Meta分析评价全景片在口腔癌下颌骨侵犯中的诊断效能

目的 评价全景片作为筛查口腔癌下颌骨侵犯的诊断效能.方法 根据预先设定的检索式对MEDLINE、荷兰医学文摘、MEDION和中国生物医学文献数据库等7个数据库进行电子检索,检索时间截至2014年10月25日;同时进行手动检索.2位评价者独立使用QUADAS-2评价纳入研究的方法学质量并进行数据提取.运用MetaDisc 1.4软件进行Meta分析.结果 共纳入12篇研究,涉及患者528名.7篇为前瞻性研究,2篇有高偏倚风险,其余偏倚风险情况不清.Meta分析结果显示,增强CT在诊断下颌骨侵犯的合并敏感度为0.761,合并特异度为0.828,曲线下面积为0.884,Q*为0.814.结论 全景片可以作为口腔癌颌骨侵犯的筛查工具,但其在诊断口腔癌颌骨骨髓侵犯的诊断效能需进一步研究.     

口腔癌前哨淋巴结活检价值的系统评价

目的:探讨前哨淋巴结活检(SLNB)对于判断口腔癌颈淋巴结转移的敏感性和特异性及临床预测价值.方法:计算机检索PubMed、EMBASE、CENTRAL、中国期刊全文、万方、中国生物医学文献等相关数据库,搜集已公开发表的有关SLNB预测口腔癌颈淋巴结转移的相关诊断试验,应用Meta-disc 1.4统计软件进行分析,评价SLNB预测口腔癌颈淋巴结转移敏感性、特异性和受试者工作特征曲线(ROC)下面积(AUC).结果:最终共25项诊断实验、934例受试者纳入本研究.Meta分析结果显示SLNB预测口腔癌颈淋巴结转移敏感性和特异性分别为91％(95％ CI 88％-94％)和100％(95％ CI 99％-100％);综合受试者工作特征曲线(SROC)下面积(AUC)为0.99.结论:SLNB预测口腔癌颈淋巴结转移敏感性、特异性均较高,作为判断颈淋巴结转移的标准有较高的临床应用价值.     

CCND1 G870A基因多态性与口腔癌易感性的Meta分析

目的:采用循证医学Meta分析方法评价细胞周期蛋白D1(Cyclin D1, CCND1)基因多态性与口腔癌易感性的关联。方法:计算机检索PubMed、CBM、万方、维普、CNKI等中英文数据库,检索范围从建库至2013年7月1日,全面收集相关文献数据并计算优势比(OR)及95%置信区间(CI)以评价关联性。结果:本Meta分析共计纳入10项病例对照研究,包括1622例口腔癌患者及1859例健康对照人群。Meta分析的结果表明:CCND1 G870A基因多态性与口腔癌发病风险增加显著相关(A vs. G: OR=1.23, 95%CI: 1.02~1.49, P=0.033; AA+AG vs. GG:OR=1.39, 95%CI: 1.03~1.87, P=0.031; AA vs. AG+GG: OR=1.32, 95%CI:1.13~1.55,P=0.001; AA vs.GG:OR=1.47,95%CI:1.00~2.16, P=0.049; AA vs. AG: OR=1.22, 95%CI: 1.03~1.44, P=0.020)。亚组分析的结果进一步表明:CCND1 G870A基因多态性与口腔癌发病风险的关联性在亚洲人群和吸烟人群中尤为显著,但在高加索人群和非吸烟人群中并不显著。结论:本文提供的证据表明:CCND1 G870A基因多态性与口腔癌易感性显著相关,这一关联性在亚洲人群与吸烟人群中尤为显著。然而,CCND1 G870A基因多态性与口腔癌易感性之间的关联性,有待更大样本规模的病例对照研究加以证实。     

MDM2基因SNP309多态性与口腔癌易感性的Meta分析

目的：探讨鼠双微体基因2（MDM2）SNP309多态性与口腔癌风险的关系。方法：检索文献并按要求提取相关信息,纳入MDM2 SNP309与口腔癌风险的病例－对照研究,对研究结果进行Meta分析。结果：共纳入5个病例－对照研究,包括1369例口腔癌患者和2167例对照。 Meta分析结果显示：与纯合子基因型个体相比较,杂合子基因型个体与口腔癌风险的降低存在显著关联性（TG vs． TT：OR＝0．81,95％CI,0．68～0．96,P＝0．02）,然而纯合子基因型个体与口腔癌风险无明显相关性。在显性遗传模式中（TG＋GG vs． TT）口腔癌风险降低具有统计学意义（OR＝0．82,95％CI,0．69～0．97,P＝0．02）,而在隐性遗传模式中却无统计学意义。纳入研究结果间不存在异质性,且未发现显著的发表偏倚。结论：MDM2基因SNP309多态性与口腔癌易感性相关,可能是口腔癌易感的保护性因素。     

单光子发射计算机断层成像在诊断口腔癌颌骨侵犯中的价值：系统评价及Meta分析

目的 评价单光子发射计算机断层成像（SPECT）技术在诊断口腔癌下颌骨侵犯的诊断效能。方法 对5个常用数据库进行电子检索,检索时间截至2016年8月5日;并对纳入研究参考文献进行手检。研究质量由两位评价者独立使用Cochrane协作网推荐的标准进行评价并提取数据。运用STATA 11.0软件进行Meta分析。结果 共纳入10篇研究,共涉及患者460名。1项研究存在低偏倚风险,2项研究存在高偏倚风险,7项研究偏倚风险不清。合并敏感度为0.99 [95%可信区间=0.87~1.00]。Meta分析结果显示,合并受试者工作特征曲线（SROC）的曲线下面积（AUC）为0.93 [95%可信区间=0.90~0.95],Q*点处敏感度为0.99,特异度为0.61。其合并阳性预测值为2.555,合并阴性预测值为0.015,而合并诊断比值比为5.115。结论 SPECT在诊断口腔癌下颌骨侵犯中敏感度较高,适合用于排除没有骨侵犯存在的患者,但特异度低,不适合进行确诊,临床医生应该根据具体患者情况进行合理选择。     

增强CT在诊断口腔癌下颌骨侵犯中的价值：基于诊断性试验的系统评价

目的 评价增强CT诊断口腔癌下颌骨侵犯的诊断效能。方法 对PubMed、荷兰医学文摘EMBASE、欧洲灰色文献数据库、中国生物医学文献数据库及重庆维普数据库进行电子检索,检索时间截至2014年1月3日;同时手工检索19种中文口腔医学杂志。两位评价者独立使用Cochrane协作网推荐的标准对纳入文献进行偏倚风险评价并提取数据。运用Meta Disc 1.4软件进行Meta分析。结果 共纳入14篇研究,共涉及患者642名,其中7篇研究为前瞻性研究,1篇研究存在低偏倚风险,其余研究的偏倚风险情况不清。Meta分析结果显示：增强CT诊断下颌骨侵犯的合并敏感度（SEN）为0.718 ,95%可信区间（CI）为0.665~0.767,合并特异度（SPE）为0.909,95%CI为0.872~0.938,曲线下面积（AUC）为0.906 1,Q*值为0.837 8;增强CT在诊断口腔癌下颌骨骨髓侵犯时,SEN为0.787（0.643~0.893）,SPE为0.904（0.790~0.968）,AUC为0.949 6,Q*值为0.890 0。Meta回顾显示层厚较低的增强CT诊断效能较高。结论 增强CT在诊断口腔癌下颌骨侵犯及下颌骨骨髓侵犯时有较高的诊断效能,其SPE较高,适合用于颌骨侵犯的确诊。选择层厚较低的增强CT能够提高诊断效能。     

前哨淋巴结活检判断口腔癌颈部淋巴结转移的系统评价

目的:系统评价前哨淋巴结活检(SLNB)预测口腔癌颈淋巴结转移的临床价值。方法:通过计算机检索CENTRAL、Medline、EMBASE、IFCC、中国生物医学文献数据库系统(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(CQVIP)、万方数据库等,收集应用前哨淋巴结活检判断口腔癌颈淋巴转移的诊断试验,应用统计软件Meta-DiSc 1.4进行数据分析。结果:纳入分析的文献9篇,前哨淋巴结活检判断口腔癌颈淋巴转移的敏感度、特异度、阳性似然比(+LR)、阴性似然比(-LR)、诊断优势比(DOR)及系统接收操作特性曲线(SROC)下面积分别为84%(95%CI 73%～92%)、100%(95%CI97%～100%)、19.16(95%CI 7.65～47.77)、0.22(95%CI 0.10～0.51)、97.72(95%CI 29.69～321.61)和0.99。结论:前哨淋巴结活检可作为临床上判断口腔癌颈淋巴结转移有效可行的方法。     

口腔癌患者术后吞咽障碍危险因素的系统评价

通过系统评价的方法探究口腔癌患者术后吞咽障碍的危险因素。     

保留腮腺咬肌筋膜预防Frey综合征的系统评价与Meta分析

目的：通过系统评价和Meta分析的方法评估腮腺切除手术中保留腮腺咬肌筋膜对于预防术后Frey综合征的有效性及安全性。方法采用主题词检索策略,电子检索Pubmed、EMBase、Cochrane临床随机对照试验数据库、中国生物医学文献数据库、中国知网、维普数据库、万方数据库,检索时间截止至2013年3月30日。2位评价员按照Cochrane协作网推荐的方法和标准,对纳入的文献提取数据,并独立进行偏倚风险评价,并进行系统评价。运用Review manager 5.2进行Meta分析。结果共纳入随机对照试验13篇,偏倚风险不清。Meta分析结果显示：保留腮腺咬肌筋膜能够减少81%的主观Frey综合征的发生率（P〈0.00001）,能够减少69%的客观Frey综合征的发生率。患者术后复发情况的Meta分析结果显示：两组患者术后复发情况没有统计学差异（P=0.47）。结论保留腮腺咬肌筋膜能够明显降低患者术后Frey综合征的发生,具有良好的有效性和安全性,而且术后复发情况无差异。     

富血小板纤维蛋白在下颌第三磨牙拔除术的应用系统评价与Meta分析

目的 通过系统评价及Meta分析的方法评估下颌第三磨牙拔除术中使用富血小板纤维蛋白(PRF)的有效性,为缓解术后并发症提供建议.方法 对Pubmed、EMBASE、Web of Science和中国生物医学文献数据库针对在下颌第三磨牙术中使用PRF的临床随机对照试验进行电子检索,检索时间截至2020年2月.评价者使用C...     

负压引流预防腮腺术后并发症的系统评价

目的:用系统评价方法评价负压引流在预防腮腺术后并发症方面的疗效及安全性。方法:计算机检索PubMed、Cochrane图书馆临床随机对照试验库、荷兰医学文摘、欧洲灰色文献数据库、中国生物医学文献数据库、维普数据库、万方数据库,检索时限为建库截至2013年3月10日;同时手工检索19种中文口腔医学杂志,搜集负压引流与开放式引流预防腮腺术后并发症的临床随机对照试验。2位评价者独立使用Cochrane 协作网推荐的标准对纳入文献进行偏倚风险评价并提取数据,采用Revman5.2软件进行meta分析。结果:最终纳入10项研究,偏倚风险评价显示均为中等偏倚风险。Meta分析结果显示,与开放式引流相比,负压引流能明显减少腮腺术后并发症(涎瘘/积液、血肿)的发生,提高临床综合疗效及患者的生活质量(P<0.05)。结论: 负压引流在预防腮腺术后并发症发生方面有一定的疗效和安全性,但还需要更多高质量的临床随机对照试验支持。     

Characteristics of child dental neglect: A systematic review

Objective

Neglect of a child's oral health can lead to pain, poor growth and impaired quality of life. In populations where there is a high prevalence of dental caries, the determination of which children are experiencing dental neglect is challenging. This systematic review aims to identify the features of oral neglect in children.

Methods

Fifteen databases spanning 1947–2012 were searched; these were supplemented by hand searching of 4 specialist journals, 5 websites and references of full texts. Included: studies of children 0–18 years with confirmed oral neglect undergoing a standardised dental examination; excluded: physical/sexual abuse. All relevant studies underwent two independent reviews (+/− 3rd review) using standardised critical appraisal.

Results

Of 3863 potential studies screened, 83 studies were reviewed and 9 included (representing 1595 children). Features included: failure or delay in seeking dental treatment; failure to comply with/complete treatment; failure to provide basic oral care; co-existent adverse impact on the child e.g. pain and swelling. Two studies developed and implemented ‘dental neglect’ screening tools with success. The importance of Quality of Life tools to identify impact of neglected dental care are also highlighted.

Conclusions

A small body of literature addresses this topic, using varying definitions of neglect, and standards of oral examination. While failure/delay in seeking care with adverse dental consequences were highlighted, differentiating dental caries from dental neglect is difficult, and there is a paucity of data on precise clinical features to aid in this distinction.

Clinical significance

Diagnosing dental neglect can be challenging, influencing a reluctance to report cases. Published evidence does exist to support these referrals when conditions as above are described, although further quality case control studies defining distinguishing patterns of dental caries would be welcome.     

Nd：YAG激光治疗口腔扁平苔藓疗效的Meta分析

目的探讨Nd：YAG激光在口腔扁平苔藓治疗中的疗效。 方法以口腔扁平苔藓、Nd：YAG激光和激光治疗等主题词在中国知网（CNKI）、中国生物医学文献数据库（CBM）、维普、Medline和PubMed等数据库进行电子检索（检索时限为建库至2022年3月）,收集有关Nd：YAG激光治疗口腔扁平苔藓的临床随机对照试验。筛选纳入文献并提取数据后采用RevMan 5.3.3进行合并Meta分析。 结果最终纳入8篇文献,共470例受试者,其中试验组232例。Meta分析结果表明,试验组口腔扁平苔藓患者接受Nd：YAG激光治疗的临床有效率明显高于对照组,差异有统计学意义[OR = 3.51,95%CI（2.05,6.00）,Z = 4.59,P<0.001],试验组患者治疗后疼痛症状视觉模拟评分[MD = -0.95,95%CI（-1.82,-0.08）,Z = 2.14,P = 0.03]和临床体征评分[MD = -0.81,95%CI（-1.33,-0.29）,Z = 3.04,P = 0.002]均明显低于对照组,差异均具有统计学意义。 结论Nd：YAG激光治疗可改善口腔扁平苔藓患者的临床体征,缓解其疼痛症状,具有较好的临床疗效。     

Oral cancer in Libya and development of regional oral cancer registries: A review

The aims of this paper are three-fold: (1) to summarize the current epidemiological data on oral cancer in Libya as reported in the published literature and as compared to other national oral cancer rates in the region; (2) to present both the history of the early development, and future goals, of population-based oral cancer tumor registries in Libya as they partner with the more established regional and international population-based cancer tumor registries; and, (3) to offer recommendations that will likely be required in the near future if these nascent, population-based Libyan oral cancer registries are to establish themselves as on-going registries for describing the oral cancer disease patterns and risk factors in Libya as well as for prevention and treatment. This comprehensive literature review revealed that the current baseline incidence of oral cancer in Libya is similar to those of other North Africa countries and China, but is relatively low compared to the United Kingdom, the United States, and India. The recently established Libyan National Cancer Registry Program, initiated in 2007, while envisioning five cooperating regional cancer registries, continues to operate at a relatively suboptimal level. Lack of adequate levels of national funding continue to plague its development…and the accompanying quality of service that could be provided to the Libyan people.     

Comparison of primary care doctors and dentists in the referral of oral cancer: a systematic review

Oral cancer is referred to specialists by both general practitioners (GPs) and dentists, with varying proportions reported in different studies. However, some have noted that dentists more commonly refer oral cancer in the absence of patient-perceived symptoms and may refer at an earlier stage. Unfortunately, approximately half the UK adult population do not receive regular dental care. We have conducted a systematic review of studies that compare GPs and dentists in the referral of oral cancer and have focused on three aspects: the proportion of diagnosed oral cancers, stage on presentation, and delay. Searches of the databases Medline, Embase, Scopus, Google Scholar, Web of Science, and CINAHL, together with additional searches of reference lists, authors, and conference proceedings, found 22 studies from 10 countries, which included a total of 4953 oral cancers. The percentage of medical referrals ranged from 13% to 86%; dental referrals ranged from 15% to 80%. Random-effects meta-analysis indicated a combined relative risk of medical referral to dental referral of 1.36 (95% CI: 0.99 to 1.86). For UK-based studies, the relative risk was also 1.36 (95% CI: 1.05 to 1.76). There was considerable heterogeneity for all studies and for a subgroup of UK studies: I²96.4% (95% CI 95.4 to 97.1) and 81.0% (95% CI 63.3 to 90.1), respectively. Several studies showed a lower stage for dentally-referred cancers; the combined risk for dentists and GPs referring early (stages 1 and 2) disease was 1.37 (95% CI: 1.17 to 1.60), and one cause may be the much higher number of cases referred by dentists in the absence of symptoms. No studies showed a significant difference in delay. Oral cancer is referred by both GPs and dentists, typically about 50% and 40%, respectively, although there is a wide range, probably depending on local circumstances. Both groups require skills in oral examination, recognition of lesions, and knowledge of the risk factors. Effectively, regular dental attenders are a select group that is regularly screened for oral cancer, and it is likely that screening is not delivered to those with the highest risk. We suggest that further work is required on how to access high-risk individuals both for possible screening and preventive interventions.     

Fat grafting in patients with cleft lip and palate: A systematic review

This systematic review aims to compare different fat-grafting techniques for cleft lip and palate repair. A search was conducted in PubMed, Embase, Cochrane Library, gray literature and reference lists of selected articles. A total of 25 articles were included, 12 on closure of palatal fistula and 13 on cleft lip repair. The rate of complete resolution of palatal fistula ranged from 88.6% to 100% in studies with no control group, whereas in comparative studies patients receiving a fat graft showed better outcomes than those not receiving a graft. Evidence suggests that fat grafting can be indicated for the primary and secondary repair of cleft palate, with good results. The use of dermis-fat grafts in lip repair was associated with gains in surface area (11.5%), vertical height (18.5%–27.11%), and lip projection (20%). Fat infiltration was associated with increased lip volume (6.5%), vermilion show (31.68% ± 24.03%), and lip projection (46.71% ± 31.3%). The available literature suggests that fat grafting is a promising autogenous option for palate and fistula repair and for improvement of lip projection and scar aesthetics in patients with cleft. However, to develop a guideline, further studies are needed to confirm whether one technique is superior to the other.