Objectives:Obstructive sleep apnea (OSA) is a prevalent disease with significant health impacts.While first line therapy is CPAP,long-term compliance is low and device misuse is common,highlighting the need for altern...Objectives:Obstructive sleep apnea (OSA) is a prevalent disease with significant health impacts.While first line therapy is CPAP,long-term compliance is low and device misuse is common,highlighting the need for alternative therapies.Upper airway surgery is one alternative,but substantial side effects hamper efficacy.A new alternative is an implantable hypoglossal nerve stimulator (HNS).These devices utilize neuromodulation to dilate/reinforce the airway and reduce side effects associated with traditional surgery.Several recent trials investigated the efficacy of these devices.The purpose of this study was to perform meta-analysis of available HNS studies investigating treatment of OSA to analyze objective and subjective outcomes and side effects.Methods:A comprehensive literature search of PubMed and Scopus was performed.Two independent reviewers examined clinical trials investigating HNS in treatment of sleep apnea in adults.Studies with objective and subjective endpoints in sleep were included for analysis.Adverse events from trials were also recorded.Results:Across 16 studies,381 patients were analyzed.At 6 months (p =0.008),mean SAQLI improved by 3.1 (95%CI,2.6-3.7).At 12 months (p < 0.0001),mean AHI was reduced by 21.1 (95%Cl,16.9-25.3),mean ODI was reduced by 15.0 (95%CI,12.7-17.4),mean ESS was reduced by 5.0 (95%CI,4.2-5.8),mean FOSQ improved by 3.1 (95%CI,2.6-3.4).Pain (6.2%:0.7-16.6),tongue abrasion (11.0%:1.2-28.7),and internal (3.0%:0.3-8.4)/external device (5.8%:0.3-17.4) malfunction were common adverse events.Conclusions:HNS is a safe and effective treatment for CPAP refractory OSA.Further study comparing HNS to other therapies is required.展开更多
Objective:To provide an understanding of the incidence of anaplastic thyroid cancer within the United States.Methods:Patients in the Surveillance,Epidemiology,and End Results (SEER) database were included from 1973 to...Objective:To provide an understanding of the incidence of anaplastic thyroid cancer within the United States.Methods:Patients in the Surveillance,Epidemiology,and End Results (SEER) database were included from 1973 to 2014 based on a diagnosis of anaplastic thyroid cancer using ICDO-3 codes.Patients were categorized into cohorts based on their year of diagnosis.Results:1527 patients were diagnosed with anaplastic thyroid cancer within the SEER 18 registries.The age-adjusted incidence rate was 0.2 per 1,000,000 people (95% CI:0.0-0.5) in 1973 and was 1.2 per 1,000,000 people (95% Cl:0.8-1.6) in 2014 (average annual percent change:3.0% [95% CI:2.2%-3.7%]).Patients tended to be of older age (mean age:70.5 [range 15.0-102.0]),of female sex (62.8%),and Caucasian (81.1%).Finally,survival over time remained the same,as median disease specific survival months was 4.00 (95% CI:2.26-5.74) from 1995 to 1999 and 4.00 (95% Cl:3.26-4.74) from 2010 to 2014.Conclusions:The incidence rate of anaplastic thyroid cancer has increased from 1973 to 2014.Interestingly,median survival in months did not greatly change overtime.Based on this increasing incidence,physicians must act appropriately to identify patients with anaplastic thyroid cancer as it possesses a high morbidity and mortality.展开更多
Background: PD-1 and PD-L1 inhibitors have emerged as promising treatments for patients with head and neck squamous cell carcinoma (HNSCC).Methods: Systematic review and meta-analysis of PD-1 and PD-L1 inhibitors in H...Background: PD-1 and PD-L1 inhibitors have emerged as promising treatments for patients with head and neck squamous cell carcinoma (HNSCC).Methods: Systematic review and meta-analysis of PD-1 and PD-L1 inhibitors in HNSCC. Outcomes: median overall survival (mOS), median progression-free survival (mPFS), Response Evaluation Criteria in Solid Tumors (RECIST) and treatment-related adverse events (TRAEs).Results: Eleven trials reported data on 1088 patients (mean age: 59.9 years, range: 18-90). The total mOS was 7.97 months (range: 6.0-16.5). Mean mPFS for all studies was 2.84 months (range: 1.9-6.5). PD-1 inhibitors had a lower rate of RECIST Progressive Disease than PD-L1 inhibitors (42.61%, 95% confidence interval [CI]: 36.29-49.06 vs. 56.79%, 95% CI: 49.18-64.19,P < 0.001). The rate of TRAEs of any grade (62.7%, 95% CI: 59.8-65.6) did not differ.Conclusions: Meta-analysis shows the efficacy of PD-1 and PD-L1 inhibitors in HNSCC and suggests a possible difference in certain RECIST criterion between PD-1 and PD-L1 inhibitors. Future work to investigate the clinical significance of these findings is warranted.展开更多
文摘Objectives:Obstructive sleep apnea (OSA) is a prevalent disease with significant health impacts.While first line therapy is CPAP,long-term compliance is low and device misuse is common,highlighting the need for alternative therapies.Upper airway surgery is one alternative,but substantial side effects hamper efficacy.A new alternative is an implantable hypoglossal nerve stimulator (HNS).These devices utilize neuromodulation to dilate/reinforce the airway and reduce side effects associated with traditional surgery.Several recent trials investigated the efficacy of these devices.The purpose of this study was to perform meta-analysis of available HNS studies investigating treatment of OSA to analyze objective and subjective outcomes and side effects.Methods:A comprehensive literature search of PubMed and Scopus was performed.Two independent reviewers examined clinical trials investigating HNS in treatment of sleep apnea in adults.Studies with objective and subjective endpoints in sleep were included for analysis.Adverse events from trials were also recorded.Results:Across 16 studies,381 patients were analyzed.At 6 months (p =0.008),mean SAQLI improved by 3.1 (95%CI,2.6-3.7).At 12 months (p < 0.0001),mean AHI was reduced by 21.1 (95%Cl,16.9-25.3),mean ODI was reduced by 15.0 (95%CI,12.7-17.4),mean ESS was reduced by 5.0 (95%CI,4.2-5.8),mean FOSQ improved by 3.1 (95%CI,2.6-3.4).Pain (6.2%:0.7-16.6),tongue abrasion (11.0%:1.2-28.7),and internal (3.0%:0.3-8.4)/external device (5.8%:0.3-17.4) malfunction were common adverse events.Conclusions:HNS is a safe and effective treatment for CPAP refractory OSA.Further study comparing HNS to other therapies is required.
文摘Objective:To provide an understanding of the incidence of anaplastic thyroid cancer within the United States.Methods:Patients in the Surveillance,Epidemiology,and End Results (SEER) database were included from 1973 to 2014 based on a diagnosis of anaplastic thyroid cancer using ICDO-3 codes.Patients were categorized into cohorts based on their year of diagnosis.Results:1527 patients were diagnosed with anaplastic thyroid cancer within the SEER 18 registries.The age-adjusted incidence rate was 0.2 per 1,000,000 people (95% CI:0.0-0.5) in 1973 and was 1.2 per 1,000,000 people (95% Cl:0.8-1.6) in 2014 (average annual percent change:3.0% [95% CI:2.2%-3.7%]).Patients tended to be of older age (mean age:70.5 [range 15.0-102.0]),of female sex (62.8%),and Caucasian (81.1%).Finally,survival over time remained the same,as median disease specific survival months was 4.00 (95% CI:2.26-5.74) from 1995 to 1999 and 4.00 (95% Cl:3.26-4.74) from 2010 to 2014.Conclusions:The incidence rate of anaplastic thyroid cancer has increased from 1973 to 2014.Interestingly,median survival in months did not greatly change overtime.Based on this increasing incidence,physicians must act appropriately to identify patients with anaplastic thyroid cancer as it possesses a high morbidity and mortality.
文摘Background: PD-1 and PD-L1 inhibitors have emerged as promising treatments for patients with head and neck squamous cell carcinoma (HNSCC).Methods: Systematic review and meta-analysis of PD-1 and PD-L1 inhibitors in HNSCC. Outcomes: median overall survival (mOS), median progression-free survival (mPFS), Response Evaluation Criteria in Solid Tumors (RECIST) and treatment-related adverse events (TRAEs).Results: Eleven trials reported data on 1088 patients (mean age: 59.9 years, range: 18-90). The total mOS was 7.97 months (range: 6.0-16.5). Mean mPFS for all studies was 2.84 months (range: 1.9-6.5). PD-1 inhibitors had a lower rate of RECIST Progressive Disease than PD-L1 inhibitors (42.61%, 95% confidence interval [CI]: 36.29-49.06 vs. 56.79%, 95% CI: 49.18-64.19,P < 0.001). The rate of TRAEs of any grade (62.7%, 95% CI: 59.8-65.6) did not differ.Conclusions: Meta-analysis shows the efficacy of PD-1 and PD-L1 inhibitors in HNSCC and suggests a possible difference in certain RECIST criterion between PD-1 and PD-L1 inhibitors. Future work to investigate the clinical significance of these findings is warranted.
