Ablative vs. Non-Ablative Radiotherapy in Palliating Locally Advanced Pancreatic Cancer: A Single Institution Experience and a Systematic Review of the Literature.

We studied the dose-local control (LC) relationship in ablative vs. non-ablative radiotherapy in a non-radical treatment setting of "locally advanced pancreatic cancer (LAPC)" by comparing our patients (n = 89) treated with SBRT on the CyberKnife unit vs. conventional radiation between January 2005 and January 2021, and by reviewing the literature. A systematic search was performed leveraging Medline for references on SBRT use in pancreatic cancer without date terms or language restrictions. A total of 3702 references were identified and the search was then repeated in Embase and the Cochrane database. Ultimately, 12 studies were eligible for inclusion, which either compared SBRT to conventional radiation, or SBRT use in dose escalation for primary LAPC in a non-neoadjuvant setting. Our cohort's median overall survival was 152 days (CI 95%, 118-185); including 371 days (CI 95%, 230-511) vs. 126 days (CI 95%, 90-161) favoring SBRT, p = 0.004. The median time to local progression was 170 days (48-923) for SBRT vs. 107 days (27-489) for the non-ablative group. In our SBRT patients, no local progressions were seen with BED10 > 60 Gy. Even when palliating LAPC, SBRT should be considered as an alternative to conventional radiation, especially in patients with a low disease burden. BED10 ≥ 60-70 Gy offers better local control without increasing toxicity rates. Less local progression may provide a better quality of life to those patients who already have a short life expectancy.

Diagnostic instruments for the assessment of disruptive mood dysregulation disorder: a systematic review of the literature.

Disruptive mood dysregulation disorder (DMDD) involves non-episodic irritability and frequent severe temper outbursts in children. Since the inclusion of the diagnosis in the DSM-5, there is no established gold-standard in the assessment of DMDD. In this systematic review of the literature, we provide a synopsis of existing diagnostic instruments for DMDD. Bibliographic databases were searched for any studies assessing DMDD. The systematic search of the literature yielded K = 1167 hits, of which n = 110 studies were included. The most frequently used measure was the Kiddie Schedule for Affective Disorders and Schizophrenia DMDD module (25%). Other studies derived diagnostic criteria from interviews not specifically designed to measure DMDD (47%), chart review (7%), clinical diagnosis without any specific instrument (6%) or did not provide information about the assessment (9%). Three structured interviews designed to diagnose DMDD were used in six studies (6%). Interrater reliability was reported in 36% of studies (ranging from κ = 0.6-1) while other psychometric properties were rarely reported. This systematic review points to a variety of existing diagnostic measures for DMDD with good reliability. Consistent reporting of psychometric properties of recently developed DMDD interviews, as well as their further refinement, may help to ascertain the validity of the diagnosis.

Isolated aneurysms of the spinal circulation: a systematic review of the literature.

Aneurysms arising in the spinal circulation are rare and underreported. The objective of this study was to systematically review the English literature on different aspects of isolated spinal aneurysms using the PubMed, Ovid MEDLINE, and Google Scholar databases. Eighty-two papers reporting 107 individual patient cases were included. Most isolated spinal aneurysms have a fusiform morphology, and are most commonly found in the anterior spinal artery at the thoracic or cervical levels. Subarachnoid hemorrhage is the most common form of presentation, and sudden onset back pain is the most common initial symptom. The diagnosis of spinal aneurysms requires a high degree of clinical suspicion. Because of their small size, they can be missed on CT/MR angiography and spinal angiogram may be employed. Treatment of spinal aneurysms should be individualized on a case-by-case basis. Conservative management can be a valid option in spinal aneurysms where the risk of treatment is high. Surgical or endovascular intervention may be indicated in cases of significant or progressive neurologic decline due aneurysmal mass effect, or progressive growth of the aneurysm despite conservative treatment.

Ablation of atrial fibrillation in patients with Brugada syndrome: A systematic review of the literature.

Supraventricular arrhythmias are common in Brugada syndrome (BS), and notoriously difficult to manage with medical therapy secondary to associated risks. Pulmonary vein isolation (PVI) is often utilized instead, but its outcomes in this population are not well-known. We aim to provide a holistic evaluation of interventional treatment for Atrial fibrillation (AF) in the BS population. Electronic databases Medline, Embase, Cinahl, Cochrane, and Scopus were systematically searched for publications between 01/01/1995 and 12/31/2017. Studies were screened based on predefined inclusion and exclusion criteria. A total of 49 patients with BS and AF were included. Age range from 28.8 to 64 years, and 77.5% were male. 38 patients were implanted with implantable cardioverter-defibrillators (ICD) at baseline, and of them, 39% suffered inappropriate shocks for rapid AF. 34/49 (69%) of patients achieved remission following a single PVI procedure. Of the remaining, 13 patients underwent one or more repeat ablation procedures. Overall, 45/49 (91.8%) of patients remained in remission during long-term follow-up after one or more PVI procedures in the absence of antiarrhythmic drug (AAD) therapy. Postablation, no patients suffered inappropriate ICD shock. Furthermore, no major complications secondary to PVI occurred in any patient. AF ablation achieves acute and long-term success in the vast majority of patients. It is effective in preventing inappropriate ICD therapy secondary to rapid AF. Complication rates of PVI in BS are low. Thus, in light of the risks of AADs and risk of inappropriate ICD shocks in the BS population, catheter ablation could represent an appropriate first-line therapy for paroxysmal atrial fibrillation in BS patients.

Leiomyosarcoma of the Urinary Bladder in Adult Patients: A Systematic Review of the Literature and Meta-Analysis.

PURPOSE: Leiomyosarcoma of the urinary bladder is exceedingly rare. Most clinicians come across only a few cases during their career, and information regarding treatment and outcome is scattered in the scientific literature. Interested clinicians and patients have to undertake troublesome search for treatment and outcome information. MATERIAL AND METHODS: We performed a systematic review of the literature using the PubMed and Web of Science databases and included all identified cases published in English language between 1970 and June 2018 into a meta-analysis. Prior to the literature search, key questions were formulated and with the data obtained, answers to these questions should be derived. RESULTS: We analyzed clinical data of 210 cases of urinary bladder leiomyosarcoma revealed by this review and seen in our institution. The mean age of patients was 52 years. The majority (75%) of the tumors was classified as high-grade sarcomas. We found no report of a prior radiation therapy to the pelvic organs, but some authors suggested an association between cyclophosphamide treatment and the development of bladder leiomyosarcoma, especially in patients with retinoblastoma. For the whole sample, we determined 5- and 10-year cancer-specific cumulative mortality rates of 38 and 50%. Patients with high-grade sarcomas had a trend toward a higher mortality compared with low-grade tumors (p = 0.0280). The most promising treatment option seems to be surgery (radical or partial cystectomy) with negative resection margins, possibly supplemented by chemotherapy or radiation. CONCLUSION: About half of patients with bladder leiomyosarcoma survived on the long run. Low-grade tumors may have a better outcome with, nevertheless, countable long-term mortality. For better assessment of that rare bladder tumor, its best treatment options, and the influence of neoadjuvant or adjuvant therapies on the outcome of patients, a larger series with long-term survival data is required.

Model Comparisons of the Effectiveness and Cost-Effectiveness of Vaccination: A Systematic Review of the Literature.

OBJECTIVES: To describe all published articles that have conducted comparisons of model-based effectiveness and cost-effectiveness results in the field of vaccination. Specific objectives were to 1) describe the methodologies used and 2) identify the strengths and limitations of the studies. METHODS: We systematically searched MEDLINE and Embase databases for studies that compared predictions of effectiveness and cost-effectiveness of vaccination of two or more mathematical models. We categorized studies into two groups on the basis of their data source for comparison (previously published results or new simulation results) and performed a qualitative synthesis of study conclusions. RESULTS: We identified 115 eligible articles (only 5% generated new simulations from the reviewed models) examining the effectiveness and cost-effectiveness of vaccination against 14 pathogens (69% of studies examined human papillomavirus, influenza, and/or pneumococcal vaccines). The goal of most of studies was to summarize evidence for vaccination policy decisions, and cost-effectiveness was the most frequent outcome examined. Only 33%, 25%, and 3% of studies followed a systematic approach to identify eligible studies, assessed the quality of studies, and performed a quantitative synthesis of results, respectively. A greater proportion of model comparisons using published studies followed a systematic approach to identify eligible studies and to assess their quality, whereas more studies using new simulations performed quantitative synthesis of results and identified drivers of model conclusions. Most comparative modeling studies concluded that vaccination was cost-effective. CONCLUSIONS: Given the variability in methods used to conduct/report comparative modeling studies, guidelines are required to enhance their quality and transparency and to provide better tools for decision making.

Ondansetron in Pregnancy and the Risk of Congenital Malformations: A Systematic Review.

OBJECTIVE: Ondansetron, not approved for use in pregnancy, is increasingly being prescribed for nausea and vomiting in pregnancy and hyperemesis gravidarum. A number of recent lawsuits have highlighted the possibility that ondansetron may cause congenital malformations. The aim of this study was to systematically review epidemiological evidence on the potential association of prenatal exposure to ondansetron and congenital malformations. METHODS: Systematic searches in Medline and Embase were performed in June 2017 using controlled vocabulary and key words, and references of search results were reviewed. Full papers (RCTs, cohort, and case-control studies) were eligible for inclusion if they reported fetal outcomes of prenatal ondansetron exposure in humans. Excluded were: case reports, studies involving pre-medication with ondansetron prior to CS, animal studies, and foreign languages studies. RESULTS: Ten epidemiologic studies were included: five large retrospective cohort studies, two prospective observational studies, two population-based case-controls. and a retrospective case series. Sample sizes ranged from 17 to 1 501 434 infants exposed to ondansetron. A case-control study identified an association between prenatal exposure to ondansetron and cleft palate, and one cohort study found an increased risk of cardiovascular defects. These findings were not reproduced in the other studies. CONCLUSION: While further investigation of the literature is needed, our results highlight the paucity of evidence linking prenatal exposure to ondansetron to an increased risk of congenital malformations. There is a need for additional epidemiologic studies to confirm whether ondansetron represents a safe and effective alternative treatment for nausea and vomiting in pregnancy and hyperemesis gravidarum.

Assessment of data on vector and host competence for Japanese encephalitis virus: A systematic review of the literature.

Japanese encephalitis virus (JEV) is a virus of the Flavivirus genus that may result in encephalitis in human hosts. This vector-borne zoonosis occurs in Eastern and Southeastern Asia and an intentional or inadvertent introduction into the United States (US) would have major public health and economic consequences. The objective of this study was to gather, appraise, and synthesize primary research literature to identify and quantify vector and host competence for JEV, using a systematic review (SR) of the literature. After defining the research question, we performed a search in selected electronic databases and journals. The title and abstract of the identified articles were screened for relevance using a set of exclusion and inclusion criteria, and relevant articles were subjected to a risk of bias assessment, followed by data extraction. Data were extracted from 171 peer-reviewed articles. Most studies were observational studies (59.1%) and reported vector competence (60.2%). The outcome measures reported pertained to transmission efficiency, host preference, and vector susceptibility to infection within vector competence; and susceptibility to infection within host competence. Regarding vector competence, the proportion of JEV infection reported across all 149 mosquito species in all observational studies ranged from 0 to 100%. In experimental studies, infection, dissemination, and transmission rates varied between 0 and 100%. Minimum infection rates (MIR) varied between 0 and 333.3 per 1000 mosquitoes. Maximum likelihood estimation (MLE) values ranged from 0 to 53.8 per 1000 mosquitoes. The host species in which mosquitoes mostly fed consisted of pigs and cattle (total of 84 blood meals taken by mosquitoes from each of these host species). As for host competence, the proportion of JEV infection varied between 0 (in rabbits, reptiles, and amphibians) and 88.9% (cattle). This SR presents comprehensive data on JEV vector and host competence, which can be used to quantify risks associated with the introduction of JEV into the US.

[Factors influencing the acceptability of pediatric galenic formulations]. / Facteurs influençant l'acceptabilité des formulations galéniques en pédiatrie ­ revue de la littérature.

BACKGROUND AND GOAL OF THIS STUDY: Few available galenic formulations of drugs have pediatric doses, so that many of them are used off label in children. The influence of such pharmaceutical formulation on therapeutic adherence was evaluated in a systematic review of the literature. MATERIALS AND METHODS: This search was performed in 4 data bases: Medline, the Cochrane Library, Web of Science and Science Direct. Included articles were in French or English and focused on therapeutic adherence and route of administration. RESULTS: Overall, 51 articles were included in the study: 46 from Medline (27 selected), 1 from The Cochrane Library (1 duplicate), 61 from Web of Science (13 selected) and 23 articles from Science Direct (11 selected). The two main pharmaceutical formulations studied were liquid dosage form 51% (n=28) and solid oral form 35% (n=19). DISCUSSION: Easy use of liquid forms (n=18) (easy dose adjustment and administration) was associated with good adherence. Optimization of organoleptic properties was found to improve adherence (n=20). The main limitations to the use of solid oral formulations are the risk of choking in a child under 6 and difficulty adapting doses for pediatric use. Commercialization of minitablets should help solve these problems (n=3) and therapeutic education sessions could make it possible to prescribe selected pills to children aged 4 or older (n=2). A risk of misuse because of incorrect administration seems to be the reason that aerosols are underused. CONCLUSION: Drug formulation influences therapeutic adherence in children, which is a cornerstone for successful pharmacotherapeutic management.

Achenbach's syndrome: Case report and systematic review of the literature / Síndrome de Achenbach: presentación de un caso y revisión sistemática de la literatura

Abstract Introduction: Achenbach's syndrome is a vascular disorder of the hands and feet. It is of unknown etiology and has a benign course. Because of its low prevalence, available literature is limited, and most publications are case reports. No Latin-American publications were found on the subject. The case of a 58 year-old man is presented, along with a systematic review of the literature to describe its clinical characteristics. Methods: A literature search was conducted in PubMed, Embase and Lilacs using free terms and controlled vocabulary (MeSH, Emtree, and DeCS). Results: An analysis was made on a total of 23 articles, 19 of which were case reports, with a total of 46 patients, 43 women and 3 men, from 7 countries. The disorder occurs most often in women over 50 years, and is manifested by the sudden appearance of a blue coloration of the palmar surface of the fingers. It is less common in the feet. Conclusions: Achenbach's syndrome is benign, and does not require medical intervention. Diagnostic methods are of little use. Therefore, identification is important to avoid unnecessary procedures.

Resumen Introducción: El síndrome de Achenbach es un trastorno vascular de manos y pies, de etiología desconocida y de curso benigno. Dada su baja frecuencia de presentación, la literatura disponible es escasa; la mayoría son reportes de casos. No se encontraron publicaciones latinoamericanas sobre el tema. Aquí se presenta un caso clínico, en un hombre de 58 anos, y se hace una revisión sistemática de la literatura para describir sus características clínicas. Métodos: Se realizó una búsqueda de literatura en PubMed, Embase y Lilacs utilizando términos libres y vocabulario controlado (MeSH, Emtree y DeCS). Resultados: Se evaluaron 23 artículos de los cuales 19 fueron reportes de caso. Los reportes de caso muestran la historia de 46 pacientes, 43 mujeres y 3 hombres, en 7 países. El trastorno se presenta más frecuentemente en mujeres mayores de 50 anos y se manifiesta por la aparición súbita de una coloración azul de la cara palmar de los dedos y menos frecuente en los pies. Conclusiones: El síndrome de Achenbach es benigno y no requiere intervenciones médicas. Los métodos diagnósticos son de poca utilidad. Es necesario reconocerlo para evitar procedimientos innecesarios.

Produção científica sobre família e comunidade na base de dados PePSIC (2002/2012) / Scientific publications concerning family and community in the PePSIC database (2002–2012) / La literatura científica sobre la familia y la comunidad en el PePSIC database (2002/2012)

Esta revisão sistemática de literatura teve por objetivo mapear as variáveis relacionadas à produção científica sobre família e comunidade, indexada na base de dados Periódicos Eletrônicos em Psicologia (PePSIC). A busca de informações foi realizada por meio dos vocábulos "família" e "comunidade" e contemplou artigos completos, publicados entre 2002 e 2012 (n = 44). Foi realizado tratamento quantitativo e qualitativo na amostra. No geral, os estudos foram produzidos no sudeste brasileiro, em instituições privadas de ensino superior, com relativo destaque para investigações empíricas e relatos de experiência desenvolvidos por mulheres, e na modalidade de autoria múltipla. A produção foi divulgada em periódicos nacionais, que seguem critérios editoriais reconhecidos pela comunidade acadêmica (Qualis/CAPES). Temáticas sobre infância e adolescência foram priorizadas nos trabalhos, com diversidade de enfoques teóricos da Psicologia. As intervenções psicológicas relatadas abarcaram propostas terapêuticas e não terapêuticas, individuais e grupais, e transcorreram em ambientes institucionais. Análises comparativas, com amostras obtidas em outras fontes de informação, são desejáveis e encontram-se em andamento.(AU)

This systematic literature review aimed to map the variables associated with the scientific publications about family and community indexed in the database Periódicos Eletrônicos em Psicologia (PePSIC). The search was performed using the keywords "family" and "community" and included articles published between 2002 and 2012 (n = 44). The sample was quantitatively and qualitatively analyzed. Overall, the studies were produced in southeastern Brazil, in private institutions of higher learning, with an emphasis on empirical research and experience reports developed by women with multiple authorship. The publications were published in national journals, following editorial criteria recognized by the academic community (Qualis/CAPES). Childhood and adolescence issues were prioritized, with a wide range of psychological theoretical models. The reported psychological interventions encompassed therapeutic and non-therapeutic, individuals and groups, and passed in institutional settings. Comparative analyses with samples from other sources of information are required, which are in progress.(AU)

Esta revisión sistemática tuvo como objetivo mapear las variables relacionadas con la literatura científica sobre la familia y la comunidad, indexados en la base de datos electrónica Periódicos Electrónicos en Psicologia (PePSIC). La búsqueda de información se realizó mediante las palabras clave "familia" y "comunidad" y artículos publicados entre 2002 y 2012 (n = 44). Se realizó tratamiento cuantitativo y cualitativo en la muestra. En general, los estudios fueron realizados en el sureste de Brasil, en las instituciones privadas de educación superior, con énfasis en la investigación empírica, los informes de experiencias desarrolladas por mujeres y en la forma de la autoría múltiple. La producción fue publicada en revistas nacionales, siguiendo los criterios editoriales reconocidos por la comunidad académica (Qualis / CAPES). Se dio prioridad a los trabajos, sobre la niñez y la adolescencia,, producidos con la diversidad teórica de la Psicología. Las intervenciones psicológicas informaron propuestas enfocadas en lo terapéutico y no terapéutico, individual y en grupo, y realizadas en instituciones. El análisis comparativo con muestras de otras fuentes de información son deseables y están en curso.(AU)

Produção científica sobre família e comunidade na base de dados PePSIC (2002/2012) / Scientific publications concerning family and community in the PePSIC database (2002–2012) / La literatura científica sobre la familia y la comunidad en el PePSIC database (2002/2012)

Esta revisão sistemática de literatura teve por objetivo mapear as variáveis relacionadas à produção científica sobre família e comunidade, indexada na base de dados Periódicos Eletrônicos em Psicologia (PePSIC). A busca de informações foi realizada por meio dos vocábulos "família" e "comunidade" e contemplou artigos completos, publicados entre 2002 e 2012 (n = 44). Foi realizado tratamento quantitativo e qualitativo na amostra. No geral, os estudos foram produzidos no sudeste brasileiro, em instituições privadas de ensino superior, com relativo destaque para investigações empíricas e relatos de experiência desenvolvidos por mulheres, e na modalidade de autoria múltipla. A produção foi divulgada em periódicos nacionais, que seguem critérios editoriais reconhecidos pela comunidade acadêmica (Qualis/CAPES). Temáticas sobre infância e adolescência foram priorizadas nos trabalhos, com diversidade de enfoques teóricos da Psicologia. As intervenções psicológicas relatadas abarcaram propostas terapêuticas e não terapêuticas, individuais e grupais, e transcorreram em ambientes institucionais. Análises comparativas, com amostras obtidas em outras fontes de informação, são desejáveis e encontram-se em andamento...

This systematic literature review aimed to map the variables associated with the scientific publications about family and community indexed in the database Periódicos Eletrônicos em Psicologia (PePSIC). The search was performed using the keywords "family" and "community" and included articles published between 2002 and 2012 (n = 44). The sample was quantitatively and qualitatively analyzed. Overall, the studies were produced in southeastern Brazil, in private institutions of higher learning, with an emphasis on empirical research and experience reports developed by women with multiple authorship. The publications were published in national journals, following editorial criteria recognized by the academic community (Qualis/CAPES). Childhood and adolescence issues were prioritized, with a wide range of psychological theoretical models. The reported psychological interventions encompassed therapeutic and non-therapeutic, individuals and groups, and passed in institutional settings. Comparative analyses with samples from other sources of information are required, which are in progress...

Esta revisión sistemática tuvo como objetivo mapear las variables relacionadas con la literatura científica sobre la familia y la comunidad, indexados en la base de datos electrónica Periódicos Electrónicos en Psicologia (PePSIC). La búsqueda de información se realizó mediante las palabras clave "familia" y "comunidad" y artículos publicados entre 2002 y 2012 (n = 44). Se realizó tratamiento cuantitativo y cualitativo en la muestra. En general, los estudios fueron realizados en el sureste de Brasil, en las instituciones privadas de educación superior, con énfasis en la investigación empírica, los informes de experiencias desarrolladas por mujeres y en la forma de la autoría múltiple. La producción fue publicada en revistas nacionales, siguiendo los criterios editoriales reconocidos por la comunidad académica (Qualis / CAPES). Se dio prioridad a los trabajos, sobre la niñez y la adolescencia,, producidos con la diversidad teórica de la Psicología. Las intervenciones psicológicas informaron propuestas enfocadas en lo terapéutico y no terapéutico, individual y en grupo, y realizadas en instituciones. El análisis comparativo con muestras de otras fuentes de información son deseables y están en curso...

Evaluation of medicinal interventions for the management of oral submucous fibrosis: a systematic review of the literature.

Oral submucous fibrosis is a chronic, progressive scarring disease associated with both significant morbidity including pain and limited mouth opening and an increased risk for malignancy. This systematic review evaluated the different medicinal (i.e. nonsurgical) interventions available for the management of oral submucous fibrosis. An automated literature searches of online databases from January 1960 to December 2013 were performed and only studies with high level of evidence based on the guidelines of the Oxford Centre for evidence-based medicine were selected. Thirteen studies (3 randomized controlled trials and 10 clinical trials/controlled clinical trials) were included and drugs like steroids, hyaluronidase, human placenta extracts, chymotrypsin and collagenase, pentoxifylline, nylidrin hydrochloride, iron and multivitamin supplements including lycopene were used. There is a clear lack of evidence on the available drug treatment for oral submucous fibrosis and further high quality randomized controlled trials are needed to evaluate the different therapeutic agents.