Helicobacter Pylori Infection and Carcinoma of the Larynx

Helicobacter Pylori Infection and Carcinoma of the Larynx Association between helicobacter pylori infection and carcinoma of the larynx or pharynx JIAN ZHOU, DUO ZHANG, YUE YANG, LIANG ZHOU LEI TAO   Abstract: Background: Infection with Helicobacter pylori (H. pylori) plays a role in the development of gastric carcinoma. However, there is controversy as to whether H. pylori infection increases laryngeal or pharyngeal cancers. Methods: We managed a systematic review of researches related to H. pylori infection in laryngeal or pharyngeal carcinomas, distributed up to December 2014. Odds ratios (ORs) and 95% confidence intervals (CIs) were assessed by random effects models or  according to heterogeneity I2. Results: Eleven studies were involved in the meta-analysis. Overall, H. pylori infection was significantly higher in the study group compared with the normal control group (OR = 2.87; 95% CI = 1.71-4.84, I2 = 67.1, P 2 = 58, P Conclusion: This study supported the proposition that Infection with H. pylori was related to laryngeal carcinoma, specifically in the hospital-based control group and diagnosed by PCR or ELISA. Nevertheless, no significant relationship was discovered between H. pylori infection and pharyngeal cancer. Keywords: Helicobacter pylori, laryngeal cancer, pharynx cancer Introduction: Laryngeal carcinoma is one of the common malignancies of the upper aerodigestive tract. It accounts for 25% of all the carcinomas of the head and neck and 2-3% of the carcinomas of the entire body [1]. Tobacco smoking and alcohol consuming are major risk factors for laryngeal and pharyngeal cancer. The other risk factors for instance, microbes, viruses, occupational exposures, gastroesophageal reflux, and genetic inheritance have also been associated with the malignancy [2]. It has been verified that H. pylori has an important effect on the pathogenesis of duodenal and gastric ulcers, chronic gastritis, gastric lymphoma, and adenocarcinoma [3]. H. pylori immigration in the upper aerodigestive zone was proved by a previous study [4].There are some articles studying the association between H. pylori and laryngeal malignancy, the outcomes of which are still conflicting [5–11]. The purpose of this meta-analysis study is to determine whether H. pylori infection is related to cancers of the larynx and pharynx by summarizing proof from published studies. Material and methods Literature search We made a systematic literature search in Web of Knowledge, PubMed, and Embase for articles published up to December, 2014 by means of related keywords and combinations thereof: for instance, ‘laryngeal cancer,’ ‘larynx carcinoma,’ ‘pharyngeal cancer,’ ‘pharynx carcinoma,’ and ‘helicobacter pylori’. We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) strategies. Inclusion and exclusion standards Inclusion standards were the following: (1) diagnoses of laryngeal or pharyngeal cancer, and sources of cases and controls, (2) clear evaluation of the relationship of malignances of the pharynx or larynx with H. pylori infection, (3) satisfactory data for pharyngeal or laryngeal carcinoma cases as well as controls, (4) unequivocal information on the H. pylori detection method used, (5) most updated and latest version of published articles. Exclusion standards were the following: (1) case reports, review articles, and studies not in English, and involving patients with benign sickness, (2) uncontrolled studies, (3) cohort studies, (4) animal studies, (5) and manifold articles providing outcomes from the same study. Data extraction The subsequent data were collected from every qualified article: first author’s surname, publication year, city and country of source, amount and type of controls, means of identification of H. pylori, and cases related to smoking or drinking, correspondingly. All studies were studied independently by two authors, and based on consensus. Statistical analysis Meta-analysis was managed using the random fixed effect model to pool individual study evaluations into an overall summary estimate of the associations between H. pylori infection and laryngeal cancer (or pharyngeal cancer). The results were given by 95% confidence interval (CI) and odds ratio (OR). The significance of the OR was decided by the Z test and p 2 was used to evaluate the heterogeneity between studies. Subsequently, stratified analyses were carried out with regarding to the features of the study (type of carcinoma, sources of controls, methods of diagnosis of H. pylori, and sample sizes). We assessed publication bias with Begg’s funnel plot. The random effects model introduces additional variation across diverse studies. We used the Stata 12.0 (Stata Corporation, College Station, TX, USA) to complete wholly statistical analyses. Results Study characteristics As displayed in Figure1, we identified 177 studies by database searches, with 57 containing overlapping details. After subsequent initial screening of the abstracts, 22 entitled articles were selected. Among these 22 studies, two articles were removed owing to absence of controls, and eight were short of necessary statistics. Lastly, 11 articles were involved in this study. Designated characteristics of cases and controls are displayed in Table I. All articles were retrospective in scope. The carcinoma cases were primarily confirmed histologically. Seven researches addressed laryngeal carcinoma alone, and four researches addressed laryngeal cancer or pharyngeal cancer. Hospital-based controls were involved in seven researches, population-based controls were used in two researches and clinic-based controls were included in two researches. The technique of identification of H. pylori varies with authors. Meta-analysis Generally, comparison of H. pylori infection for laryngeal cancer against a local control was statistically significant and favoured laryngeal cancer (OR = 2.87; 95% CI = 1.71-4.84, I2 = 67.1, random effects mode). Table II showed the separate risk assessments of researches assessed in meta-analysis. Selected researches supplied full data on H. pylori infection, by carcinomas, sources of controls, H. pylori diagnosis, and sample magnitude. The results of analyses stratified with these aspects were presented in Table II. Once stratifying for carcinomas, the pooled ORs for laryngeal cancer were 3.28 (95% CI =1.91-5.63; I2 = 58, random effects model) and 1.35 (95% CI = 0.86-2.12; I2 = 0, random effects model) for pharyngeal carcinoma. In the subcategory analysis founded on the basis of controls, significant relations were detected in the hospital-based researches (OR = 3.31; 95% CI =1.49-7.35; I2 =68.2, random effects model) and in the clinic-based researches (OR =2.60; 95% CI = 1.00-6. 76; I2 = 62.1, random effects model), but not in the population-based researches (OR = 2.05; 95% CI = 0.70-5.91, random effects models). Significant relations were also detected in the different ways of identifying of H. pylori infection and sample magnitude. In both overall and subcategory analyses, I2 values were 50% or greater and related p values were Sensitivity analysis and publication bias No publication bias was evident (Figure 2) in meta-analyses of the association between H. pylori and risk of laryngeal or pharyngeal carcinoma, this was established on the basis of Begg’s rank correlation test and Egger’s regression test (Begg’s test, p = 0.876; Egger’s test, p = 0.615). We researched the influence of a single study on the whole meta-analysis assessment. Figure 3 shows the outcomes of this study, in which the meta-analysis estimates were computed omitting one study at a time. The results show that the corresponding pooled ORs were not essentially changed, demonstrating that our results were statistically forceful. Discussion The impact of H. pylori in the pathogenesis of chronic illnesses and cancer of the digestive regions is well acknowledged [20, 21]. H. pylori infection has a prevalence of up to 90% in underdeveloped countries and around 30% in developed countries [22]. The potential for damaging epithelial and mucosal obstacles and inflammation could lead to chronic harm and epithelial cell proliferation resulting in larynx pathology [23, 24]. The possible relationship between H. pylori infection and carcinomas of the larynx or pharynx has been an source of argument for decades. Numerous studies have been performed to demonstrate this cause-and-effect association. This study combined formerly published data related to the association between H. pylori infection and cancers of the larynx(or pharynx) into a terse assessment of influence. The risk of developing laryngeal cancer is 2.87 times higher for the people infected with H. pylori, than for the control group (95% CI:1.71-4.84, P A previous (2008) meta-analysis of five studies showed that the risk of developing laryngeal carcinoma is two times higher for the people infected with H. pylori, than for those in the control group [23], providing an indication that H. pylori infection may be related to an increased risk of laryngeal(or pharynx) carcinoma. Our research studied and analysed the outcomes of 11 researches. Once the study was stratified by category of carcinoma, there is a higher rate of laryngeal cancer among patients infected with H. pylori than among the general population (OR =3.28, 95% CI = 1.91-5.63). No significant relationship was discovered in pharyngeal cancer, signifying that patients are perhaps more susceptible to laryngeal than pharyngeal neoplasm, or that the small number of pharyngeal cancer patients in this study resulted in such a result. Hospital-based researches (OR = 3.31, 95% CI = 1.49-7.35) reported a higher frequency of H. pylori infection than clinic-based researches (OR =2.60, 95% CI =1.00-6.76). No significant relationship was discovered in population-based controls (OR = 2.05, 95% CI =0.70-5.91, Table II). In the subcategory investigation by sample magnitude, the deviation of the pooled OR in large sample sizes (number of controls and cases≠¥50) was smaller compared to small-sized sets, signifying that a large sample size with adequate power was an essen tial to the strategy of meta-analysis. After the study was stratified by H. pylori diagnosis, we found that the best method for detection of H. pylori in the larynx (or pharynx) tissue is PCR with high specificity and sensitivity (OR=7.03, 95% CI = 4.19-11.79). This finding is similar to the research of Gong [16]. A well-controlled large-scale prospective study is important to completely realize the fundamental relationship between carcinomas of the larynx (or pharynx) and H. pylori infection. Finally, a number of important limitations need to be considered. Firstly, researches involved in this meta-analysis were published in English only, signifying that a possible language bias existed. Secondly, evident heterogeneity was detected in involved researches. Thirdly, the influence of smoking and alcohol consumption on H. pylori and laryngeal carcinoma was not removed from our study. Nevertheless, it is uncertain whether the H. pylori infection was causal or related to the tobacco and alcohol consumption among most malignancy patients. Fourthly, wholly studies were case-control researches, which are responsive to recall and information and selection bias, and this may influence the outcomes of the present research. Conclusion This meta-analysis favours the suggestion that H. pylori infection is related to laryngeal carcinoma, specifically in hospital-based control researches and when diagnosed by PCR and ELISA. Nevertheless, no significant relationship was found between H. pylori infection and pharyngeal cancer. Furthermore, the small number of studies involved in this study led to a large CI in this assessment. Acknowledgments This work was supported by the National Natural Science Foundation of China (grant no. 30801283), the Technology Project of Shanghai (grant nos 09QA1401000, 10QA1405900 and 14411961900), Shanghai’s Health System of Talents Training Plan (grant nos XYQ2011055 and XYQ2011015). Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. References [1] Koufman J A, Burke A J. The etiology and pathogenesis of laryngeal carcinoma[J]. Otolaryngologic clinics of North America, 1997, 30(1): 1-19. [2] Tutar H, Erdamar H, Kà ¶ybaÃ…Å ¸ioÄÅ ¸lu A, et al. Can bile acids be an etiological factor for laryngeal carcinoma?[J]. ORL; journal for oto-rhino-laryngology and its related specialties, 2010, 73(3): 156-161. [3] Malfertheiner P, Megraud F, OMorain C A, et al. Management of Helicobacter pylori infection—the Maastricht IV/Florence consensus report[J]. Gut, 2012, 61(5): 646-664. [4] Yokoyama A, Yokoyama T, Omori T, et al. Helicobacter pylori, chronic atrophic gastritis, inactive aldehyde dehydrogenaseà ¢Ã¢â€š ¬Ã‚ 2, macrocytosis and multiple upper aerodigestive tract cancers and the risk for gastric cancer in alcoholic Japanese men[J]. Journal of gastroenterology and hepatology, 2007, 22(2): 210-217. [5] Akbayir N, BaÃ…Å ¸ak T, Seven H, et al. Investigation of Helicobacter pylori colonization in laryngeal neoplasia[J]. European Archives of Oto-Rhino-Laryngology and Head Neck, 2005, 262(3): 170-172. [6] Aygenc E, Selcuk A, Celikkanat S, et al. The role of Helicobacter pylori infection in the cause of squamous cell carcinoma of the larynx[J]. OtolaryngologyHead and Neck Surgery, 2001, 125(5): 520-521. [7] Borkowski G, Sudhoff H, Koslowski F, et al. A possible role of Helicobacter pylori infection in the etiology of chronic laryngitis[J]. European archives of oto-rhino-laryngology, 1997, 254(9-10): 481-482. [8] Grandis J R, Perezà ¢Ã¢â€š ¬Ã‚ Perez G I, Yu V L, et al. Lack of serologic evidence for Helicobacter pylori infection in head and neck cancer[J]. Head neck, 1997, 19(3): 216-218. [9] Aydind A K L S A, Kalcioglua M T, Aydinb O O N E. Histopathologic examination for Helicobacter pylori as a possible etiopathogenic factor in laryngeal carcinoma[J]. Chemotherapy, 2006, 52: 80-82. [10] Rubin J S, Benjamin E, Prior A, et al. The prevalence of Helicobacter pylori infection in malignant and premalignant conditions of the head and neck[J]. The Journal of Laryngology Otology, 2003, 117(02): 118-121. [11] Titiz A, Ozcakir O, Ceyhan S, et al. The presence of Helicobacter pylori in the larynx pathologies[J]. Auris Nasus Larynx, 2008, 35(4): 534-538. [12]Guilemany J M, Langdon C, Ballesteros F, et al. Prognostic significance and association of Helicobacter pylori infection in pharyngolaryngeal cancer[J]. European Archives of Oto-Rhino-Laryngology, 2014, 271(9): 2539-2543. [13]Fellmann J, Weisert J U, Soltermann A, et al. Helicobacter pylori detected in pharyngeal and laryngeal pathologies in patients with proven gastric colonization[J]. Head neck, 2014, 36(11): 1562-1566. [14]Genà § R, ÇaÄÅ ¸lÄ ± S, Yà ¼ce Ä °, et al. The Role of H. pylori in the Development of Laryngeal Squamous Cell Carcinoma[J]. Disease markers, 2013, 35(5): 447-449. [15] Siupsinskiene N, Jurgutaviciute V, Katutiene I, et al. Helicobacter pylori infection in laryngeal diseases[J]. European Archives of Oto-Rhino-Laryngology, 2013, 270(8): 2283-2288. [16] Gong H, Shi Y, Zhou L, et al. Helicobacter pylori infection of the larynx may be an emerging risk factor for laryngeal squamous cell carcinoma[J]. Clinical and Translational Oncology, 2012, 14(12): 905-910. [17] Shi Y, Gong H, Zhou L, et al. Association between Helicobacter pylori infection and laryngeal squamous cell carcinoma in a Chinese male population[J]. ORL; journal for oto-rhino-laryngology and its related specialties, 2010, 73(6): 295-300. [18] Pirzadeh A, Doustmohammadian N, Khoshbaten M, et al. Is there any association between Helicobacter Pylori infection and laryngeal carcinoma[J]. Asian Pac J Cancer Prev, 2011, 12(4): 897-900. [19] Nurgalieva Z Z, Graham D Y, Dahlstrom K R, et al. A pilot study of Helicobacter pylori infection and risk of laryngopharyngeal cancer[J]. Head neck, 2005, 27(1): 22-27. [20] Selbach M, Moese S, Backert S, et al. The Helicobacter pylori CagA protein induces tyrosine dephosphorylation of ezrin[J]. Proteomics, 2004, 4(10): 2961-2968. [21] Hou P, Tu Z X, Xu G M, et al. Helicobacter pylori vacA genotypes and cagA status and their relationship to associated diseases[J]. World Journal of Gastroenterology, 2000, 6(4): 605-607. [22] Harrisons principles of internal medicine [M]. New York: McGraw-Hill Medical, 2008. [23] Zhuo X L, Wang Y, Zhuo W L, et al. Possible association of Helicobacter pylori infection with laryngeal cancer risk: an evidence-based meta-analysis[J]. Archives of medical research, 2008, 39(6): 625-628. [24] Ozyurt M, Gungor A, Ergunay K, et al. Real-time PCR detection of Helicobacter pylori and virulence-associated cagA in nasal polyps and laryngeal disorders[J]. Otolaryngology-Head and Neck Surgery, 2009, 141(1): 131-135.

A Separate Peace - Symbolism Essays -- essays research papers fc

In John Knowle’s A Separate Peace, symbols are used to develop and advance the themes of the novel. One theme is the lack of an awareness of the real world among the students who attend the Devon Academy. The war is a symbol of the "real world", from which the boys exclude themselves. It is as if the boys are in their own little world or bubble secluded from the outside world and everyone else. Along with their friends, Gene and Finny play games and joke about the war instead of taking it seriously and preparing for it. Finny organizes the Winter Carnival, invents the game of Blitz Ball, and encourages his friends to have a snowball fight. When Gene looks back on that day of the Winter Carnival, he says, "---it was this liberation we had torn from the gray encroachments of 1943, the escape we had concocted, this afternoon of momentary, illusory, special and separate peace" (Knowles, 832). As he watches the snowball fight, Gene thinks to himself, "There they all were now, the cream of the school, the lights and leaders of the senior class, with their high IQs and expensive shoes, as Brinker had said, pasting each other with snowballs"(843). Another of the principal themes in this novel is the theme of maturity. The two rivers that are part of the Devon School property symbolize how Gene and Finny grow up through the course of the novel. The Devon River is preferred by the students because it is above the dam and contains clean water. It is a symbol of childhood and innocence because it is safe and simple. It is preferred which shows how the boys choose to hold onto their youth instead of growing up. The Naguamsett is the disgustingly dirty river which symbolizes adulthood because of its complexity. The two rivers intermingle showing the boys’ changes from immature individuals to slightly older and wiser men. Sooner or later, Gene and Phineas, who at the beginning of the novel are extremely immature, have to face reality. Signs of their maturity appear when the boys have a serious conversation about Finny’s accident. Finny realizes that Gene did shake the tree limb purposely so that he would fall. However, he knows that this action was spontaneous, and that Gene never meant to cause him life-long grief. Finny sympathetically says to his best friend, "Something just seized you. It wasn’t anything you really felt against ... ...iendship between Gene and Phineas is amidst themes such as lack of reality, low maturity levels, and false appearances. Their relationship deteriorates and leads to death because they fail to learn these valuable life lessons. The purpose of Knowles’ novel is to exaggerate the life of two young boys to the extreme in order to reveal the unfortunate things that can occur in a relationship when these themes are not taken seriously. As stated in Magill’s Survey of American Literature, "It (A Separate Peace) can be viewed, for example, as a tale of Original Sin, with the Devon School as an Eden enclosing the great Tree of Knowledge through which humankind falls far from innocence but is redeemed by the suffering of a totally innocent one. It may also be approached as a reworking of the classic tale of the need to accept the potential evil within everyone and thus make peace with one’s self." BIBLIOGRAPHY "A Separate Peace." Magill’s Survey of American Literature, Vol. 3. New York: Marshall Cavendish Corp., 1993. Beacham’s Guide to Literature for Young Adults, Vol. 3, pages 1186- 1192. Knowles, John. A Separate Peace. Prentice-Hall Literature, Platinum, 1996 ed.

City and Country Living

City living and country living have a wide range of differences and similarities but every day new people enter each and call it there home. When living in the city you are an on-the go kind of person and enjoy the world at a fast pace. In comparison to a country living style when time stands still. It’s as though you watch as the seasons come and pass every year. Both have many positives and some negatives but it’s a very hard choice when you are talking about living in a jam packed city compared to a spacious in the country-side.While living in the city, you have numerous things to do the opportunities are endless. On any given night you can walk around and enjoy the wonders of the city the sights, sounds, and delightfulness takes your breath away at all times. In addition the city has other things that also are beneficial like numerous cultures that live there and how they are portrayed through the different clubs and restaurants throughout the city. Also a great thi ng about the city is its different array of foods you can eat an expensive dinner or you can stop on the corner and get a hot dog.The city also has many different bar like atmospheres where you can get a casual dinner, or you can have an alcoholic beverage and enjoy yourself. Being a city-dweller you are always around excitement and a great place to make-a-living seeming that there are so many opportunities for work. Although the city seems to have a lot of great things, the country can offer just as much excitement as the city does just in a different type of excitement. The country is a marvelous place to live it offers a very relaxing feel, and is filled with magnificent views.Even though you’re not living there you can still access the city via transportation. Also the country can maybe help you become a more self-sufficient person, growing your own produce and becoming more of an outdoors person often enjoying the voices of nature through the night with crickets chirping or the rooster crow in the morning nature and its occupants are surrounding you in the country. Another thing about the country is it offers a very safe community with very little chance of crime and the air quality is a lot less polluted then living in the city.Living in the country is awesome and has a wide variety of positives when setting up a family environment. In contrast to all of the great things the city provides, the city can have a downside. The noise level of a city can stress you out; rarely having downtime when there is constant commotion. Another negative about the city is thatitss such an expensive lifestyle without much money it would be hard to live in the city because it’s a much more extravagant lifestyle then the country.It’s a very hectic lifestyle and can sometimes prove to be too much for people; it’s also a very noisy place with the screeching of brakes or babies crying there is always something going on in the city. People in the city usually aren’t worried about you either there more worried about keeping up and on time for their self and they would much rather move along then stop and associate with you. The city does have a downside like everywhere else but can provide a very safe and stable home. Even though the country can be an awesome place to live and start a family there is, like the city a downside.Being in the country you don’t have such interesting things to do in your free time as the city. If you don’t have a car it may be hard to commute to work because there aren’t any buses that go that far away from the city. Another bad side of the country is the lack of entertainment because there aren’t many places to go, hangout and have a bite to eat at in the community you would have to travel to have that luxury. Even though there are negatives, the positives outweigh them and the country still provides a great place to live.Having to choose between these two places to live would be very tough. Although I think both places are great they both have some disadvantages that would represent problems. The country is for relaxing and enjoying the outdoors more suitable for the slow-paced people; while the city is more cluttered and people live for the nightlife and a much more fast-paced lifestyle. Your character and how you want to live are the only ways you will be able to make the choice on where you want to live; the city or the country.

The Homeless Population - 953 Words

There are many avenues one could choose when looking for a way to give back to the community. I decided to focus on giving back to the homeless population. For one week, a group of church members, and myself went to the state of California to serve the homeless population in Los Angeles, and San Francisco in more ways than one. We started the journey in downtown L.A.. That first morning we were given beaten-up clothing, and sent out the door of the hotel with no breakfast or money. In partners we headed toward skid row to seek out a corner for pan-handling before meeting at The Mission for lunch. Skid row is an area of L.A. that most do not venture into. The streets are filled to capacity with many different people that all have one thing in common, homelessness. The filth is outrageous, and the smell of different bodily fluids is unbearable. There are no smiles, or warm feelings; it is survival of the fittest. 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