Liang Zhou

PURPOSE: We evaluated the effects of α-blockers, antimuscarinics, or a combination of both in reducing ureteral stent-related symptoms. METHODS: The relevant studies were identified by searching MEDLINE, EMBASE and Cochrane Library Database from January 2000 to May 2014. Randomized controlled trials evaluating effects of α-blocker, antimuscarinic, and combination therapy for stent-related symptoms were included. Two reviewers independently screened studies and extracted data. RESULTS: A total of 13 articles were identified including 1408 patients. There were statistically significant differences in urinary symptom (-6.37; P<0.0001) and body pain index score (-7.03; P=0.0008) of the Ureteral Stent Symptom Questionnaire (USSQ), total International Prostate Symptom Score (IPSS) (-4.16; P=0.0006), Visual Analogue Pain Scale (VAPS) score (-2.48; P<0.00001), and quality of life (QoL) (-1.42; P=0.0009) in favor of the α-blocker group. Antimuscarinics alone vs the control group showed significant improvement in total IPSS (mean difference [MD]: -3.76; 95% confidence interval [CI], -5.08 to -2.43; P<0.00001) and QoL (MD: -0.82; 95% CI, -1.31 to -0.32; P=0.001). Compared with α-blockers monotherapy, combination therapy has significant lower total IPSS (MD: -3.74; 95% CI, -4.94 to -2.54; P<0.00001), VAPS (MD: -0.50; 95% CI, -0.89 to -0.11; P=0.01), and QoL (MD: -0.93; 95% CI, -1.30 to -0.55; P<0.00001). CONCLUSIONS: Our data showed the beneficial effect of α-blockers alone and antimuscarinics alone in reducing stent-related symptoms. Furthermore, we suggested significant advantages of combination therapy of α-blocker and antimuscarinic compared with α-blocker monotherapy. However, more high quality, randomized controlled trials are warranted to better address this issue, however.

The FDA approved lenvatinib (Lenvima, Eisai Inc.) for the treatment of patients with locally recurrent or metastatic, progressive, radioactive iodine-refractory (RAI-refractory) differentiated thyroid cancer (DTC). In an international, multicenter, double-blinded, placebo-controlled trial (E7080-G000-303), 392 patients with locally recurrent or metastatic RAI-refractory DTC and radiographic evidence of disease progression within 12 months prior to randomization were randomly allocated (2:1) to receive either lenvatinib 24 mg orally per day (n = 261) or matching placebo (n = 131) with the option for patients on the placebo arm to receive lenvatinib following independent radiologic confirmation of disease progression. A statistically significant prolongation of progression-free survival (PFS) as determined by independent radiology review was demonstrated [HR, 0.21; 95% confidence interval (CI), 0.16-0.28; P < 0.001, stratified log-rank test], with an estimated median PFS of 18.3 months (95% CI, 15.1, NR) in the lenvatinib arm and 3.6 months (95% CI, 2.2-3.7) in the placebo arm. The most common adverse reactions, in order of decreasing frequency, observed in the lenvatinib-treated patients were hypertension, fatigue, diarrhea, arthralgia/myalgia, decreased appetite, decreased weight, nausea, stomatitis, headache, vomiting, proteinuria, palmar-plantar erythrodysesthesia syndrome, abdominal pain, and dysphonia. Adverse reactions led to dose reductions in 68% of patients receiving lenvatinib at the 24 mg dose and 18% of patients discontinued lenvatinib for adverse reactions leading to residual uncertainty regarding the optimal dose of lenvatinib.

PURPOSE: Holmium YAG laser lithotripsy (LL) and pneumatic lithotripsy (PL) are the most commonly used procedures in the treatment of ureteral calculi. In a previous meta-analysis examining the treatment effect of the 2 modalities, the authors highlighted the need for large sample size and high quality trials to provide more uncovered outcome. Recently, several randomized controlled trials (RCTs) evaluating the same issue with larger patient number and more complicated data have been published. Therefore, we conducted this meta-analysis to update and synthesize evidence on the efficacy and safety of the 2 procedures in the treatment of ureteral calculi. METHODS: The relevant studies were identified by searching Medline, EMBASE and Cochrane Library Database from January 1990 to November 2015. RCTs assessing the efficacy and safety of Holmium YAG laser and PL for ureteral stones were included. Two reviewers independently screened studies and extracted data. RESULTS: A total of 8 studies were identified including 1,555 patients. Compared with PL, Holmium YAG LL significantly reduced the mean operative time (weighted mean difference = -11.52, 95% CI -17.06 to -5.99, p < 0.0001) and increased the early stone-free rate (OR 2.69, 95% CI 1.91-3.78, p < 0.00001) and the delayed stone-free rate (OR 2.12, 95% CI 1.40-3.21, p = 0.0004). However, a higher postoperative ureteral stricture rate (OR 3.38, 95% CI 1.56-7.31, p = 0.002) was observed in LL group over PL group. There was no statistical significance in the ureteral perforation rate (OR 1.19, 95% CI 0.65-2.16, p = 0.58), the stone migration rate (OR 0.64, 95% CI 0.41-1.00, p = 0.05), the postoperative gross hematuria rate (OR 0.71, 95% CI 0.40-1.25, p = 0.23) and the postoperative fever rate (OR 0.73, 95% CI 0.50-1.09, p = 0.12). CONCLUSIONS: Our data reconfirmed that Holmium LL for ureteral stones can achieve shorter mean operative time, better early and delayed stone-free rate with larger sample size and more high quality studies. And further trials are unlikely to considerably alter this conclusion. In terms of higher risk of postoperative ureteral stricture in LL group over PL group observed in our review, more high quality, multicenter RCTs with long-term follow-up outcome are warranted to better assess this issue.

OBJECTIVE: We aim to examine the abilities of objective acoustic analysis methods (nonlinear dynamic and traditional perturbation measures) to describe voices from individuals with vocal nodules and polyps. SUBJECTS AND METHODS: Sustained vowel recordings from normal subjects, patients with vocal nodules, and patients with vocal polyps were analyzed. Perturbation measures of jitter and shimmer were obtained with the Multi-Dimensional Voice Program (MDVP) and CSpeech. Signal-to-noise ratio was calculated using CSpeech. Nonlinear dynamic measures of phase space reconstruction and correlation dimension were also applied to analyze the voices. RESULTS: A significant difference between normal and polyp groups was found in jitter and shimmer obtained from MDVP, as well as in jitter and signal-to-noise ratio from CSpeech. However, no parameters significantly differentiated between normal and nodule groups. Shimmer from CSpeech did not reveal any significant differences among any of the groups. Correlation dimension values for the nodule and polyp groups were significantly higher than the normal group. CONCLUSION: Nonlinear dynamic analysis has great potential value for the characterization of voice from patients with vocal nodules and polyps. The combination of traditional perturbation and nonlinear dynamic measures may improve our ability to provide objective clinical analysis of voices with vocal mass lesions.