Spinal Reirradiation-Mediated Myelopathy: A Systematic Review and Meta-Analysis.

Reirradiation of the spine is carried out in 42% of patients who do not respond to treatment or have recurrent pain. However, there are few studies and data on the effect of reirradiation of the spine and the occurrence of acute and chronic side-effects caused by reirradiation, such as myelopathy, in these patients. This meta-analysis aimed to determine the safe dose in terms of biological effective dose (BED), cumulative dose and dose interval between BED1 and BED2 to decrease or prevent myelopathy and pain control in patients undergoing radiation therapy in the spinal cord. A search was carried out using EMBASE, MEDLINE, PUBMED, Google Scholar, Cochrane Collaboration library electronic databases, Magiran, and SID from 2000 to 2022 to recognise qualified studies. In total, 17 primary studies were applied to estimate the pooled effect size. The random effects model showed that the pooled BED in the first stage, the BED in the second stage and the cumulative BED1 and BED2 were estimated at 77.63, 58.35 and 115.34 Gy, respectively. Studies reported on dose interval. The results of a random effects model showed that the pooled interval was estimated at 13.86 months. The meta-analysis revealed that using appropriate BED1 and/or BED2 in a safe interval between the first and second phases of treatment can have an influential role in preventing or reducing the effects of myelopathy and regional control pain in spinal reirradiation.

The level of allergens in dust samples collected from selected schools in Shiraz, Iran and its asthma-risk implications.

BACKGROUND: Both home and school are important places where children are exposed to various indoor allergens. This study aimed to identify the profile of indoor allergens in schools and its impact on asthma development. METHODS: A total of 104 classrooms from 52 schools were selected for dust collection during the fall of 2017. The levels of indoor allergens including dust mite (Der f1, Der p1), cat (Fel d1), cockroach (Bla g1) and mouse (Mus m1) were measured by enzyme linked immunosorbent assay (ELISA). The diagnosis of asthma was made in all students of the selected classes by the allergist. The collected data were analyzed using SPSS version 21.0. RESULTS: Out of 2816 students in the selected classes, 180 students were involved with asthma. Students were mostly exposed to Bla g1 (83.1%), followed by Der f1 (51.5%), Mus m 1 (45.5%), Der p1 (8.9%) and Fel d1 (7.9%) in the dust collected from 101 classrooms. Although levels of all studied allergens in the settled dust of the classrooms were low, there was a relationship between Fel d1 in the classroom dust and development of asthma. CONCLUSION: This study showed considerable levels of cockroach allergens in schools. Exposure to cat allergen in our schools played an important role in asthma development; further school-based investigations require evaluating the role of classroom allergen on asthma development.

Color Doppler ultrasonography diagnostic value in detection of malignant nodules in cysts with pathologically proven thyroid malignancy: a systematic review and meta-analysis.

AIMS: Today, the color Doppler ultrasonography is used to further evaluate suspected malignant tumors. This study investigates the malignant thyroid nodules using color Doppler. METHODS: After extracting true positive, false positive, false negative, and true negative among included studies, a quality was evaluated by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (with 95% confidence interval) were found using a random effect model. Summary receiver operating characteristic curves (SROC) were used to assess relationship between sensitivity and specificity. The area under the curve of the SROC was calculated to estimate the performance of color Doppler ultrasound to distinguish malignant thyroid nodules. Our registration code in PROSPERO is CRD42018111198. RESULTS: Of 1125 articles, 288 articles were selected for the further investigation. After excluding irrelevant and poor articles, 20 studies were included for the meta-analysis. According to a random effect model, the pooled sensitivity and specificity of color Doppler ultrasound to distinguish malignant thyroid nodules were estimated as 0.74 (95% CI 0.62-0.83; [Formula: see text]) and 0.70 (95% CI 0.56-0.81; [Formula: see text]), respectively. The SROC curve consists of representing the paired results for sensitivity and specificity. According to SROC, AUC = 0.78 (95% CI 0.74-0.81) is between 0.75 and 0.92, so that color Doppler ultrasound has a good accuracy. CONCLUSION: Color Doppler is a valuable non-invasive method for evaluating thyroid nodules, and it is a high-sensitivity diagnostic tool for assessing thyroid nodules. Resistive index > 0.75 and a pattern III or more in color Doppler predicts malignant with the confidence. Due to its precision, cost-efficiency, easy access, and non-invasive nature, color Doppler should be included in the standard clinical protocol for the decision-making period and the treatment evaluation.