULTS: A total number of 584 lymph nodes were excised in the 46 patients. Of these, 134 metastatic lymph nodes were pathologically confirmed in 31 patients. There were 189 lymph nodes detected and suspected to be metastatic by standard single-time 18 F-FDG PET-CT imaging, and 161 by dual-time-point imaging. Therefore, the sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value in the detection of hilar and mediastinal lymph node metastasis were 87.3%, 84.0%, 84.8%, 61.9% and 95.7% by standard single-time 18F-FDG PET-CT imaging, versus 94.8%, 92.2%, 92.8%, 78.9% and 98.1%, respectively, by dual-time-point imaging. There was a statistically significant difference in the detection of lymph node metastasis between the standard single-time imaging and dual-time-point 18F-FDG PET-CT imaging. CONCLUSION: Dual-time-point 18F-FDG PET-CT imaging is more sensitive, specific and accurate than standard single-time 18F-FDG PET-CT imaging in the detection of hilar and mediastinal lymph node metastasis, and may provide more information for diagnosis, staging and treatment of non-small cell lung cancer.

[Preliminary study of 18F-FDG PET-CT in defining lymph node radiation target volume for non-small-cell lung cancer patients].

OBJECTIVE: To investigate the value of 18F-FDG PET-CT in detecting metastatic lymph node and radiation planning for patient with non-small-cell lung cancer (NSCLC). METHODS: The data of 58 NSCLC patients were retrospectively analyzed. Preoperatively, Both 18F-FDG PET-CT and CT scan were performed for all patients. Blinded interpretation of these images was then carried out. The gross tumor volume defined by radiation oncologist based on imaging results of either PET-CT or CT alone was compared with pathological results eventually. RESULTS: The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of detecting metastatic lymph node in the mediastinum was 56.0%, 54.2%, 54.8%, 38.9%, 70.3% by CT alone, and 88.0%, 85.4%, 86.3%, 75.9%, 93.2% by PET-CT, respectively. There was a statisticalty significant difference between two methods(P < 0.05). However, statisticalty no significant difference in detecting hilar lymph nodes was observed. The radiation target volume defined by CT was identical to that by PET-CT in 31(53.5%) cases, but changed in the other 27 (46.5%) cases when 18F-FDG PET data was added. The accuracy was 75.9% in detecting metastatic lymph nodes in the radiation target volume defined by PET-CT, while it was much lower by CT alone (48.3%) with a statistically significant difference between two methods (P < 0.05). CONCLUSION: 18F-FDG PET-CT is more accurate than CT alone in assessment of mediastinal lymph nodes for NSCLC patients. It may be recommended as a method in defining the radiation target volume.

Prognostic value of expression of EGFR and nm23 for locoregionally advanced nasopharyngeal carcinoma.

The purpose of this study was to evaluate the prognostic value of expression of EGFR and nm23 in patients with advanced-stage nasopharyngeal carcinoma (NPC). The study population comprised 127 patients with stage III-IVa NPC with sufficient pretreatment tumor biopsy specimens from 2003 to 2004 and clinical follow-up data. The expression of EGFR and nm23 was detected by immunohistochemistry. Survival analysis was performed using Kaplan-Meier method. The correlation between pretreatment expression of EGFR and nm23, and the effectiveness of chemoradiotherapy was analyzed. The EGFR expression was correlated with primary lesion stage and clinical stage (P = 0.001, 0.002, respectively). There was a statistically significant association between nm23 expression and local lymph node stage (P = 0.000). The positive EGFR expression had a higher recurrent rate than the negative (P = 0.015). The positive nm23 expression had a lower distant metastasis rate than the negative (P = 0.021). Negative expression of EGFR had a significantly better 5-year OS and DFS than positive expression (P = 0.015, 0.013, respectively). Positive expression of nm23 had a significantly higher 5-year OS and DFS than negative expression (P = 0.001, 0.006, respectively). Multivariate analysis indicated that both pretreatment EGFR and nm23 expression were strong independent factors for the overall survival of patients with NPC (P = 0.000, 0.000, respectively). Our data suggested that EGFR and nm23 can serve as reliable biomarkers for prognosis prediction in patients with NPC who may benefit from alternate treatment strategy and targeted treatment.