Background ClariFix for posterior nasal nerve ablation has been approved for use since 2017, and this is the first study attempting to synthesize and assess the efficacy of this new device on the management of chronic rhinitis. Objective The primary objective of this meta-analysis is to assess the efficacy of ClariFix in the symptomatic management of patients with chronic rhinitis. The main outcome measure is the mean difference in the reflective total nasal symptom score (rTNSS). Methods A systematic search of Pubmed/Medline, Web of Science, and EBSCOhost was conducted from inception to May 2022. Peer-reviewed clinical trials reporting postcryotherapy rTNSS at both 1- and 3-month intervals for patients with chronic rhinitis were included. A random-effects model was utilized for meta-analysis. Study heterogeneity, bias, and overall quality were all assessed. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The primary outcome measures included mean differences in rTNSS from baseline to both 1- and 3-month postoperative time points. Secondary measures included other questionnaires including the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Results There were 5 studies that met the criteria (247 individuals). The pooled rTNSS mean difference from baseline to 1 and 3 months postoperatively was found to be −3.48 points (95% CI: −3.73 to −3.23, I2 = 0.13). and −3.50 (95% CI: −3.71 to −3.29, I2 = 0.00), respectively. The mean difference from baseline to 3 months postoperatively regarding the RQLQ was found to be −1.53 (95% CI: −1.74 to −1.31, I2 = 0.00). The most common adverse effects included facial or surgical site pain (40.4%), followed by headache (18.2%), oral numbness (11.1%), and sinusitis (4.0%). Conclusions The findings of this systematic review suggest that cryoablation with Clarifix is an effective treatment modality for chronic rhinitis. However, higher-quality randomized controlled trials will need to be performed to affirm the findings of this study.
Surgical margin status is one of the strongest prognosticators in predicting patient outcomes in head and neck cancer, yet head and neck surgeons continue to face challenges in the accurate detection of these margins with the current standard of care. Novel intraoperative imaging modalities have demonstrated great promise for potentially increasing the accuracy and efficiency in surgical margin delineation. In this current study, we collated and analyzed various intraoperative imaging modalities utilized in head and neck cancer to evaluate their use in discriminating malignant from healthy tissues. The authors conducted a systematic database search through PubMed/Medline, Web of Science, and EBSCOhost (CINAHL). Study screening and data extraction were performed and verified by the authors, and more studies were added through handsearching. Here, intraoperative imaging modalities are described, including optical coherence tomography, narrow band imaging, autofluorescence, and fluorescent-tagged probe techniques. Available sensitivities and specificities in delineating cancerous from healthy tissues ranged from 83.0% to 100.0% and 79.2% to 100.0%, respectively, across the different imaging modalities. Many of these initial studies are in small sample sizes, with methodological differences that preclude more extensive quantitative comparison. Thus, there is impetus for future larger studies examining and comparing the efficacy of these intraoperative imaging technologies.
Introduction Anti-angiogenic therapy with bevacizumab has failed to provide substantial gains in overall survival. Epithelial membrane protein 2 (EMP2) is a cell surface protein that has been previously shown to be expressed in glioblastoma, correlate with poor survival, and regulate neoangiogenesis in cell lines. Thus, the relationship of bevacizumab and EMP2 was investigated. Methods Tumor samples were obtained from 12 patients with newly diagnosed glioblastoma at two time points: 1) during the initial surgery and 2) during a subsequent surgery following disease recurrence post bevacizumab treatment. Clinical characteristics and survival data from these patients were collected, and tumor samples were stained for EMP2 expression. The IVY glioblastoma atlas project database was used to evaluate EMP2 expression levels in 270 samples by differing histological areas of tumor. Results Patients with high EMP2 staining at initial diagnosis had decreased progression free and overall survival after bevacizumab [median progression free survival 4.6 months vs. 5.9 months; Log-Rank P = 0.076 & overall survival 7.7 months vs. 14.4 months; Log-Rank P = 0.011]. There was increased EMP2 staining in samples obtained after bevacizumab treatment in both unpaired [Mean H-score 2.31 vs 1.76; P=0.006] and paired analyses [Mean difference 0.571; P=0.019]. This expression increase correlated with length of bevacizumab therapy [R2=0.449; Pearson P=0.024]. Conclusions Bevacizumab treatment increased EMP2 protein expression. This increase in EMP2 correlated with reduced mean survival time post bevacizumab therapy. We hypothesize a role of EMP2 in clinical bevacizumab resistance and as a potential anti-angiogenic therapeutic target in glioblastoma.
BACKGROUND Intracranial meningiomas have been associated with a heterogenous set of genetic and molecular alterations. Despite these genetic associations, targeted therapies have been unable to increase survival in recurrent or residual meningiomas. There is a need for identification of therapeutic targets in meningioma. MATERIALS & METHODS Normal brain tissue from routine autopsy and tumor specimens from patients undergoing primary surgical resection of meningioma were analyzed. Pathologic diagnosis and grade were identified. Samples were stained with anti-EMP2 antisera and visualized with DAB (3,3’-Diaminobenzidine). Western blot analysis was carried out RESULTS In 17 patients with meningioma, there was statistically significant EMP2 staining in fresh brain tumor samples. EMP2 expression was confirmed and quantified with western blot which demonstrated significant positive expressivity. There were 12 grade I, 4 grade II, and 1 grade III meningiomas in our dataset and a significant trend towards increased EMP2 expression with higher grade. EMP2 expression was not identified in normal brain tissue samples from different locations including gray matter, white matter, and meninges in 3 control patients. CONCLUSIONS EMP2 is a protein associated with cell migration, invasion, and angiogenesis not identified in normal brain tissue but found in meningioma. EMP2 expression may be associated with increased tumor invasion and is a potential therapeutic target for residual or recurrent meningioma.
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