Effect of prophylactic low level laser therapy on oral mucositis: a systematic review and meta-analysis.

Objective was to determine whether prophylactic low level laser therapy (LLLT) reduces the risk of severe mucositis as compared to placebo or no therapy.MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched until February 2014 for randomized controlled trials (RCTs) comparing prophylactic LLLT with placebo or no therapy in patients with cancer or undergoing hematopoietic stem cell transplantation (HSCT). All analyses used random effects models.Eighteen RCTs (1144 patients) were included. Prophylactic LLLT reduced the overall risk of severe mucositis (risk ratio (RR) 0.37, 95% confidence interval (CI) 0.20 to 0.67; P = 0.001). LLLT also reduced the following outcomes when compared to placebo/no therapy: severe mucositis at the time of anticipated maximal mucositis (RR 0.34, 95% CI 0.20 to 0.59), overall mean grade of mucositis (standardized mean difference -1.49, 95% CI -2.02 to -0.95), duration of severe mucositis (weighted mean difference -5.32, 95% CI -9.45 to -1.19) and incidence of severe pain (RR 0.26, 95% CI 0.18 to 0.37).Prophylactic LLLT reduced severe mucositis and pain in patients with cancer and HSCT recipients. Future research should identify the optimal characteristics of LLLT and determine feasibility in the clinical setting

Summary of outcomes of low level laser therapy as compared to placebo/no treatment.

<p>Abbreviations: RR - risk ratio; SMD - standardized mean difference; WMD – weighted mean difference; CI – confidence interval;</p><p>*Maximum anticipated mucositis was week 6±1 in head and neck cancer radiotherapy/chemo-radiotherapy trials and day 10±4 in chemotherapy and hematopoietic stem cell transplantation trials (from date of chemotherapy initiation and stem cell infusion respectively).</p><p>** Severe pain defined as a visual analogue scale score >7.</p>¥<p>All analyses used a random-effect model. A risk ratio <1 and a standardized mean difference or weighted mean difference <0 with 95% CIs that do not include 1 or 0 respectively, suggest that low level laser is better than placebo/no therapy.</p><p>Summary of outcomes of low level laser therapy as compared to placebo/no treatment.</p

Forest plot of overall incidence of severe (grade 3 or 4) mucositis.

<p>Squares to the left of the vertical line indicate that low level laser therapy reduces mucositis. Horizontal lines through the squares represent 95% confidence intervals (CIs). The size of the squares reflects each study's relative weight, and the diamond represents the aggregate risk ratio and 95% CI.</p

Funnel plot “trim and fill” technique assessing publication bias for overall incidence of severe mucositis.

<p>The x-axis represents the risk ratio for the effect of low level laser therapy and the y-axis represents the inverse of the variance of the effect. Estimated number of missing studies on right side = 4.</p

Effect of low level laser therapy as compared to placebo/no therapy on overall incidence of severe (grade 3 or 4) mucositis stratified by patient, laser and risk of bias characteristics.

<p>Abbreviations: RR – risk ratio; CI – confidence interval; HSCT – hematopoietic stem cell transplantation.</p>¥<p>All analyses used a random-effect model. A risk ratio <1 with 95% CIs that do not include 1, suggests that low level laser is better than placebo/no therapy.</p><p>Effect of low level laser therapy as compared to placebo/no therapy on overall incidence of severe (grade 3 or 4) mucositis stratified by patient, laser and risk of bias characteristics.</p

Flow diagram of trial identification and selection.

<p>Flow diagram of trial identification and selection.</p

Baseline characteristics of studies included in the meta-analysis^*.

<p>Abbreviations: Allo - allogeneic hematopoietic stem cell transplant; Auto-autologous hematopoietic stem cell transplant; Chemo – chemotherapy; EORTC-European Organization for Research and Treatment of Cancer; GaAIAs/AsGaAI – gallium-aluminium-arsenide/arsenate; He-Ne- helium-neon; HSCT – hematopoietic stem cell transplantation; InGaAIP – indium-gallium-aluminium phosphide; LED – light emitting diode; NA – not available; NCI CTC – National Cancer Institute Common Terminology Criteria; OMAS – Oral Mucositis Assessment Scale; OMI - Oral Mucositis Index; Pub – published; Radio- radiotherapy; RTOG – Radiation Therapy Oncology Group; VAS – visual analog scale; WHO – World Health Organization.</p><p>*There were 18 studies reporting 19 separate comparisons between low level light therapy and placebo/no therapy as one study stratified the population by underlying disease diagnosis and HSCT regimen.</p><p>Baseline characteristics of studies included in the meta-analysis^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0107418#nt102" target="_blank">*</a>}.</p

Autologous transplantation of hematopoietic stem cells in Hodgkin’s Lymphoma : experience of the bazilian group of pediatric bone marrow transplantation

Conventional methods for monitoring lung function can require complex, or special, gas analysers, and may therefore not be practical in clinical areas such as the intensive care unit (ICU) or operating theatre. The system proposed in this article is a compact and non-invasive system for the measurement and monitoring of lung variables, such as alveolar volume, airway dead space, and pulmonary blood flow. In contrast with conventional methods, the compact apparatus and non-invasive nature of the proposed method could eventually allow it to be used in the ICU, as well as in general clinical settings. We also propose a novel tidal ventilation model using a non-invasive oscillating gas-forcing technique, where both nitrous oxide and oxygen are used as indicator gases. Experimental results are obtained from healthy volunteers, and are compared with those obtained using a conventional continuous ventilation model. Our findings show that the proposed technique can be used to assess lung function, and has several advantages over conventional methods such as compact and portable apparatus, easy usage, and quick estimation of cardiopulmonary variables