The Experts below are selected from a list of 258 Experts worldwide ranked by ideXlab platform
Bart J Staal - One of the best experts on this subject based on the ideXlab platform.
-
spinal manual therapy in infants children and adolescents a systematic review and meta analysis on Treatment Indication technique and outcomes
PLOS ONE, 2019Co-Authors: Femke Driehuis, Thomas J Hoogeboom, Maria Nijhuisvan Der W G Sanden, Bart J StaalAbstract:BACKGROUND: Studies on effectiveness and safety of specific spinal manual therapy (SMT) techniques in children, which distinguish between age groups, are lacking. OBJECTIVE: To conduct a systematic review of the evidence for effectiveness and harms of specific SMT techniques for infants, children and adolescents. METHODS: PubMed, Index to Chiropractic Literature, Embase, CINAHL and Cochrane Library were searched up to December 2017. Controlled studies, describing primary SMT Treatment in infants (<1 year) and children/adolescents (1-18 years), were included to determine effectiveness. Controlled and observational studies and case reports were included to examine harms. One author screened titles and abstracts and two authors independently screened the full text of potentially eligible studies for inclusion. Two authors assessed risk of bias of included studies and quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines and CONSORT and TIDieR checklists. If appropriate, random-effects meta-analysis was performed. RESULTS: Of the 1,236 identified studies, 26 studies were eligible. Infants and children/adolescents were treated for various (non-)musculoskeletal Indications, hypothesized to be related to spinal joint dysfunction. Studies examining the same population, Indication and Treatment comparison were scarce. Due to very low quality evidence, it is uncertain whether gentle, low-velocity mobilizations reduce complaints in infants with colic or torticollis, and whether high-velocity, low-amplitude manipulations reduce complaints in children/adolescents with autism, asthma, nocturnal enuresis, headache or idiopathic scoliosis. Five case reports described severe harms after HVLA manipulations in four infants and one child. Mild, transient harms were reported after gentle spinal mobilizations in infants and children, and could be interpreted as side effect of Treatment. CONCLUSIONS: Based on GRADE methodology, we found the evidence was of very low quality; this prevented us from drawing conclusions about the effectiveness of specific SMT techniques in infants, children and adolescents. Outcomes in the included studies were mostly parent or patient-reported; studies did not report on intermediate outcomes to assess the effectiveness of SMT techniques in relation to the hypothesized spinal dysfunction. Severe harms were relatively scarce, poorly described and likely to be associated with underlying missed pathology. Gentle, low-velocity spinal mobilizations seem to be a safe Treatment technique in infants, children and adolescents. We encourage future research to describe effectiveness and safety of specific SMT techniques instead of SMT as a general Treatment approach.
Jordi Bruix - One of the best experts on this subject based on the ideXlab platform.
-
Prognostic prediction in patients with hepatocellular carcinoma.
Seminars in liver disease, 2020Co-Authors: Margarita Sala, Alejandro Forner, Maria Varela, Jordi BruixAbstract:With most solid tumors, the estimation of life expectancy is related to tumor stage at diagnosis and staging is directly linked to Treatment Indication. By contrast, in patients with hepatocellular carcinoma (HCC) the prediction of prognosis is more complex. There is no worldwide consensus on the use of any HCC staging system. Classifications that take into account only one of the relevant prognostic parameters, such as tumor, nodes, and metastasis (TNM) or Child-Pugh staging, are useless. Several scoring systems have been developed, but unfortunately their major capacity is to identify end-stage patients and they do not link staging with therapy. The Barcelona Clinic Liver Cancer (BCLC) staging system was developed according to the results of cohort studies and randomized clinical trials. It considers tumor stage, liver functional status, physical status, and cancer-related symptoms and, by dividing patients into early, intermediate, advanced, and end-stage categories, provides a link to Treatment Indication.
-
Medical Treatments: in association or alone, their roles and their future perspectives
Journal of Hepato-Biliary-Pancreatic Sciences, 2010Co-Authors: Maria Reig, Jordi BruixAbstract:Management of hepatocellular carcinoma (HCC) is a complex issue, as it needs to take into account the liver disease, the cancer stage and the performance status of the patient. The Treatment decision has to be based on robust scientific evidence and for this it is instrumental to have a proper staging system linked to the Treatment Indication. The BCLC proposal serves these two purposes and has been validated worldwide and endorsed by several scientific associations. The sole systemic therapy that has shown efficacy in improving the survival of HCC patients is sorafenib, an oral kinase inhibitor that blocks the Raf/MEK/ERK pathway and the receptor for VEGFR 2 and PDGFR-beta. Sorafenib has been recognized as the standard of care for patients who cannot benefit from Treatments of higher priority and established efficacy, such as surgical resection, transplantation, ablation and transarterial chemoembolization. Sorafenib has changed the management of HCC, opening the path to combination therapies for patients at advanced stages and to evaluation as an adjuvant for those in earlier evolutionary stages.
-
The Barcelona approach: Diagnosis, staging, and Treatment of hepatocellular carcinoma
Liver Transplantation, 2004Co-Authors: Josep M Llovet, Josep Fuster, Jordi BruixAbstract:Hepatocellular carcinoma (HCC) is the fifth most common neoplasm in the world, and the third most common cause of cancer-related death. It affects mainly patients with cirrhosis of any etiology. Patients with cirrhosis are thus usually included in surveillance plans aiming to achieve early detection and effective Treatment. Only patients who would be treated if diagnosed with HCC should undergo surveillance, which is based on ultrasonography and alpha-fetoprotein every 6 months. Upon diagnosis, the patients have to be staged to define tumor extent and liver function impairment. Thereafter, the best Treatment option can be indicated and a prognosis estimate can be established. The present manuscript depicts the Barcelona-Clínic Liver Cancer Group diagnostic and Treatment strategy. This is based on the analysis of several cohort and randomized controlled studies that have allowed the continuous refinement of Treatment Indication and application. Surgical resection is considered the first Treatment option for early stage patients. It is reserved for patients with solitary tumors without portal hypertension and normal bilirubin. If these conditions are not met, patients are considered for liver transplantation (cadaveric or live donation) or percutaneous ablation if at an early stage (solitary < or =5 cm or up to 3 nodules < or =3 cm). These patients will reach a 5-year survival between 50 and 75%. If patients are diagnosed at an intermediate stage and are still asymptomatic and have preserved liver function, they may benefit from chemoembolization. Their 3-year survival will exceed 50%. There is no effective Treatment for patients with advanced disease and thus, in such instances, the patients have to be considered for research trials with new therapeutic options. Finally, patients with end-stage disease should receive only palliative Treatment to avoid unnecessary suffering.
Hideyo Fujino - One of the best experts on this subject based on the ideXlab platform.
-
gamma knife surgery for metastatic brain tumors from primary breast cancer Treatment Indication based on number of tumors and breast cancer phenotype
Journal of Neurosurgery, 2010Co-Authors: Shigeo Matsunaga, Takashi Shuto, Nobutaka Kawahara, Jun Suenaga, Shigeo Inomori, Hideyo FujinoAbstract:Object The goal of this study was to analyze prognostic factors for local tumor control and survival and Indications for initial Treatment with the Gamma Knife in patients with up to 10 metastatic brain tumors from primary breast cancer. Methods Outcomes were retrospectively reviewed in 101 women with a total of 600 tumors, who underwent Gamma Knife surgery (GKS) for metastatic brain tumors between April 1992 and December 2008 at 1 institution. The inclusion criteria were up to 10 brain metastases, maximum diameter of tumor < 3 cm, and total tumor volume < 15 cm3. The exclusion criteria were poor systemic condition, presence of carcinomatous meningitis, and previous whole brain radiation Treatment and/or craniotomy. Results The mean tumor volume at GKS was 3.7 cm3 (range 0.016–14.3 cm3). The mean margin dose was 19 Gy (range 8–30 Gy). Neuroimaging showed that the local tumor growth control rate was 97%, and the tumor response rate was 82.3%. Larger tumor volume (p = 0.001) and lower margin dose (p = 0.001...
Paul Schopf - One of the best experts on this subject based on the ideXlab platform.
-
prevalence and development of kig relevant symptoms in primary school students from frankfurt am main
Journal of Orofacial Orthopedics-fortschritte Der Kieferorthopadie, 2006Co-Authors: Bettina Glasl, Bjorn Ludwig, Paul SchopfAbstract:Objective:To determine the actual need for orthodontic Treatment in the late mixed dentition according to the German KIG system (Kieferorthopadische Indikationsgruppen = Orthodontic Indication Groups). By comparing the findings with those of the early mixed dentition, we aimed to evaluate whether a change in the spectrum of malocclusions would occur.Subjects and Methods:Dental check-ups took place in schools in Frankfurt am Main, during which the orthodontically-relevant symptoms of 1251 schoolchildren (female 49.5%, male 50.5%) in grades 4 and 5 were recorded and compared with findings documented 4 years earlier in the same classes at the same schools.Results:Of those orthodontic malocclusions in need of therapy and covered by the statutory health insurance, lateral crossbite and enlarged overjet (more than 6 mm) dominated by 9.2% and 8.7%, respectively, among the 9- to 11-year-old children. Of all the malocclusions recorded within the KIG-group showing a Treatment need degree ≥ 3, category D4 (overjet greater than 6 mm) at 17.4% was the most frequent, followed by K4 (unilateral crossbite) at 15.3%, and M4 (negative overjet up to −3 mm) at 14.9%. 41.4% of all the children examined presented a Treatment Indication according to statutory health insurance directives (KIG ≥3). The 10% reduction in Treatment cases financed by statutory health insurance has been achieved in any case [1], as mandated by health policy.Conclusions:Our comparison of results gathered from 2000 and 2004 showed that as the children grew older, the prevalence of already-enlarged overjets increased, as did the frequency of deep bite. We observed fewer frontal open bites and crossbites in late mixed dentition. Treatment need according to current statutory health insurance directives was clearly higher in the late mixed dentition (41.4%) than in the early mixed dentition (8%).
-
Prevalence and Development of KIG-relevant Symptoms in Primary School Students from Frankfurt am Main*
Journal of Orofacial Orthopedics Fortschritte der Kieferorthopädie, 2006Co-Authors: Bettina Glasl, Bjorn Ludwig, Paul SchopfAbstract:Ziel: Unter Berücksichtigung der Kieferorthopädischen Indikationsgruppen-(KIG-)Klassifikation sollte der aktuelle kieferorthopädische Behandlungsbedarf bei Kindern in der späten Wechselgebissphase bestimmt werden. Durch Gegenüberstellung der Daten mit den Befunden aus dem frühen Wechselgebiss ist eine mögliche Veränderung im Anomaliespektrum festzustellen. Probanden und Methodik: Im Rahmen der schulzahnärztlichen Untersuchung in Frankfurt am Main wurden bei 1251 Schülern (weiblich 49,5%, männlich 50,5%) der vierten und fünften Jahrgangsstufe kieferorthopädisch relevante Befunde erfasst und mit vor 4 Jahren an denselben Schulen und Klassen erhobenen Daten verglichen. Ergebnisse: Unter den festgestellten Zahnstellungs- und Kieferanomalien mit großer Therapiebedürftigkeit im Sinne einer von den Krankenkassen finanzierten Behandlung dominierten in der Gruppe der 9- bis 11-Jährigen der laterale Kreuzbiss mit 9,2% und die vergrößerte sagittale Frontzahnstufe (über 6 mm) mit 8,7%. Unter allen registrierten Anomalien der KIG-Gruppe ≥3 waren die Kategorien D4 (sagittale Stufe über 6 mm) mit 17,4%, K4 (einseitiger Kreuzbiss) mit 15,3% und M4 (mesiale Stufe bis −3 mm) mit 14,9% am häufigsten vertreten. Eine Behandlungsindikation im Sinne der gesetzlichen Krankenversicherung (KIG ≥3) fand sich in 41,4% aller untersuchten Fälle. Die gesundheitspolitisch gewollte Reduzierung der vertragszahnärztlichen Behandlungsfälle um 10% [1] ist somit in jedem Fall gelungen. Schlussfolgerungen: Der Vergleich der Ergebnisse aus den Jahren 2000 und 2004 zeigte, dass mit zunehmendem Alter die Prävalenz einer bereits vergrößerten Frontzahnstufe anstieg und die Häufigkeit eines tiefen Bisses zunahm. Im späten Wechselgebiss wurde eine geringere Anzahl an frontal offenen Bissen und generell an Kreuzbissen festgestellt. Die Behandlungsbedürftigkeit entsprechend den jeweils gültigen GKV-Richtlinien im späten Wechselgebiss war mit 41,4% deutlich höher als im frühen Wechselgebiss mit 8,0%. Objective: To determine the actual need for orthodontic Treatment in the late mixed dentition according to the German KIG system (Kieferorthopädische Indikationsgruppen = Orthodontic Indication Groups). By comparing the findings with those of the early mixed dentition, we aimed to evaluate whether a change in the spectrum of malocclusions would occur. Subjects and Methods: Dental check-ups took place in schools in Frankfurt am Main, during which the orthodontically-relevant symptoms of 1251 schoolchildren (female 49.5%, male 50.5%) in grades 4 and 5 were recorded and compared with findings documented 4 years earlier in the same classes at the same schools. Results: Of those orthodontic malocclusions in need of therapy and covered by the statutory health insurance, lateral crossbite and enlarged overjet (more than 6 mm) dominated by 9.2% and 8.7%, respectively, among the 9- to 11-year-old children. Of all the malocclusions recorded within the KIG-group showing a Treatment need degree ≥ 3, category D4 (overjet greater than 6 mm) at 17.4% was the most frequent, followed by K4 (unilateral crossbite) at 15.3%, and M4 (negative overjet up to −3 mm) at 14.9%. 41.4% of all the children examined presented a Treatment Indication according to statutory health insurance directives (KIG ≥3). The 10% reduction in Treatment cases financed by statutory health insurance has been achieved in any case [1], as mandated by health policy. Conclusions: Our comparison of results gathered from 2000 and 2004 showed that as the children grew older, the prevalence of already-enlarged overjets increased, as did the frequency of deep bite. We observed fewer frontal open bites and crossbites in late mixed dentition. Treatment need according to current statutory health insurance directives was clearly higher in the late mixed dentition (41.4%) than in the early mixed dentition (8%).
Shigeo Matsunaga - One of the best experts on this subject based on the ideXlab platform.
-
gamma knife surgery for metastatic brain tumors from primary breast cancer Treatment Indication based on number of tumors and breast cancer phenotype
Journal of Neurosurgery, 2010Co-Authors: Shigeo Matsunaga, Takashi Shuto, Nobutaka Kawahara, Jun Suenaga, Shigeo Inomori, Hideyo FujinoAbstract:Object The goal of this study was to analyze prognostic factors for local tumor control and survival and Indications for initial Treatment with the Gamma Knife in patients with up to 10 metastatic brain tumors from primary breast cancer. Methods Outcomes were retrospectively reviewed in 101 women with a total of 600 tumors, who underwent Gamma Knife surgery (GKS) for metastatic brain tumors between April 1992 and December 2008 at 1 institution. The inclusion criteria were up to 10 brain metastases, maximum diameter of tumor < 3 cm, and total tumor volume < 15 cm3. The exclusion criteria were poor systemic condition, presence of carcinomatous meningitis, and previous whole brain radiation Treatment and/or craniotomy. Results The mean tumor volume at GKS was 3.7 cm3 (range 0.016–14.3 cm3). The mean margin dose was 19 Gy (range 8–30 Gy). Neuroimaging showed that the local tumor growth control rate was 97%, and the tumor response rate was 82.3%. Larger tumor volume (p = 0.001) and lower margin dose (p = 0.001...
