Chunjie Li

Ultrasonography for detection of disc displacement of temporomandibular joint: a systematic review and meta-analysis

PURPOSE To assess the diagnostic efficacy of ultrasonography in detecting disc displacement of the temporomandibular joint. MATERIALS AND METHODS MEDLINE (using OVID, 1950 to April 2011), EMBASE (1980 to April 2011), and the Chinese Biomedical Literature Database (1978 to April 2011) were searched electronically. In addition, relevant journals and reference lists of the included studies were manually searched for any eligible studies on diagnostic accuracy. Two authors performed the study inclusion, data extraction, and risk of bias assessment in duplicate. Meta-analysis was performed with MetaDisc 1.4. RESULTS Fifteen studies were included in this meta-analysis; 6 studies had a low risk of bias, 6 studies an unclear risk, and 3 studies a high risk. Meta-regression indicated that the detected results were not influenced by the types of ultrasonography, image dimensions, types of transducer, and ultrasonic image of the disc (P > .05). The Q* values of ultrasonography for the closed- and open-mouth positions were 0.79 and 0.91, respectively. The diagnostic efficacy of disc displacement with reduction had a sensitivity of 0.76, a specificity of 0.82, a positive likelihood ratio of 3.80, a negative likelihood ratio of 0.36, a diagnostic odds ratio of 10.95, an area under the curve of 0.83, and a Q* of 0.76. The diagnostic efficacy of disc displacement without reduction had a sensitivity of 0.79, a specificity of 0.91, a positive likelihood ratio of 80.5, a negative likelihood ratio of 0.25, diagnostic odds ratio of 36.80, an area under the curve of 0.97, and a Q* of 0.92. CONCLUSIONS The diagnostic efficacy of ultrasonography is acceptable and can be used as a rapid preliminary diagnostic method to exclude some clinical suspicions. However, positive ultrasonographic findings should be confirmed by magnetic resonance imaging. Also, the ability of ultrasonography to detect lateral and posterior displacements is still unclear. More high-quality studies are needed to assess the diagnostic efficacies of some specific ultrasonographic methods. Standards and criteria for ultrasonographic techniques in the diagnosis of disc displacement should be established in the future.

Magnetic Resonance Imaging for Diagnosis of Mandibular Involvement from Head and Neck Cancers: A Systematic Review and Meta-Analysis

Background Diagnosis of mandibular involvement caused by head and neck cancers is critical for treatment. We performed a meta-analysis to determine the diagnostic efficacy of MR for distinguishing mandibular involvement caused by head and neck cancers. Methods Thirteen databases were searched electronically and hand-searching was also done. Two reviewers conducted study inclusion, data extractions, and quality assessment of the studies independently. Meta-disc 1.4 and STATA 11.0 were used to conduct the meta-analysis. Results 16 studies involving a total of 490 participants underwent MR examinations and were accounted for in this meta-analysis. Among the included studies, 2 had high risk of bias, while the rest had unclear risk of bias. Meta-regression showed that the slight clinical and methodological heterogeneities did not influence the outcome (P>0.05). Meta-analysis indicated that the MR for the diagnosis of mandibular involvement had a pooled sensitivity (SEN) of 78%, specificity (SPE) of 83%, positive likelihood ratio (+LR) of 3.80, negative likelihood ratio (-LR) of 0.28, diagnostic odds ratio (DOR) of 28.94, area under curve (AUC) of 0.9110, and Q* of 0.8432. Two studies detected the diagnostic efficacy of MR for the mandibular medullar invasion, and only one study reported the inferior alveolar canal invasion, which made it impossible to include it in our meta-analysis. In comparing to CT, MR had a higher SEN without statistical significance (P = 0.08), but a significantly lower SPE (P = 0.04). The synthesized diagnostic efficacy (AUC and Q*) on mandibular involvement was similar between the two modalities (P>0.05). Conclusions Present clinical evidence showed that MR had an acceptable diagnostic value in detecting mandibular involvement caused by head and neck cancers. MR exceeded CT in diagnosing patients with mandibular invasion (higher sensitivity than CT) but was less efficacious to exclude patients without the mandibular invasion (lower specificity than CT).

Graft for prevention of Frey syndrome after parotidectomy: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE To detect the effect and safety of different types of grafts for the prevention of Frey syndrome after parotidectomy. MATERIALS AND METHODS The following data bases were searched electronically: MEDLINE (using OVID, from 1948 to July 2011), Cochrane Central Register of Controlled Trials (CENTRAL, issue 2, 2011), EMBASE (available from: http://embase.com, 1984 to July 2011), World Health Organization International Clinical Trials Registry Platform (July 2011), Chinese BioMedical Literature Database (1978 to July 2011), and the China National Knowledge Infrastructure (1994 to July 2011). The relevant journals and reference lists of the included studies were manually searched for randomized controlled trials studying the effect and safety of different types of grafts for preventing Frey syndrome after parotidectomy. The risk of bias assessment using Cochrane Collaborations tool and data extraction was independently performed by 2 reviewers. The meta-analysis was performed using Review Manager, version 5.1. RESULTS A total of 14 randomized clinical trials and 1,098 participants were included. All had an unclear risk of bias. The meta-analysis results showed that the use of an acellular dermis matrix can reduce by 82% the risk of Frey syndrome compared with the no-graft group using an objective assessment (relative risk [RR] 0.18, 95% confidence interval [CI] 0.12 to 0.26; P < .00001; Grading of Recommendations, Assessment, Development, and Evaluation [GRADE] quality of evidence: high). The acellular dermis matrix can also reduce by 90% the risk of Frey syndrome compared with the no-graft group using a subjective assessment (RR 0.10, 95% CI 0.05 to 0.22; P < .00001; GRADE quality of evidence: high). The muscle flaps can reduce by 81% the risk of Frey syndrome compared with the no-graft group (RR 0.19, 95% CI 0.13 to 0.27; P < .00001; GRADE quality of evidence: high). No statistically significant difference was found between the acellular dermal matrix and muscle flap groups (RR 0.73, 95% CI 0.15 to 3.53, P = .70; GRADE quality of evidence: low). No serious adverse events were reported. CONCLUSIONS The present clinical evidence suggests that grafts are effective in preventing Frey syndrome after parotidectomy. More randomized clinical trials are needed to confirm our conclusions and prove the safety of the grafts.

Inferior or double joint spaces injection versus superior joint space injection for temporomandibular disorders: a systematic review and meta-analysis.

PURPOSE To compare the effect and safety of inferior or double temporomandibular joint spaces drug injection versus superior temporomandibular joint space injection in the treatment of temporomandibular disorders. MATERIALS AND METHODS MEDLINE (via Ovid, 1948 to March 2011), CENTRAL (Issue 1, 2011), Embase (1984 to March 2011), CBM (1978 to March 2011), and World Health Organization International Clinical Trials Registry Platform were searched electronically; relevant journals as well as references of included studies were hand-searched for randomized controlled trials comparing effect or safety of inferior or double joint spaces drug injection technique with those of superior space injection technique. Risk of bias assessment with the tool recommended by Cochrane Collaboration, reporting quality assessment with CONSORT and data extraction, were carried out independently by 2 reviewers. Meta-analysis was delivered with RevMan 5.0.23. RESULTS Four trials with 349 participants were included. All the included studies had moderate risk of bias. Meta-analysis showed that inferior or double spaces injection technique could significantly increase 2.88 mm more maximal mouth opening (P = .0001) and alleviate pain intensity in the temporomandibular area on average by 9.01 mm visual analog scale scores (P = .0001) compared with superior space injection technique, but could not markedly change synthesized clinical index (P = .05) in the short term; nevertheless, they showed more beneficial maximal mouth opening (P = .002), pain relief (P < .0001), and synthesized clinical variable (P < .0001) in the long term than superior space injection. No serious adverse events were reported. CONCLUSIONS Inferior or double temporomandibular joint spaces drug injection technique shows better effect than superior space injection technique, and their safety is affirmative. However, more high-quality studies are still needed to test and verify the evidence.

Predicting extracapsular spread of head and neck cancers using different imaging techniques: a systematic review and meta-analysis.

This study compared the diagnostic ability of computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), and positron emission tomography/CT (PET/CT) for extracapsular spread. MEDLINE, EMBASE, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Sciencepaper Online databases were searched. The mean sensitivity of CT was 0.77, specificity was 0.85, positive likelihood ratio (LR+) was 4.839, negative likelihood ratio (LR-) was 0.287, diagnostic odds ratio (DOR) was 19.239, area under the summary receiver operating characteristic curve (AUC) was 0.8615, and Q* was 0.7922. The mean sensitivity of MRI was 0.85, specificity was 0.84, LR+ was 4.615, LR- was 0.191, DOR was 60.270, AUC was 0.9454, and Q* was 0.8844. The sensitivity and specificity of PET/CT were both 0.86. The mean sensitivity of US was 0.87 and specificity was 0.75. Overall, CT had the lowest sensitivity (P=0.0355); specificity was similar for all methods (P=0.1159). CT and MRI had equivalent summary diagnostic efficacy (AUC and Q*) (P>0.05). This evidence indicates that CT might have a relatively lower sensitivity when diagnosing ECS, and that CT and MRI may be similarly effective in diagnosing ECS. MRI showed positive trends in diagnosing ECS. Evidence was lacking for PET/CT and US diagnosis. More related studies are required to confirm these inconclusive results.

Computed Tomography for the Diagnosis of Mandibular Invasion Caused by Head and Neck Cancer: A Systematic Review Comparing Contrast-Enhanced and Plain Computed Tomography

PURPOSE To detect the diagnostic efficacy of computed tomography (CT) in distinguishing mandibular invasion caused by head and neck cancer and to compare the accuracy of contrast-enhanced and plain CT in the diagnosis. MATERIALS AND METHODS Studies designed as cohort studies that detected the diagnostic efficacy of CT on mandibular invasion (including bone cortex and bone marrow invasion) and mandibular medullary alone (bone marrow invasion) were included. The included studies were required to use the pathologic diagnosis as the reference standard and reported true-positive, false-positive, false-negative, true-positive, and related data. Thirteen databases were electronically and manually searched to retrieve any possible related studies. Two reviewers independently conducted the study inclusion, data extraction, and assessment of the quality of the included studies. Meta-diSc, version 1.4, and STATA, version 11.0, were used to conduct the meta-analysis. RESULTS A total of 30 studies with 1459 patients were included in the present study. Of those patients, 1,257 underwent CT and were accounted for in the meta-analysis. Of the included studies, 1 had a low risk and 6 had a high risk of bias; 23 studies had an unclear risk of bias. Meta-regression showed that the slight clinical heterogeneity did not influence the outcome (P > .10). The meta-analysis showed that CT for the diagnosis of mandibular invasion had a pooled sensitivity of 0.72, specificity of 0.90, positive likelihood ratio (+LR) of 5.33, negative likelihood ratio (-LR) of 0.36, diagnostic odds ratio (DOR) of 21.41, area under the curve (AUC) of 0.9022, and Q* (the value of the sensitivity or specificity when the sensitivity equals the specificity on the summary receiver operating characteristics curve) of 0.8336. The CT findings for mandibular medullar invasion had a sensitivity of 0.81, specificity of 0.85, +LR of 4.76, -LR of 0.24, DOR of 29.49, AUC of 0.9240, and Q* of 0.8580. No statistical significance was found in the sensitivity (P = .809), specificity (P = .27), AUC (P = .4296), and Q* (P = .4277) between the contrast-enhanced and plain CT scans. CONCLUSIONS The present clinical evidence has shown that CT had an acceptable diagnostic value in detecting mandibular invasion caused by head and neck cancer. The high specificity of CT predicted it would be helpful when it was used to confirm the clinical diagnosis of bone invasion. Contrast-enhanced and plain CT scans had a similar diagnostic efficacy.

Submandibular gland transfer for the prevention of postradiation xerostomia in patients with head and neck cancer: a systematic review and meta-analysis.

Background: Submandibular gland transfer has been widely used to prevent postradiation xerostomia in head-and-neck cancers. However, there are still some controversies. Methods: Six databases were searched, data extraction was performed and the risk of bias was assessed by 2 reviewers independently. The meta-analysis was performed using Review Manager, version 5.2. Results: A total of 7 trials (12 articles) and 369 participants were included. Conclusions: The present clinical evidence suggests that submandibular gland transfer might be highly effective to prevent postradiation xerostomia in head-and-neck cancers without serious adverse events. However, more randomized controlled trials are still needed to confirm this conclusion.

Evaluation of Recombinant Human FGF-2 and PDGF-BB in Periodontal Regeneration: A Systematic Review and Meta-Analysis

The prognosis for successful treatment of periodontal diseases is generally poor. Current therapeutic strategies often fail to regenerate infected periodontium. Recently an alternative strategy has been developed that combines conventional treatment with the application of recombinant human growth factors (rhGFs). But ambiguities in existed studies on the clinical efficacy of rhGFs do not permit either the identification of the specific growth factors effective for therapeutic interventions or the optimal concentration of them. Neither is it known whether the same rhGF can stimulate regeneration of both soft tissue and bone, or whether different patient populations call for differential use of the growth factors. In order to explore these issues, a meta-analysis was carried out. Particular attention was given to the therapeutic impact of fibroblast growth factor 2(FGF-2) and platelet derived growth factor BB (PDGF-BB). Our findings indicate that 0.3% rhFGF-2 and 0.3 mg/ml rhPDGF-BB show a greater capacity for periodontal regeneration than other concentrations and superiority to control groups with statistical significance. In the case of patients suffering only from gingival recession, however, the application of rhPDGF-BB produces no significant regenerative advantage. The findings of this study can potentially endow clinicians with guidelines for the appropriate application of these two rhGFs.

TGF-β1/TβRII/Smad3 signaling pathway promotes VEGF expression in oral squamous cell carcinoma tumor-associated macrophages.

Oral squamous cell carcinoma (OSCC) is the most common type of malignant cancer affecting the oral cavity. Tumor associated macrophages (TAMs) play a vital role in the initiation, progression and metastasis of OSCC. In this study, we investigated the correlation between macrophages and several clinical and pathological indicators, and we also explored how transforming growth factor-β1 (TGF-β1) effect on VEGF expression in TAMs. Seventy-two paraffin-embedded OSCC samples were collected. Association between macrophages density, micro vascular density (MVD) and clinical-pathological feature were explored by immunohistochemical staining. Western blot, ELISA and qRT-PCR were conducted to assess the VEGF expression in TAMs treated with or without neutralizing TGF-β1, TβRII and smad3 antibodies. Results showed that CD68+ macrophages were absent in normal tissues. Macrophages density was directly correlated to low pathological differentiation, late clinical staging and poor survival rate. MVD showed positive correlation with clinical staging and macrophages density. Furthermore, OSCC-associated macrophages expressed more VEGF than macrophages in healthy lymph nodes. However, when TGF-β1 or TβRII were neutralized or the Smad3 was inhibited, VEGF expression was down regulated as well. It is concluded that TGF-β1 could promote OSCC-associated macrophages to secrete more VEGF via TβRII/Smad3 signaling pathway. This result might explain the correlation between macrophages density and worse clinical-pathological condition.

Parent satisfaction with primary repair of paediatric cleft lip in Southwest China

The purpose of this study was to investigate the key factors in relation to parent satisfaction with the primary repair of paediatric cleft lip. One hundred and ninety-five children born with cleft lip and/or palate aged between 3 months and 1 year were recruited, along with their caregivers. All patients underwent primary cleft lip repair, and a telephone interview was held with their main caregivers at 3 months postoperative. The level of satisfaction with each item included in a simplified Cleft Evaluation Profile was ascertained and recorded. Patient clinical data were obtained from the medical records. One hundred and thirty-eight (71%) parents reported satisfaction with the general outcome of surgery. Parents were satisfied with the appearance of the lip and profile of the face, but were dissatisfied with the appearance of the nose and teeth. Mothers of patients showed lower satisfaction levels than fathers and grandparents. Parental satisfaction with the appearance of the lip was lower for patients without a cleft palate than for those with a cleft palate. The results of this study suggest that most Chinese parents of children who undergo primary cleft lip repair express satisfaction with the surgical outcomes. Satisfaction with the appearance of the nose and teeth is low and this needs to be improved. Other factors are likely to influence expressions of satisfaction.