Fetal echocardiography for congenital heart disease diagnosis: a meta-analysis, power analysis and missing data analysis.

BACKGROUND: Prenatal ultrasonography is the most widely available diagnostic test for fetal congenital heart disease (CHD), but the factors influencing its diagnostic accuracy remain uncertain despite extensive research. The aim of the present study was to evaluate the potential role of demographic, clinical and ultrasonographic characteristics on diagnostic yields for detecting CHD. METHODS: A systematic search of PubMed, ISI Web of Science, SinoMed, and the Cochrane Library was performed to identify studies assessing the accuracy of prenatal ultrasound in the detection of CHD. A random effects model was used to generate pooled sensitivity and specificity in addition to summary receiver operating characteristic (SROC) curves. RESULTS: Overall, prenatal ultrasound in the detection of CHD had a moderate sensitivity of 68.1% (95% CI 59.6-75.5) and a favorable specificity of 99.9% (99.7-99.9). Risk level and gestation age were independent predictors of diagnostic performance for detecting CHD (p = 0.004 vs. p = 0.002, respectively). The pooled sensitivities significantly increased to varying extents with the following echocardiographic views: 48.7% (34.8-67.2) for four-chamber view (4CV); 58.0% (40.3-73.9) for a combination of 4CV and outflow tract views (OTV); 73.5% (59.2-84.1) for combination of 4CV, OTV and three vessels and trachea view (3VTV); 77.1% (62.0-87.5) for extensive cardiac echocardiography examination (ECEE); and 89.6% (81.0-94.6) for spatiotemporal image correlation (STIC). CONCLUSIONS: Prenatal ultrasound is a powerful tool for the diagnosis of CHD; however, a single ultrasonographic regime is not definitive on its own and must be interpreted in the context of demographic and clinical characteristics.

Minimally invasive endoscopic staging for mediastinal lymphadenopathy in lung cancer: a systematic review protocol.

INTRODUCTION: Minimally invasive endoscopic biopsy techniques have been widely available as potential alternatives for mediastinal lesions staging in patients with known or suspected lung cancer. Previous efforts have been made to evaluate the diagnostic performance of specific endoscopic modality alone at the level of the mediastinum for staging lung cancer, however, few studies focus on the accuracy of comparisons between different endoscopic modalities, especially at the level of any individual lymph node station. The objective of our study is to determine the diagnostic yields of different endoscopic modalities for staging mediastinal lymphadenopathy in lung cancer, especially concerning the individual lymph node station. METHODS/DESIGN: A systematic electronic search of MEDLINE, EMBASE, SinoMed and ISI Web of Science were performed to identify studies evaluating endoscopic modalities accuracy with restriction of English and Chinese languages from inception to an update until May 2014. Data were extracted with the patient as the unit of analysis with regards to the abilities of different endoscopic modalities at the level of mediastinum and particular lymph node station. The methodological quality was assessed independently according to the Quality Assessment of Diagnostic Accuracy Study (QADAS) criteria. An exact binomial rendition of bivariate mixed-effects regression model was used to estimate the pooled sensitivity and specificity. Also, pre-post probability analysis, publication bias analysis and sensitivity analysis were performed for a synthesis of knowledge of this context. DISSEMINATION: The findings will advance our better available knowledge of optimal clinical decision-making when dealing with staging of mediastinal metastasis in lung cancer. TRIAL REGISTRATION NUMBER: PROSPERO-NIHR Prospective Register of Systematic Reviews (CRD42014009792).

[Evaluation of digital subtraction angiography rabbit VX2 hepatic carcinoma model with modified hepatic artery catheterization].

OBJECTIVE: To modify the success rate of establishing VX2 transplanted tumor model with different methods in rabbits, and access new typed modification and improved technique in catheterization. METHODS: In the study, 30 rabbits were randomly divided into 2 groups. In prophase, tumor cell suspension was implanted in group I, while tumor tissue particles were implanted into liver under direct vision, to establish VX2 transplanted tumor model. The rabbits were catheterized from femoral artery to selective hepatic artery under DSA, by using conventional modification with Seldinger technique in group I and by using new typed modification with improved technique in group II. The imaging and histological features of VX2 tumor were evaluated by combining pathology and DSA, then the success rate, operation time and postoperative complications were compared and evaluated. RESULTS: The success rates of the liver tumor model were 60.0% and 93.3%; the disposable success rates of catheterization were 66.7% and 92.8%; the operation time of catheterization were (35.6±5.8) min and (27.4±5.3) min; the incidence rates of adverse reaction were 22.5% and 18.0%; the differences between the two groups in the experimental rabbits were significant (P<0.05) statistically. CONCLUSION: The efficiency of tumor tissue particles implanted is better than that of tumor cell suspension implanted in establishing VX2 transplanted tumor model under direct vision. The cathetenzation quality and outcomes of new typed modification by improved technique, from femoral artery to selective hepatic artery, is superior to those of conventional modification with Seldinger technique.

Applied anatomy of a new approach of endoscopic technique in thyroid gland surgery.

OBJECTIVE: To explore the feasibility and safety of transtracheal assisted sublingual approach to totally endoscopic thyroidectomy by studying the anatomical approach and adjacent structures. METHODS: A total of 5 embalmed adult cadavers from Chengdu Medical College were dissected layer by layer in the cervical region, pharyngeal region, and mandible region, according to transtracheal assisted sublingual approach that was verified from the anatomical approach and planes. A total of 15 embalmed adult cadavers were dissected by arterial vascular casting technique, imaging scanning technique, and thin layer cryotomy. Then the vessel and anatomical structures of thyroid surgical region were analyzed qualitatively and quantitatively. Three-dimensional visualization of larynx artery was reconstructed by Autodesk 3ds Max 2010(32). Transtracheal assisted sublingual approach for totally endoscopic thyroidectomy was simulated on 5 embalmed adult cadavers. RESULTS: The sublingual observed access was located in the middle of sublingual region. The geniohyoid muscle, mylohyoid seam, and submental triangle were divided in turn in the middle to reach the plane under the plastima muscles. Superficial cervical fascia, anterior body of hyoid bone, and infrahyoid muscles were passed in sequence to reach thyroid gland surgical region. The transtracheal operational access was placed from the cavitas oris propria, isthmus faucium, subepiglottic region, laryngeal pharynx, and intermediate laryngeal cavit, and then passed from the top down in order to reach pars cervicalis tracheae where a sagittal incision was made in the anterior wall of cartilagines tracheales to reach a ascertained surgical region. CONCLUSION: Transtracheal assisted sublingual approach to totally endoscopic thyroidectomy is anatomically feasible and safe and can be useful in thyroid gland surgery.

[Concealed penis affects the morphology of the corpus cavernosum in rats].

OBJECTIVE: To explore the influence of concealed penis on the morphology of the corpus cavernosum in rats. METHODS: Rat models of concealed penis were established by intra-pocket-suture of the root of the penis. Fifty rats were equally assigned to Groups A (2-month) and B (4-month), each further divided into a buried (n = 15) and a normal subgroup (n = 10). Changes in the morphology of the penile cavernous tissue were observed under the light microscope and transmission electron microscope. RESULTS: Compared with Group A, Group B showed significant ultra-structural pathological changes in the corpus cavernosum, including abnormal arrangement of endothelial and smooth muscle cells, massive hyperplasia of interstitial tissues, narrowed cavernous sinus, atrophic smooth muscle cells, degenerated mitochondria, dilated endoplasmic reticula, decreased dense bodies and contractile fibers, and cytoplasmic vacuolization. No significant differences were found in the appearance and weight of the corpus cavernosum between the buried and normal groups (P > 0.05). CONCLUSION: Concealed penis does not significantly affect the appearance and weight of the corpus cavernosum, but causes ultra-structural pathological changes in it with the lengthening of time.