The value of FDG PET/CT imaging in outcome prediction and response assessment of lymphoma patients treated with immunotherapy: a meta-analysis and systematic review.

PURPOSE: Treatment strategies of lymphoid malignancies have been revolutionized by immunotherapy. Because of the inherent property of Hodgkin lymphoma and some subtypes of non-Hodgkin lymphoma as a highly FDG-avid tumor, functional 18F-FDG PET/CT imaging is already embedded in their routine care. Nevertheless, the question is whether it is still valuable in the context of these tumors being treated with immunotherapy. Herein, we will review the value of 18F-FDG PET/CT imaging lymphoid tumors treated with immunotherapy regimens. METHODS: A comprehensive literature search of the PubMed database was conducted on the value of the 18F-FDG PET/CT for immunotherapy response monitoring of patients with malignant lymphoma. The articles were considered eligible if they met all of the following inclusion criteria: (a) clinical studies on patients with different types of malignant lymphoma, (b) treatment with anti-CD20 antibodies, immune checkpoint inhibitors or immune cell therapies, (c) and incorporated PET/CT with 18F-FDG as the PET tracer. RESULTS: From the initial 1488 papers identified, 91 were ultimately included in our study. In anti-CD20 therapy, the highest pooled hazard ratios (HRs) of baseline, early, and late response monitoring parameters for progression-free survival (PFS) belong to metabolic tumor volume (MTV) (3.19 (95%CI: 2.36-4.30)), maximum standardized uptake value (SUVmax) (3.25 (95%CI: 2.08-5.08)), and Deauville score (DS) (3.73 (95%CI: 2.50-5.56)), respectively. These measurements for overall survival (OS) were MTV (4.39 (95%CI: 2.71-7.08)), DS (3.23 (95%CI: 1.87-5.58)), and DS (3.64 (95%CI: 1.40-9.43)), respectively. Early and late 18F-FDG PET/CT response assessment in immune checkpoint inhibitors (ICI) and immune cell therapy might be an effective tool for prediction of clinical outcome. CONCLUSION: For anti-CD20 therapy of lymphoma, the MTV as a baseline 18F-FDG PET/CT-derived parameter has the highest HRs for PFS and OS. The DS as visual criteria in early and late response assessment has higher HRs for PFS and OS compared to the international harmonization project (IHP) visual criteria in anti-CD20 therapy. Early changes in 18F-FDG PET parameters may be predictive of response to ICIs and cell therapy in lymphoma patients.

The role of [18F]FDG PET/CT in paraneoplastic autoimmune disorders: an umbrella review.

Paraneoplastic autoimmune disorders (PAD) are a group of autoimmune diseases associated with neoplasms. Several evidence-based articles (systematic reviews and meta-analyses) have reported data about the role of positron emission tomography (PET) and related hybrid modalities (e.g., PET/CT) using 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) in patients with PAD. We performed an umbrella review of published systematic reviews and meta-analyses in this setting to provide an evidence-based summary and suggestions for further studies. Several databases were searched to find systematic reviews and meta-analysis on [18F]FDG PET/CT in PAD. Evidence-based data support the use of [18F]FDG PET/CT in patients with suspected PAD for investigating an underlying malignancy even if it is still unclear whether [18F]FDG PET/CT should be performed after negative/inconclusive conventional imaging or as part of the initial workup of PAD.

Factors Associated With Trabecular Bone Score and Bone Mineral Density; A Machine Learning Approach.

INTRODUCTION: Bone indexes including trabecular bone score (TBS) and bone mineral density (BMD) have been shown to be associated with wide spectrum of variables including physical activity, vitamin D, liver enzymes, biochemical measurements, mental and sleep disorders, and quality of life. Here we aimed to determine the most important factors related to TBS and BMD in SUVINA dataset. METHODS: Data were extracted from the Survey of Ultraviolet Intake by Nutritional Approach (SUVINA study) including all 306 subjects entered this survey. All the available parameters in the SUVINA database were included the analysis. XGBoost modeler software was used to define the most important features associated with bone indexes including TBS and BMD in various sites. RESULTS: Applying XGBoost modeling for 4 bone indexes indicated that this algorithm could identify the most important variables in relation to bone indexes with an accuracy of 92%, 93%, 90% and 90% respectively for TBS T-score, lumbar Z-score, neck of femur Z-score and Radius Z-score. Serum vitamin D, pro-oxidant-oxidant balance (PAB) and physical activity level (PAL) were the most important factors related to bone indices in different sites of the body. CONCLUSIONS: Our findings indicated that XGBoost could identify the most important variables with an accuracy of >90% for TBS and BMD. The most important features associated with bone indexes were serum vitamin D, PAB and PAL.

The value of 18F-FDG PET/CT for predicting or monitoring immunotherapy response in patients with metastatic melanoma: a systematic review and meta-analysis.

PURPOSE: To investigate the ability of 18F-FDG PET/CT to assess the response of patients with metastatic melanoma to immunotherapy. METHODS: A comprehensive search of the literature for studies examining the prognostic value of 18F-FDG PET/CT in monitoring the response of patients with metastatic melanoma to immunotherapy was performed. We also screened the references of the selected articles to identify any other relevant studies. Detailed data were extracted and categorized. Comprehensive meta-analysis software was used for analysis. RESULTS: Twenty four eligible articles were included in the systematic review. Based on the baseline 18F-FDG PET/CT imaging, the pooled hazard ratios of MTV, SLR, SUV/SULmax, SUV/SULpeak, and TLG for overall survival (OS) were 1.777 (95%CI: 1.389-2.275, p < 0.001), 3.425 (95%CI: 1.707-6.869, p = 0.001), 0.941 (95%CI: 0.599-1.477, p = 0.791), 1.704 (95%CI: 1.253-2.316, p = 0.016), and 1.755 (95%CI: 1.315-2.342, p < 0.001), respectively. The conventional and modified response assessment criteria exhibited a pooled sensitivity of 64% (95%CI: 46-79%) and 94% (95%CI: 81-99%) and a pooled specificity of 80% (95%CI: 59-93%) and 84% (95%CI: 64-95%), respectively, for the early 18F-FDG PET/CT scan. On the other hand, based on the late 18F-FDG PET/CT scan, the pooled sensitivity of 67% (95%CI: 35-90%) and 92% (95%CI: 73-99%) and pooled specificity of 77% (95%CI: 56-91%) and 76% (95%CI: 50-93%) were observed for the conventional and modified criteria, respectively. PET-detectable immune-related adverse events (irAEs) were associated with the response to therapy. CONCLUSIONS: The baseline SUVpeak, MTV, and TLG parameters represent promising predictors of the final response of metastatic melanoma patients to immunotherapy. Modified response assessment criteria are potentially an appropriate method for monitoring immunotherapy. irAEs are also valuable for predicting eventual clinical benefit of treatment.

Simultaneous anaerobic decolorization/degradation of Reactive Black-5 azo dye and chromium(VI) removal by Bacillus cereus strain MS038EH followed by UV-C/H2O2 post-treatment for detoxification of biotransformed products.

The existence of synthetic dyes and heavy metals in textile wastewater is a serious problem. These compounds should be removed before discharge into the environment by an appropriate method. The present study was conducted for the characterization of efficient multi-functional strain Bacillus cereus MS038EH for the simultaneous removal of Reactive Black-5 and Chromium(VI). Maximum decolorization efficiency of 94.74% was achieved at pH 7, 35 °C, and 4% inoculum size for 900 mg/L of Reactive Black-5. Also, 94.10% efficiency was observed in the presence of 8 g/L of yeast extract as an optimum nitrogen source, while carbon sources had no significant effect on decolorization. It should be pointed out that the decolorization efficiency was decreased from 94 to 64% by increasing NaCl concentrations from 0 to 50 g/L, respectively. Bacillus cereus strain MS038EH could decolorize 94.31% of Reactive Black-5 (900 mg/L) and remove 87.31% of chromium(VI) (30 mg/L) within 36 h. Results of Gas chromatography-mass spectrometry and Fourier transform-infrared spectroscopy proved that Reactive Black-5 was cleaved into the lower molecular weight products without any azo bonds. However, the phyto-toxicity analysis showed that Reactive Black-5 was not toxic for Triticum aestivum and Maize, while biologically treated Reactive Black-5 was toxic for seeds. Therefore, ultraviolet-C/H2O2 was applied for the detoxification of biotransformed products. When ultraviolet-C/H2O2 was applied as post-treatment, the seeds were germinated completely. It is demonstrated that the application of ultraviolet-C/H2O2 after anaerobic treatment is effective for toxicity reduction of textile wastewater.

Head-to-Head Comparison of Fibroblast Activation Protein Inhibitors (FAPI) Radiotracers versus [18F]F-FDG in Oncology: A Systematic Review.

Several recent studies comparing radiolabeled fibroblast activation protein inhibitors (FAPI) and fluorine-18 fluorodeoxyglucose ([18F]F-FDG) as positron emission tomography (PET) radiotracers in oncology have been published. The aim of this systematic review is to perform an updated evidence-based summary about the comparison of these PET radiotracers in oncology to better address further research in this setting. Studies or subsets of studies comparing radiolabeled FAPI and [18F]F-FDG as PET radiotracers in oncology were eligible for inclusion in this systematic review. A systematic literature search of PubMed/MEDLINE and Cochrane library databases was performed until August 2021. Literature data about the comparison of [18F]F-FDG and radiolabeled FAPI are rapidly increasing. Overall, taking into account radiotracer uptake and tumor-to-background uptake ratio, compared to [18F]F-FDG PET, an equal or higher detection of primary tumors and/or metastatic lesions was usually demonstrated by using radiolabeled FAPI PET. In particular, the cancer entities with better detection rate of tumor lesions by using radiolabeled FAPI PET, compared to [18F]F-FDG PET, were gastrointestinal tumors, liver tumors, breast cancer and nasopharyngeal carcinoma. Further comparison studies are needed to better evaluate the best field of application of radiolabeled FAPI PET.

Exploring the roots of clinical trial methodology in medieval Islamic medicine.

There is a dominant opinion in the Western sources of history of medicine that the roots of modern clinical trials and methodology of experimental medicine first started in the Renaissance. However, this opinion has been disputed with the thorough study of the rich medical literature of the medieval Islamic era. In the current review, the roots of clinical trial methodology have been traced back to the medieval Islamic tradition and the contribution of Islamic scholars in this field is discussed. The importance of experimental versus theoretical reasoning, the need for a control group, a statistical approach to interpreting trial results, appreciation of uncertainty in medical practice, and the difference between human and animal trials all can be traced back to the rich medieval Islamic medical literature.

Prevalence of osteoporosis and osteopenia in men and premenopausal women with celiac disease: a systematic review.

BACKGROUND: Celiac disease (CD) is known as a reason of metabolic osteopathy. Progression of non-invasive methods such as bone densitometry has shown that an important ratio of CD cases is faced with impaired bone mass and such cases are prone to bone fractures. Variety of low bone mineral density in CD is probably because of ignored confounding factors such as age, menopause, and drug. The aim of our study was to systematically review the osteoporosis and osteopenia incidences among premenopausal females and males with CD. METHODS: This systematic review was done based on preferred reporting items for systematic reviews (PRISMA) guidelines. PubMed and Scopus and Cochran databases were searched according to the relevant medical subject headings (MeSH) of CD and bone mineral density until 2018. Prevalence of osteopenia and osteoporosis were used as effect size for meta-analysis. Cochrane Q (p < 0.05) and I2 index were presented to reveal the heterogeneity. RESULTS: 54 eligible full text reviews were included and nineteen selected for data extraction. Eleven articles didn't have our inclusion criteria and had ignored confounding factors like age and menopause, and we excluded; data extraction was done in eight studies. A total of 563 premenopausal women and men who were from, UK, Brazil, India, Hungary, and Poland were included. The pooled prevalence of osteoporosis was 14.4% [95%CI: 9-20.5%] (Cochrane Q = 7.889, p = 0.96, I2 = 49.29%), and osteopenia was 39.6% [31.1-48.8%] (Cochrane Q = 14.24, p = 0.07, I2 = 71.92%), respectively. CONCLUSION: Our findings suggest that bone loss is more prevalent in celiac disease and can be associated with increased risk of fracture. However, but results are pooled prevalence and we need more case -control studies with more sample size and consideration of confounding factors.

Sentinel Node Biopsy in Urothelial Carcinoma of the Bladder: Systematic Review and Meta-Analysis.

OBJECTIVES: To determine the application of sentinel node biopsy in urothelial carcinoma of the bladder, we performed a systematic review and meta-analysis. METHODS: Pooled false negative rate and detection rate were presented using Meta-Disc (version 1.4), and comprehensive meta-analysis (version 2). Publication bias and heterogeneity were assessed using funnel plot, Cochrane Q test, and I2 index. RESULTS: The pooled detection rate was 91% (95% CI 87-93%) and pooled sensitivity was 79% (95% CI 0.69-0.86%). When the neoadjuvant chemotherapy group of patients was omitted, the pooled sensitivity changed to 82% (95% CI 74-88%), and the Cochrane Q and I2 statistics were 15.44 and 48.2%, respectively. The pooled sensitivity of studies that included > 50% of pT 3 or 4 patients was 70% (59-80), by omitting studies that enrolled > 50% of patients at pT stage of 3 or 4, the pooled sensitivity increased to 93% (81-98). CONCLUSIONS: Although the studies on SN biopsy of muscle invasive bladder cancer patients resulted in a high detection rate and sensitivity, further validated multicenter trials with larger sample size are essential to confirm the reliability and accuracy of this approach and obtain a standardized method. We showed that pT1 or pT2 bladder cancer patients with clinically negative lymph nodes are the most appropriated group for sentinel lymph node mapping.

Tamoxifen: A Protein Kinase C Inhibitor to Treat Mania: A Systematic Review and Meta-Analysis of Randomized, Placebo-Controlled Trials.

OBJECTIVE: The aim of this study was to conduct a systematic review of literature to retrieve all randomized controlled trials that evaluated the efficacy of tamoxifen on manic mood episodes and meta-analyze their quantitative results. METHODS: Four electronic databases were systematically searched from their inception to March 2014: PubMed, Cochrane Library (Cochrane Central Register of Controlled Trials), Scopus, and PsychINFO. Pooled difference in means of changes in mania scores and pooled odds ratio of treatment response (for tamoxifen monotherapy) were calculated as the main effect size. A random effects model was used to pool the data across studies. Quantitative syntheses were expressed by forest plots. RESULTS: Five randomized controlled trials (3 adjunct trials and 2 monotherapy trials) were included. Regarding adjunct tamoxifen, the standardized difference in mean of mania score changes in tamoxifen arm as compared with control arm was 0.669 (95% confidence interval [CI], 0.15-1.189; P = 0.012). Regarding monotherapy, the pooled difference in means of mania score changes in the tamoxifen arm as compared with the placebo arm was 22.09 (95% CI, 20.98-23.192; P < 0.000000001). Pooled odds ratio of response to treatment was 15.36 (95% CI, 2.99-78.73; P = 0.001) in the tamoxifen group as compared with the placebo group. CONCLUSIONS: Tamoxifen can be considered an effective treatment for manic bipolar patients. Making a conclusion regarding the efficacy and safety for longer periods warrants further studies with a larger sample size and longer follow-up duration.

In Vitro Gluten Challenge Test for Celiac Disease Diagnosis.

OBJECTIVES: The in vitro gluten challenge test is an important diagnostic modality in celiac disease (CD), especially in patients who begin treatment with a gluten-free diet before adequate diagnostic workup or in cases with atypical CD. Available literature was reviewed regarding the accuracy of the in vitro gluten challenge test for CD diagnosis. METHODS: MEDLINE, Scopus, and Google Scholar were searched, and studies that used serology and bowel biopsy as the criterion standard for diagnosis were included in our study. Data on authors, publication year, characteristics of the patient and control groups, patients' diet, duration of the gluten challenge test, histology findings, endomysial antibody (EMA) and anti-tissue transglutaminase (tTG) levels, CD markers, and intercellular cell adhesion molecule-1, and human leukocyte antigens before and after the gluten challenge test were extracted. RESULTS: Overall, 15 studies were included in this meta-analysis. Pooled sensitivity %/specificity % was 84/99 for EMA after the challenge, 52/96 for EMA without the challenge, 95.5/98.3 for anti-tTG after the challenge, and 95.1/98.3 for anti-tTG without the challenge test. Sensitivity/specificity for immunological markers were 89/97 for the percentage of CD25⁺-lamina propria lymphocytes, 96/91 for the percentage of CD3⁺-lamina propria lymphocytes, and 96.1/85.7 for the percentage of intercellular cell adhesion molecule-1-lamina propria lymphocytes. The factors that increased the sensitivity of EMA were longer test duration, and the evaluation of patients on a gluten-containing diet or short-term gluten-free diet. CONCLUSIONS: The in vitro gluten challenge test can be a useful part of the diagnostic workup of CD, rather than only a model to evaluate its mechanisms.

Detection rate of FNA cytology in medullary thyroid carcinoma: a meta-analysis.

BACKGROUND: The early detection of medullary thyroid carcinoma (MTC) can improve patient prognosis, because histological stage and patient age at diagnosis are highly relevant prognostic factors. As a consequence, delay in the diagnosis and/or incomplete surgical treatment should correlate with a poorer prognosis for patients. Few papers have evaluated the specific capability of fine-needle aspiration cytology (FNAC) to detect MTC, and small series have been reported. This study conducts a meta-analysis of published data on the diagnostic performance of FNAC in MTC to provide more robust estimates. RESEARCH DESIGN AND METHODS: A comprehensive computer literature search of the PubMed/MEDLINE, Embase and Scopus databases was conducted by searching for the terms 'medullary thyroid' AND 'cytology', 'FNA', 'FNAB', 'FNAC', 'fine needle' or 'fine-needle'. The search was updated until 21 March 2014, and no language restrictions were used. RESULTS: Fifteen relevant studies and 641 MTC lesions that had undergone FNAC were included. The detection rate (DR) of FNAC in patients with MTC (diagnosed as 'MTC' or 'suspicious for MTC') on a per lesion-based analysis ranged from 12·5% to 88·2%, with a pooled estimate of 56·4% (95% CI: 52·6-60·1%). The included studies were statistically heterogeneous in their estimates of DR (I-square >50%). Egger's regression intercept for DR pooling was 0·03 (95% CI: -3·1 to 3·2, P = 0·9). The study that reported the largest MTC series had a DR of 45%. Data on immunohistochemistry for calcitonin in diagnosing MTC were inconsistent for the meta-analysis. CONCLUSIONS: The presented meta-analysis demonstrates that FNAC is able to detect approximately one-half of MTC lesions. These findings suggest that other techniques may be needed in combination with FNAC to diagnose MTC and avoid false negative results.

Detection rate of fluorine-18-fluorodeoxyglucose positron emission tomography in patients with marginal zone lymphoma of MALT type: a meta-analysis.

The aim of this article is to meta-analyse published data about the detection rate (DR) of fluorine-18-fluorodeoxyglucose ((18) F-FDG) positron emission tomography (PET) and PET/computed tomography (CT) in the evaluation of patients with marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT). A comprehensive literature search of studies published through February 2014 was performed. Pooled DR of (18) F-FDG PET or PET/CT including 95% confidence intervals (95% CI) was calculated on a per-patient-based analysis. Twenty studies including 376 patients with MALT lymphoma were selected. The pooled DR of (18) F-FDG PET or PET/CT was 71% (95% CI: 61-80%). A significant difference between the DR of PET/CT (69%; 95% CI: 61-80%) and that of PET alone (73%; 95% CI: 60-84%) was not demonstrated. A better DR of (18) F-FDG PET or PET/CT in bronchial (94%; 95% CI: 85-99%) and head-and-neck (90%; 95% CI: 78-98%) MALT lymphomas compared with gastric (62%; 95% CI: 46-77%) and ocular (49%; 95% CI: 36-63%) MALT lymphomas was found. This meta-analysis demonstrates that MALT lymphoma is an (18) F-FDG-avid tumour in most of the cases, suggesting a potential clinical role of (18) F-FDG PET or PET/CT in the initial evaluation of these patients. In particular, the DR of (18) F-FDG PET or PET/CT is related to the primary site of the MALT lymphoma.

Effect of birth ball on labor pain relief: A systematic review and meta-analysis.

AIM: To critically evaluate the available evidence related to the impact of using a birth ball on labor pain relief. METHODS: The Cochrane library, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed and Scopus were searched from their inception to January 2015 using keywords: (Birth* OR Swiss OR Swedish OR balance OR fitness OR gym* OR Pezzi OR sport* OR stability) AND (ball*) AND (labor OR labour OR Obstetric). All available randomized controlled trials involving women using a birth ball for pain relief during labor were considered. The search resulted in 341 titles and abstracts, which were narrowed down to eight potentially relevant articles. Of these, four studies met the inclusion criteria. Pain intensity on a 10 cm visual analogue scale was used as the main outcome measure. Risk of bias was assessed using the Cochrane Risk of Bias tool. Comprehensive Meta-Analysis Version 2 was used for statistical analysis. RESULTS: Four RCTs involving 220 women were included in the systematic review. One study was excluded from the meta-analysis because of heterogeneous interventions and a lack of mean and standard deviation results of labor pain score. The meta-analysis showed that birth ball exercises provided statistically significant improvements to labor pain (pooled mean difference -0.921; 95% confidence interval -1.28, -0.56; P = 0.0000005; I(2) = 33.7%). CONCLUSION: The clinical implementation of a birth ball exercise could be an effective tool for parturient women to reduce labor pain. However, rigorous RCTs are needed to evaluate the effect of the birth ball on labor pain relief.

Prevalence and risk of malignancy of focal incidental uptake detected by fluorine-18-fluorodeoxyglucose positron emission tomography in the parotid gland: a meta-analysis.

This study aimed at performing a meta-analysis on the prevalence and risk of malignancy of focal parotid incidental uptake (FPIU) detected by hybrid fluorine-18-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) or (18)F-FDG PET alone. A comprehensive literature search of studies published up to July 2014 was performed. Records reporting at least 5 FPIUs were selected. Pooled prevalence and malignancy risk of FPIU were calculated including 95 % confidence intervals (95 % CI). Twelve records were selected for our meta-analysis. Pooled prevalence of FPIU detected by (18)F-FDG PET or PET/CT was 0.6 % (95 % CI 0.4-0.7 %), collecting data of 220 patients with FPIU. Overall, 181 FPIUs underwent further evaluation and 165 FPIUs were pathologically proven. Pooled risk of malignancy was 9.6 % (95 % CI 5.4-14.8 %), 10.9 % (95 % CI 5.8-17.3 %) and 20.4 % (95 % CI 12.3-30 %), considering all FPIUs detected, only those which underwent further evaluation and only those pathologically proven, respectively. Selection bias in the included studies, the heterogeneity among studies and the publication bias are limitations of our meta-analysis. Overall FPIUs are observed in about 1 % of (18)F-FDG PET or PET/CT scans and they are benign in most of the cases. Nevertheless, further evaluation is needed whenever FPIUs are detected by (18)F-FDG-PET or PET/CT to exclude malignant lesions or with possible malignant degeneration. Prospective studies are needed to confirm the findings reported by our meta-analysis.

A systematic review and meta-analysis on controlled treatment trials of metacognitive therapy for anxiety disorders.

BACKGROUND: To conduct a systematic review and meta-analysis on controlled treatment trials of meta-cognitive therapy for anxiety disorders. MATERIALS AND METHODS: Studies were included if they employed controlled methodology and treated people above 18 years with anxiety disorders. Case studies (with less than 4 cases) and single case designed studies were excluded. A comprehensive literature search identified 15 trials for systematic review. RESULTS: All included studies showed better treatment results in the MCT arms compared to the control groups. We also statistically pooled the results across studies (when possible). The meta-analyses also showed that MCT had statistically significant better results compared to the control groups in GAD (both immediately post-treatment and 12 months post-therapy results), OCD, and PTSD (p-values ranged <0.0001-0.025). CONCLUSION: Based on the results of our systematic review, MCT seems to be an effective treatment for anxiety disorders and can effectively control their psychological problems.

Axillary concordance between superficial and deep sentinel node mapping material injections in breast cancer patients: systematic review and meta-analysis of the literature.

It is still unclear whether the deep and superficial lymphatics of the breast always drain into the same nodes and which route best simulates the spread of breast cancer. In the current study, we systematically searched the available literature to find the studies evaluated the sentinel node locations of deep and superficial injections in the same patients simultaneously or serially. We searched SCOPUS, and PUBMED for relevant studies. Patient basis concordance rate was defined as the ratio of patients with at least one identified axillary sentinel node by both deep and superficial injections to all patients with identified axillary sentinel nodes using either methods. Sentinel node basis concordance was defined as the ratio of the number of axillary sentinel nodes identified by both deep and superficial injections to the sum of all identified axillary sentinel nodes using either methods. Pooled sentinel node detection rates were 94 % [92.1-95.5], 91.2 % [87.1-94.1], and 97.2 % [96-98] for superficial, deep, and combined (superficial and deep) injections. Pooled patient basis and sentinel node basis concordance rates were 90 % [86.7-92.4] and 73 % [63.3-80.9]. Pooled false negative rates were 9.1 % [5.9-14], 8.6 % [3.7-18.8], and 6.5 % [3.4-11.9] for superficial, deep, and combined (superficial and deep) injections, respectively. Axillary lymphatic drainage concordance between superficial and deep sentinel node mapping material in breast cancer patients is fairly high and clinically acceptable. However, both injection techniques can complement each other and the combined superficial/deep injection technique seems to be more successful clinically and can decrease the overall false negative rate.

Risk stratification and prognosis determination using (18)F-FDG PET imaging in endometrial cancer patients: a systematic review and meta-analysis.

OBJECTIVES: In the current study, we systematically searched and analyzed the available literature on the prognostic value of semi-quantitative (18)F-FDG PET imaging (SUVmax/mean) in patients with endometrial cancer and presenting the results in a meta-analytic format. METHODS: Pubmed, SCOPUS, and ISI Web of Knowledge were searched using "endometr* AND PET" as the search algorithm. All studies evaluating the (18)F-FDG PET performance in pre-operative risk stratification or its prognostic value in patients with endometrial cancer were included. Statistical pooling of diagnostic accuracy indices was performed using random effects model. Cochrane Q test and I(2) index were used for heterogeneity evaluation. RESULTS: Ten studies (771 patients) were included in the systematic review. Pooled average SUVmax values in patients with risk factors [grade III, lymphovascular invasion (LVI), cervical invasion (CI), myometrial invasion (MI)≥50%] were statistically higher than those in patients without risk factors. Pooled HR of pre-operative SUVmax for disease free survival was 7.415 [2.892-19.432] (p=0.000046). CONCLUSION: Despite higher average SUVmax in the high-risk group compared to the low-risk group of patients with endometrial cancer, the usefulness of (18)F-FDG PET SUVmax in classifying patients into pre-defined risk groups seems to be limited. However, pre-operative SUVmax of endometrial tumors seems to be an independent prognostic marker of recurrence and death. Further large multicenter studies with adequate follow-up are needed to confirm our findings.

Relationship between prostate-specific antigen kinetics and detection rate of radiolabelled choline PET/CT in restaging prostate cancer patients: a meta-analysis.

BACKGROUND: The aim of the article was to systematically review published data about the relationship between prostate-specific antigen (PSA) kinetics, including PSA doubling time (PSAdt) and PSA velocity (PSAvel), and detection rate (DR) of positron emission tomography/computed tomography (PET/CT) using radiolabelled choline in restaging prostate cancer (PCa). METHODS: A comprehensive literature search of studies published through July 2013 regarding the relationship between PSA kinetics and DR of radiolabelled choline PET/CT was carried out. Furthermore, a meta-analysis was performed in order to establish the DR of radiolabelled choline PET/CT using different cut-off values of PSAdt (≤ or >6 months) and PSAvel [>1 or ≤1 ng/(mL year) and >2 or ≤2 ng/(mL year)]. Moreover, a pooled analysis to establish whether PSAdt and PSAvel (using the abovementioned cut-off values) may predict positive PET/CT results was carried out. RESULTS: Fourteen articles were selected. The pooled DR of radiolabelled choline PET/CT in restaging PCa was 58% [95% confidence interval (CI) 55-60]. Most articles reported a relationship between PSA kinetics and DR of PET/CT. Pooled DR of radiolabelled choline PET/CT increased to 65% (95% CI 58-71) when PSAdt was ≤6 months and to 71% (95% CI 66-76) and 77% (95% CI 71-82) when PSAvel was >1 or >2 ng/(mL year), respectively. PSAdt ≤6 months and PSAvel >1 or >2 ng/(mL year) proved to be relevant factors in predicting the positive result of radiolabelled choline PET/CT. CONCLUSIONS: Due to the strong relationship between PSA kinetics and DR of radiolabelled choline PET/CT, beyond PSA values, PSAdt and PSAvel should be taken into account in the selection of PCa patients who should undergo radiolabelled choline PET/CT for restaging.

The effects of Mozart's music on interictal activity in epileptic patients: systematic review and meta-analysis of the literature.

Mozart's music has been shown to have promising effects on nervous system functions. In this study, the effects of Mozart's work on epilepsy were reviewed. Articles were obtained from a variety of sources. The results of 12 studies were extracted. Three different meta-analyses were performed to examine (i) the percentage of patients who had changes in their interictal epileptic discharges (IEDs) by music therapy; and the changes of IEDs (ii) during and (iii) after exposure to Mozart's music. Data analysis indicated that 84% of patients listening to Mozart's music showed a significant decrease in IEDs. In addition, IEDs were decreased during (31.24%) and after (23.74%) listening to Mozart's compositions. A noteworthy response to music therapy in patients with a higher intelligence quotient, generalized or central discharges, and idiopathic epilepsy was demonstrated. The effect of Mozart's music on epilepsy seems to be significant. However, more randomized control studies are needed to determine its clinical efficacy.