The Screening Performance of Serum 1,3-Beta-D-Glucan in Patients with Invasive Fungal Diseases: A Meta-Analysis of Prospective Cohort Studies.

The serum 1,3-beta-D-glucan (BG) assay aids in the early diagnosis of invasive fungal diseases (IFDs) and has been approved for their diagnosis. However, reports on the screening performance of BG are scarce. We performed a meta-analysis of data extracted from only prospective cohort studies to evaluate the screening performance of the BG assay in the diagnosis of IFDs. We specifically searched 4 databases (the PubMed, Web of Science, Elsevier, and Cochrane Collaboration databases) according to EORTC-MSG criteria. A total of 1068 patients in 11 studies were analyzed. Deeks' funnel plot asymmetry test suggested a low likelihood of publication bias for the included studies (p = 0.055). The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the summary receiver operating characteristic curve, with 95% confidence intervals, were 0.75(0.63,0.84), 0.87(0.81,0.92), 5.85(3.96,8.63), 0.30(0.20,0.45), 19.53(11.16,34.18), and 0.89(0.86,0.91), respectively. The findings of this meta-analysis suggest that the BG assay is a useful screening tool with high sensitivity and specificity for discriminating between patients with and without IFDs. In clinical practice, BG assay results should be evaluated together with clinical and microbiological findings.

[Airway obstruction caused by large blood vessel anomalies: assessment by flexible bronchoscopy].

OBJECTIVE: To evaluate the diagnostic value and safety of flexible bronchoscopy in congenital great vessel diseases complicated with airway compression. METHOD: The medical records of patients with great vessels abnormalities who were admitted to the neonatal intensive care unit (NICU) from October 2005 to June 2009 were retrospectively reviewed; 34 cases were diagnosed as airway compression by flexible bronchoscopy, 10 cases as vascular ring, 24 cases as aortal arch obstruction. The age of the patients was 6 d - 11 m, body weight 2.2 - 8.7 kg [(4.6 +/- 1.4) kg]. Recorded airway abnormalities detected by bronchoscopy and CT, cardiac vascular defects and airway compression were consistent with the findings on operation. The relation between the airway compression and cardiac vascular abnormalities, treatment of the airway compression and outcome were analysed. RESULT: Bronchoscopic assessment was successfully performed in NICU or operating room for all the patients. (1) Initial presentation of the 34 cases were tachypnea, stridor, refractory lung infection and prolonged mechanical ventilation. (2) Extrinsic compression was found in all the 10 cases with vascular ring by bronchoscopy initially which indicated vascular ring, airway compression was mainly of lower part of trachea. Diagnosis of 9 cases was consistent with CT diagnosis and in 1 case the diagnosis was confirmed by surgery; among these cases, 7 had congenital tracheal stenosis. (3) In the 24 cases with aortic obstructive lesion, 5 were detected to have tracheal stenosis by CT before correction of vascular abnormality, among whom one case was indicated to have tracheal stenosis by bronchoscopy, the other 19 cases were found with airway compression by bronchoscopy during or after vascular correction. Among the 24 cases, 21 had left main bronchial stenosis, 2 had congenital tracheal stenosis. Airway compression diagnosed by bronchoscopy agreed with the findings of CT. Two cases developed transient decrease of oxygen saturation, 5 cases developed transient tachycardia. CONCLUSION: Flexible bronchoscopy plays an important role in assessment of the airway compression complicated with great vessel abnormalities. Bronchoscopy is an accurate, convenient, safe and rapid way for airway assessment, but further examination of the peripheral structure and vascular malformation need combined examination with CT.

[Screening analysis of retinopathy of prematurity and treatment of threshold retinopathy of prematurity].

OBJECTIVE: To investigate the incidence and the risk factors associated with the development of retinopathy of prematurity (ROP) by ROP screening in the premature infants and to evaluate the treatment effect of threshold ROP. METHODS: From March 2000 to December 2004, 108 premature infants with birth weight less than 2.0 kg or gestational age less than 37 weeks admitted to the Neonatal Intensive Care Unit at Guangdong Provincial People's Hospital were enrolled in the present study. They were examined with binocular indirect ophthalmoscope. The perinatal variables of the premature infants were analyzed to evaluate their correlation with the development of ROP. The infants with threshold ROP were treated with retinal photocoagulation or cryotherapy. RESULTS: The overall incidence of ROP was 21.3% (23 of 108). Among 23 premature infants with ROP, 56.5% (13 of 23) were in stage 1, 13.0% (3 of 23) in stage 2 and 30.4% (7 of 23) in stage 3. All infants with ROP stage 3 fulfilled the criteria of threshold ROP. As compared with non-ROP group, ROP infants had lower birth weight [(1.43 +/- 0.25) kg; t = 4.059, P < 0.001], shorter gestation age [(31.0 +/- 2.3) W; t = 2.637, P = 0.013], longer median time of oxygen supplementation (17 d; Z = -3.630, P < 0.001) and more demand of mechanical ventilation (chi(2) = 12.009, P = 0.001). Cases with multiple gestational births in ROP group were not significantly different from that in non-ROP group (chi(2) = 1.013, P = 0.314). Multivariate logistic regression analysis showed that low birth weight (beta = -2.542, OR = 0.079, P = 0.032) and mechanical ventilation (beta = 1.341, OR = 3.823, P = 0.025) were significantly associated with the development of ROP. In a total of seven cases with threshold ROP, six cases were treated with retinal laser photocoagulation or transscleral cryotherapy timely. After followed up for two months to two years, all treated eyes had normal pupil response to the light. The optic disk, macula and posterior retina appeared normal. No abnormal retinal vessels and proliferative vitreoretinopathy were found. One premature infant with threshold ROP, not treated by laser photocoagulation or transscleral cryotherapy, developed retinal detachment in both eyes. CONCLUSIONS: Premature infants with low birth weigh, shorter gestational age, longer history of oxygen supplemental and the using of mechanical ventilation have more chance of developing ROP. The analysis of risk factors will be helpful in understanding and prediction of development of ROP. ROP screening and timely treatment for threshold ROP are very important for preventing the development of advanced ROP in premature infants.