Magnetic resonance imaging for evaluation of bowel inflammation and disease activity in Crohn's disease: A systematic review and meta-analysis / Imágenes por resonancia magnética para la evaluación de la inflamación intestinal y la actividad de la enfermedad en la enfermedad de Crohn: una revisión sistemática y un metaanálisis

Background: The aim of this systematic review and meta-analysis was to determine the performance of magnetic resonance imaging (MRI) in the diagnosis of bowel inflammation and disease activity in Crohn's disease (CD). Methods: MEDLINE, Embase and Web of Science databases of biomedical literature were systematically searched to identify studies that investigated the diagnostic accuracy of MRI in diagnosing bowel inflammation and disease activity in CD by comparing it with reference standards. Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess study quality. The summary sensitivity and specificity were estimated using the bivariate model, and hierarchical summary receiver operating characteristic (HSROC) parameters were calculated and plotted. Results: Of 5492 citations of interest, 34 articles contained the diagnostic accuracy data. Of these, results for the small bowel and the colorectum were reported separately in 19 studies and jointly by 21 studies. The meta-analytic summary sensitivity and specificity under the bivariate model were 90.9% (95% CI, 85.8%–94.2%) and 90.2% (95% CI, 81.9%–95.0%), respectively. The sensitivities and specificities of individual studies ranged from 55% to 100% and 51% to 100%, respectively. Substantial heterogeneity was observed in both sensitivity (I2=84.9%) and specificity (I2=78.8%). The HSROC curve also showed considerable heterogeneity between studies. Conclusion: Although the meta-analytic summary accuracy of MRI was high for the diagnosis of bowel inflammation in CD, the summary estimates might be unreliable due to the presence of high heterogeneity.(AU)

Antecedentes: El objetivo de esta revisión sistemática y metaanálisis fue determinar el rendimiento de la resonancia magnética nuclear (RM) en el diagnóstico de la inflamación intestinal y la actividad de la enfermedad en la enfermedad de Crohn (EC). Métodos: Se realizaron búsquedas sistemáticas en las bases de datos de literatura biomédica de MEDLINE, Embase y Web of Science para identificar estudios que investigaran la precisión diagnóstica de la RM en el diagnóstico de la inflamación intestinal y la actividad de la enfermedad en la EC comparándola con estándares de referencia. Evaluación de la calidad de los estudios de precisión diagnóstica: se utilizó la herramienta 2 para evaluar la calidad del estudio. La sensibilidad y la especificidad resumidas se estimaron mediante el modelo bivariado, y se calcularon y trazaron los parámetros de características operativas del receptor resumidas jerárquicas (HSROC). Resultados: De 5.492 citas de interés, 34 artículos contenían datos de precisión diagnóstica. De estos, los resultados para el intestino delgado y el colorrectal se informaron por separado en 19 estudios y en forma conjunta en 21 estudios. La sensibilidad y la especificidad del resumen metanalítico bajo el modelo bivariado fueron del 90,9% (IC del 95%, 85,8%-94,2%) y el 90,2% (IC del 95%, 81,9%-95,0%), respectivamente. Las sensibilidades y especificidades de los estudios individuales variaron del 55 al 100% y del 51 al 100%, respectivamente. Se observó heterogeneidad sustancial tanto en la sensibilidad (I2=84,9%) como en la especificidad (I2=78,8%). La curva HSROC también mostró una considerable heterogeneidad entre los estudios. Conclusión: Aunque la precisión del resumen metaanalítico de la RM fue alta para el diagnóstico de inflamación intestinal en la EC, las estimaciones del resumen pueden no ser confiables debido a la presencia de una gran heterogeneidad.(AU)

Magnetic resonance imaging for evaluation of bowel inflammation and disease activity in Crohn's disease: A systematic review and meta-analysis.

BACKGROUND: The aim of this systematic review and meta-analysis was to determine the performance of magnetic resonance imaging (MRI) in the diagnosis of bowel inflammation and disease activity in Crohn's disease (CD). METHODS: MEDLINE, Embase and Web of Science databases of biomedical literature were systematically searched to identify studies that investigated the diagnostic accuracy of MRI in diagnosing bowel inflammation and disease activity in CD by comparing it with reference standards. Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess study quality. The summary sensitivity and specificity were estimated using the bivariate model, and hierarchical summary receiver operating characteristic (HSROC) parameters were calculated and plotted. RESULTS: Of 5492 citations of interest, 34 articles contained the diagnostic accuracy data. Of these, results for the small bowel and the colorectum were reported separately in 19 studies and jointly by 21 studies. The meta-analytic summary sensitivity and specificity under the bivariate model were 90.9% (95% CI, 85.8%-94.2%) and 90.2% (95% CI, 81.9%-95.0%), respectively. The sensitivities and specificities of individual studies ranged from 55% to 100% and 51% to 100%, respectively. Substantial heterogeneity was observed in both sensitivity (I2=84.9%) and specificity (I2=78.8%). The HSROC curve also showed considerable heterogeneity between studies. CONCLUSION: Although the meta-analytic summary accuracy of MRI was high for the diagnosis of bowel inflammation in CD, the summary estimates might be unreliable due to the presence of high heterogeneity.

Hyperpolarized 3 helium MRI measured apparent diffusion coefficient and its correlations with pulmonary functions tests in patients with chronic obstructive pulmonary disease: A meta-analysis.

BACKGROUND: This study evaluates role of hyperpolarized 3 helium (3 He) MRI measured apparent diffusion coefficient (ADC) in examining pulmonary function of chronic obstructive pulmonary disease (COPD) patients. METHODS: After literature search in electronic databases, studies were selected by following precise eligibility criteria. Meta-analyses were performed to estimate mean difference in ADC between COPD patients and healthy individuals and to seek correlations between lung ADC and pulmonary function. Metaregression analyses were performed to seek relationships between ADC and age, gender, BMI, cigarette pack-years, and pulmonary function tests. RESULTS: Twenty-five studies (622 COPD patients and 469 healthy controls) were included. Lung ADC was 0.402 (95% confidence interval [CI]: 0.374, 0.429) in COPD patients and 0.228 (95% CI: 0.205, 0.252) in healthy individuals (mean difference 0.160 [95% CI: 0.127, 0.193]; p < 0.001). In metaregression, age (coefficient: 0.006; p = 0.004), pack-years (coefficient: 0.005; p = 0.018), forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio (coefficient: -1.815; p = 0.007), percent predicted diffusion capacity of carbon monoxide (DLCO) (coefficient: -0.004; p = 0.008), and percent predicted inspiratory capacity (coefficient: -0.004; p = 0.012) were significantly associated with ADC in COPD patients. In meta-analysis of correlation coefficients, ADC was significantly correlated with FEV1 (r = -0.62; p < 0.00001), FEV1/FVC (r = -0.80; p < 0.00001), DLCO (r = -0.85; p < 0.00001), functional residual capacity (r = 0.71; p < 0.00001), reserve volume (r = 0.53; p = 0.0001), and emphysema index (r = 0.89; p < 0.00001). CONCLUSION: Hyperpolarized 3 He MRI measured ADC was higher in COPD patients than in healthy individuals and was inversely associated with FEV1, FEV1/FVC, DLCO, and inspiratory capacity.

[Significance and Expressions of MMP-1, TIMP-1 and TGF-ß1 in Valve Tissue of Rheumatic Heart Disease].

OBJECTIVES: To explore expressions of matrix metalloproteinase-1 (MMP-1), tissue inhibitor of metalloproteinases-1 (TIMP-1) and transforming growth factor-ß1 (TGF-ß1) in valve tissue of rheumatic heart disease (RHD), and to analyzed their roles in RHD. METHODS: The expressions of MMP-1, TIMP-1 and TGF-ß1 proteins and mRNAs were tested by Western blot and RT-PCR methods in valve tissues in participants with (experimental group, n=30) and without RHD (control group, n=15). Collagen fibers were detected by Masson staining, and collagen volume fraction (CVF) was caculated. The correlations of CVF and the expressions of MMP-1, TIMP-1 and TGF-ß1 were analyzed. RESULTS: The collagen fibers, CVF, and the protein and mRNA expressions of MMP-1 and TGF-ß1 in experimental group were higher than those in control group, while the protein and mRNA expressions of TIMP-1 in experimental group were lower than those in control group. The expression of TIMP-1 was negatively correlated with TGF-ß1 and CVF in valve tissues, while MMP-1 was positively correlated with them. The expression of TGF-ß1 was positively correlated with CVF in valve tissues. CONCLUSIONS: MMP-1, TIMP-1 and TGF-ß1 contribute to the progression of fibrosis in RHD.

[Experimental investigation of non-heart-beating donor in the rat lung transplantation].

OBJECTIVE: To explore the impact of different warm ischemia time on structure and function of the non-heart-beating donor lung and to find out the feasibility of non-heart-beating donor in rat lung transplantation. METHODS: Sixty Sprague-Dawley rats were randomly divided into 3 groups: heart-beating donor (HBD) group, non-heart-beating donor (NHBD) with 30 minutes of warm ischemia time (WIT) group and NHBD with 60 minutes of WIT group. Each group has 10 pairs (the donors and the recipients). The donor lungs of group HBD were flushed with low potassium dextran (LPD) solution at 4 degrees C after asystolia while the lungs of group NHBD-30 and group NHBD-60 remained ventilated at the room temperature for 30 and 60 minutes after asystolia and then were flushed with LPD solution. All the donor lungs remained inflated when they were stored in LPD solution at 4 degrees C for 4 hours. The recipient rat underwent left thoracotomy, and then orthotopic left lung transplantation. Followed by a right thoracotomy, the right pulmonary hilum were ligated with one-hour reperfusion and ventilation. RESULTS: All the recipients in group HBD and group NHBD-30 survived the observation period of one hour with excellent gas exchange, whereas 4 of recipients in group NHBD-60 survived for 10 minutes after the ligation of right pulmonary hilum and 3 for 20 minutes. The pulmonary compliance, ultrastructure, energy metabolite and other markers revealed no significant differences between group HBD and group NHBD-30 (P > 0.05). But the differences between group NHBD-60 and other two groups were significant (P < 0.05). CONCLUSIONS: The adoption of non-heart-beating donor could be a safe and effective method to expand the lung donor pool. The NHBD lung with 30 minutes of WIT may be suitable for lung transplantation in rat.

Immunosuppression induction with daclizumab and antithymocyte globulin in cardiac transplantation: clinical experience with 8 cases.

OBJECTIVE: To review the clinical experience of immunosuppression induction therapy to prevent acute rejection in 8 patients with cardiac transplant. METHODS: Between June, 2000 and May, 2002, 8 patients with end-stage dilated cardiomyopathy undergoing orthotopic cardiac transplantation received induction therapy with two-dose daclizumab (1.0 mg/kg), given intravenously within 12 h before cardiac-transplantation surgery and two weeks thereafter, and with an initial 5-day course of intravenous antithymocyte globulin (100 mg/d) following transplantation. Cyclosporine or tacrolimus, mycophenolate mofetil or azathioprine, and prednisolone were applied for immunosuppression maintenance. RESULTS: No death occurred during the follow-up. Routine endomyocardial biopsies in all cases performed in the early stage detected only mild rejection, and no acute allograft or renal dysfunction was found. Three patients developed opportunistic infection, and only one had late acute rejection in the 14th post-transplantation month. CONCLUSIONS: Induction therapy with intravenous daclizumab and antithymocyte globulin is effective to prevent acute rejection and alleviate organ dysfunction in cardiac transplantation, but might increase the chance of infections.

[Clinical research of the implantation of phakic anterior chamber intraocular lens for high myopia].

OBJECTIVE: To investigate the efficacy and safety of the implantation of phakic anterior chamber intraocular lens (IOL) for high myopia. METHODS: A consecutive group of 73 eyes in 41 patients with -7.00 to -30.00 diopters (D) of myopia were implanted. RESULTS: All of 73 eyes were implanted successfully and have been followed-up for 3 m (months). The uncorrected visual acuity was from FC/33 cm to 0.2 pre-operatively and 0.1 to 1.0 3 m post-operatively. The best corrected visual acuity (BCVA) was from 0.05 to 1.0 pre-operatively and 0.1 to 1.0 3 m post-operatively. The post-operative BCVA of every eye was not worse than the pre-operative one. The refractive diopters were from -7.00 to -30.00 D pre-operatively and -6.00 to +2.50 D 3 m post-operatively. There were no significant differences between pre- and 3 m post-operative mean corneal astigmatism (t = 1.751, P = 0.082) and mean intraocular pressure (IOP) (t = 1.181, P = 0.240), respectively. The mean counts of endothelial cells was (2 680 +/- 538)/mm(2) pre-operatively and (2 514 +/- 420)/mm(2) 3 m post-operatively. There was no significant difference (t = 1.182, P = 0.242) though it decreased 6.19%. No severe complications occurred. CONCLUSIONS: The implantation of phakic anterior chamber IOL for high myopia is predictable, reversible and controllable with simple manipulation. No severe complication occurred in 3 m post-operatively, and long-time follow-up is still required.

[Implantation of phakic anterior chamber intraocular lens for high myopia]

OBJECTIVE: To investigate the efficacy and safety of the implantation of phakic anterior chamber intraocular lens for high myopia. METHODS: A consecutive group of 29 eyes in 16 patients with (-7.00 to -30.00) D of myopia were implanted. RESULTS: All of the 29 eyes were implanted successfully and followed-up 3 approximate, equals 6 months. The mean best corrected visual acuity was 0.50+/-0.26 pre-operatively and 0.73+/-0.263 months post-operatively, there was no significant difference t=2.043, P=0.051 . The mean refractive diopter was -18.03+/-5.54 D pre-operatively and -0.82+/-1.54 D post-operatively t=30.899 P=0.000 ; The mean intraocular pressure was 2.091+/-0.380 kPa pre-operatively and (1.734+/-0.572)kPa post-operatively t=1.98 P=0.07 ; The mean counts of endothelial cells was (2704+/-390 /mm2 pre-operatively and (2 519+/-278)/mm2 post-operatively (t=1.16 P=0.26). CONCLUSION: The implantation of phakic anterior chamber intraocular lens for high myopia is predictable, reversible and controllable with simple manipulation. Long- time following-up is still required.