Diagnostic value of PET with different radiotracers and MRI for recurrent glioma: a Bayesian network meta-analysis.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic accuracy of 6 different imaging modalities for differentiating glioma recurrence from postradiotherapy changes by performing a network meta-analysis (NMA) using direct comparison studies with 2 or more imaging techniques. DATA SOURCES: PubMed, Scopus, EMBASE, the Web of Science and the Cochrane Library were searched from inception to August 2021. The Confidence In Network Meta-Analysis (CINeMA) tool was used to evaluate the quality of the included studies with the criterion for study inclusion being direct comparison using 2 or more imaging modalities. DATA EXTRACTION AND SYNTHESIS: The consistency was evaluated by examining the agreement between direct and indirect effects. NMA was performed and the surface under the the cumulative ranking curve (SUCRA) values was obtained to calculate the probability of each imaging modality being the most effective diagnostic method. The CINeMA tool was used to evaluate the quality of the included studies. MAIN OUTCOMES AND MEASURES: Direct comparison, inconsistency test, NMA and SUCRA values. RESULTS: A total of 8853 potentially relevant articles were retrieved and 15 articles met the inclusion criteria. 18F-FET showed the highest SUCRA values for sensitivity, specificity, positive predictive value and accuracy, followed by 18F-FDOPA. The quality of the included evidence is classified as moderate. CONCLUSION AND RELEVANCE: This review indicates that 18F-FET and 18F-FDOPA may have greater diagnostic value for glioma recurrence relative to other imaging modalities (Grading of Recommendations, Assessment, Development and Evaluations B). PROSPERO REGISTRATION NUMBER: CRD42021293075.

Diagnostic accuracy of circulating-free DNA for the determination of hepatocellular carcinoma: a systematic review and meta-analysis.

INTRODUCTION: Circulating cell-free DNA (cfDNA) is a good diagnostic tool for hepatocellular carcinoma as it can comprehensively reflect the heterogeneity of tumors and aid in their early detection. This study aimed to assess the diagnostic value of circulating cfDNA for hepatocellular carcinoma. METHODS: PubMed, EMBASE, Web of Science, Cochrane Library, and Scopus databases were searched to identify all relevant literature from their dates of establishment to 6 April 2022, and a total of 2,467 articles were found. Methodological quality assessment was performed using QUADAS-2. RESULTS: Fifteen articles with 3,686 patients were included in this study after screening. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve were 0.83 (95% confidence interval [CI]: 0.78, 0.87), 0.90 (95% CI: 0.86, 0.93), 8.4 (95% CI: 5.9, 12.0), 0.19 (95% CI: 0.15, 0.24), 44 (95% CI: 30, 66), and 0.93 (95% CI: 0.90, 0.95), respectively. Deek's funnel plot test did not show significant publication bias (P = 0.28). CONCLUSIONS: Results of this meta-analysis suggest that circulating cfDNA has moderate sensitivity and excellent specificity for the detection of hepatocellular carcinoma as a noninvasive test (0.83 and 0.90, respectively).

Is Gadoxetic Acid Disodium (Gd-EOB-DTPA)-Enhanced Magnetic Resonance Imaging an Accurate Diagnostic Method for Hepatocellular Carcinoma? A Systematic Review with Meta-Analysis.

BACKGROUND: Gadolinium Ethoxybenzyl Diethylenetriamine Pentaacetic Acid (Gd- EOB-DTPA) has become a widely used liver-specific contrast agent worldwide, but its value and limitations as a diagnostic technique with Hepatocellular Carcinoma (HCC), have not been assessed. INTRODUCTION: A review of the latest evidence available on the diagnostic value of Gd-EOB-DTPA- enhanced MRI for the evaluation of HCC is reported. METHODS: A systematic, comprehensive literature search was conducted with PubMed, Scopus, EMBASE, the Web of Science, the Cochrane Library, CNKI, vip, wanfangdata and CBM from inception to June 31, 2020. The QUADAS-2 tool was used to evaluate the quality of the included studies. Pooled Sensitivity (SEN), Pooled Specificity (SPE), pooled positive likelihood ratio (PLR), pooled negative likelihood ratio (NLR), pooled diagnostic odds ratio (dOR) and summary receiver operating characteristic (SROC) curves were calculated to assess the diagnostic value of the individual diagnostic tests. RESULTS: A total of 47 articles were included, involving a total of 6362 nodules in 37 studies based on per-lesion studies. There were 13 per-patient studies, including a total of 1816 patients. The results of the meta-analysis showed that the per-lesion studies pooled weighted values were SEN 0.90 [95% confidence interval (CI): 0.87-0.92], SPE 0.92 (95% CI: 0.90-0.94), PLR 11.6 (95% CI: 8.8-15.2), NLR 0.11 (95% CI: 0.09-0.14) and dOR 107.0 (95% CI: 74.0-155.0). The AUC of the SROC curve was 0.96. The per-patient studies pooled weighted values were SEN 0.84 [95% confidence interval (CI): 0.78-0.89], SPE 0.92 (95% CI: 0.88-0.94), PLR 10.4 (95% CI: 7.4-14.6), NLR 0.17 (95% CI: 0.12-0.24) and dOR 61.0 (95% CI: 42.0-87.0). The AUC of the SROC curve was 0.95 and subgroup analyses were performed. CONCLUSION: The diagnostic value of Gd-EOB-DTPA for HCC was quantitatively evaluated in a per-lesion study and a per-patient study using a systematic review of the literature. A positive conclusion was drawn: Gd-EOB-DTPA-enhanced imaging is a valuable diagnostic technique for HCC. The size of the nodules and the selection of the imaging diagnostic criteria may affect the diagnostic sensitivity.

Analysis of gastrointestinal symptoms in 80 patients with coronavirus disease 2019 / 中华危重病急救医学

Objective:To investigate the clinical characteristics of gastrointestinal symptoms in patients with coronavirus disease 2019 (COVID-19) during the whole disease process, and provide reference for etiological diagnosis and treatment.Methods:The clinical data of patients with COVID-19 admitted in the Infectious Diseases Branch of the First Affiliated Hospital of University of Science and Technology of China from January 22nd, 2020 to March 8th, 2020 were analyzed retrospectively. According to whether there were gastrointestinal symptoms (poor appetite, nausea/vomiting and diarrhea), all patients were divided into gastrointestinal symptom group and asymptomatic group. The characteristics of gastrointestinal symptoms, such as poor appetite, nausea, vomiting and diarrhea were counted and analyzed, and the correlation between gastrointestinal symptoms and gender, age, basic diseases, disease severity, laboratory examination and drug treatment were analyzed.Results:A total of 80 COVID-19 patients were involved, 43 cases (53.8%) presented with poor appetite, 17 cases (21.3%) had nausea and vomiting, and 33 cases (41.3%) had diarrhea. Among them, 5 cases, 1 case and 4 cases respectively preformed poor appetite, nausea/vomiting and diarrhea before admission, while the others experienced gastrointestinal symptoms within 48 hours after admission. Duration of poor appetite, nausea/vomiting and diarrhea (days) of all patients were 5.3±2.1, 2.2±1.0 and 1.4±0.9, respectively. The patients with poor appetite were older than those without symptoms (years old: 48.2±17.6 vs. 39.3±15.1), albumin (Alb) level and the lymphocytes ratio were lower than those in asymptomatic group [Alb (g/L): 39.8 (35.7, 45.1) vs. 46.1 (42.6, 49.4), lymphocytes ratio: 0.19 (0.09, 0.28) vs. 0.28 (0.17, 0.35)], while the neutrophil ratio, the levels of C-reactive protein (CRP), D-dimer, and lactate dehydrogenase (LDH) were higher than those in asymptomatic group [the neutrophil ratio: 0.74 (0.61, 0.85) vs. 0.64 (0.52, 0.76), CRP (mg/L): 21.4 (3.9, 52.9) vs. 5.6 (2.4, 14.0), D-dimer (mg/L): 0.2 (0.2, 0.5) vs. 0.2 (0.1, 0.3), LDH (μmol·s -1·L -1): 4.49 (3.59, 5.19) vs. 3.12 (2.77, 4.90)]; at the same time, more traditional Chinese medicine was used in the patients with gastrointestinal symptoms [65.1% (28/43) vs. 40.5% (15/37), all P < 0.05]. In addition, 14 cases of 18 patients with cardiovascular diseases presented with poor appetite, 7 patients had nausea and vomiting symptoms. All of the 3 patients with chronic kidney disease presented with poor appetite, nausea and vomiting, and 2 of them had diarrhea. Conclusions:The gastrointestinal symptoms in patients with COVID-19 are common. Whether it is caused by the virus or related drugs, diet and mental conditions, clinicians should analyze the causes of these symptoms timely, and then provide a better treatment for patients with COVID-19.

Research progress of magnetic resonance imaging in hepatocellular carcinoma / 中华肝脏病杂志

Hepatocellular carcinoma (HCC) is the most common malignant tumors of liver. Rational treatment in early stage of HCC can significantly increase the survival rate of patients. Detection of early-stage liver lesions through diffusion-weighted imaging, diffusion kurtosis imaging, incoherent motion within voxels, magnetic resonance spectroscopy imaging, dynamic contrast-enhanced imaging, or other functional imaging can accurately evaluate grade of malignancy and guide towards the curative effect of different treatment schemes. Volumetric interpolated breath-hold examination (VIBE) with three techniques, namely, CAIPIRINHA, Dixon, and TWIST, i.e., CDT-VIBE sequence can provide multiple sets of arterial phase images in a short time, and detect small foci transient enhancement that cannot be detected by other examinations, and the differences in initial enhancement phase of apparent lesions are of great significance for suggesting hemodynamic characteristics. In addition, magnetic resonance imaging predicts microvascular invasion of HCC, i.e., indirectly predicts HCC lesions recurrence rate, and overall survival time after liver transplantation. This article reviews the current research progress of magnetic resonance imaging technology in HCC.

Laparoscopic surgery for middle or lower rectal cancer / 中国内镜杂志

Objective To compare and analyze the effect of laparoscopic surgery and open toperation of rectal can﹣cer in middle or lower positions. Methods 128 patients with middle or lower rectal cancer were randomly divided into observation group and control group, 64 cases in each one, Laparoscopic surgery for observation group and con﹣trol group using traditional open surgery. Operative time, blood loss, ambulation time, length of stay, postoperative complications, anus-preserving, the recurrence during follow-up were compared between the two groups. Results Blood loss, ambulation time, length of hospital stay, the observation group were significantly less than the control group (P 0.05). Nine patients in control group with complications, the rate was 14.1 %; postoperative complication were observed in 2 cases, the rate was 3.1 %; complication rate in observation group was significantly lower than the control group (P 0.05). Con﹣clusions Compared with open operation,laparoscopic surgery is safe and effective, can reduce the surgical trauma and complications, shorten hospitalization time, improve the anus-preserving rate, worth clinical promotion.

Gadoxetic acid disodium (Gd-EOBDTPA)-enhanced magnetic resonance imaging for the detection of hepatocellular carcinoma: a meta-analysis.

PURPOSE: To evaluate the diagnostic value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: A systematic, comprehensive literature search was conducted in PubMed (2004 [Gd-EOB-DTPA was first approved in Europe in 2004] to April 2013), Embase (2004 to April 2013), Web of Science (2004 to April 2013), and the Cochrane Library (2004 to April 2013). The Quality Assessment of Diagnostic Studies (QUADAS) items was used to evaluate the quality of the included studies. Stata 12.0 was used to analyze the data. Pooled sensitivity (SEN), pooled specificity (SPE), pooled positive likelihood ratio (PLR), pooled negative likelihood ratio (NLR), pooled diagnostic odds ratio (dOR), and summary receiver operating characteristic (SROC) curves were calculated to assess the diagnostic value of the individual diagnostic tests. RESULTS: A total of 11 articles were included, involving 1578 nodules from four countries. The results of the meta-analysis showed that the pooled SEN, SPE, and SROC curve values were 0.92 (95% confidence interval [CI]: 0.89-0.94) 0.95 (95% CI: 0.93-0.97), and 0.98 (95% CI: 0.95-0.99), respectively, and subgroup analyses were performed. CONCLUSION: Gd-EOB-DTPA-enhanced MRI has value for the detection of HCC; in particular, it has high sensitivity for the detection of lesions larger than 10 mm.

The relative renal safety of iso-osmolar contrast media compared with low-osmolar contrast media in intravenous contrast-enhanced CT: a Meta-analysis / 中华肾脏病杂志

Objective To compare the nephrotoxicity of the iso-osmolar contrast media (iodixanol) to low-osmolar contrast media (LOCM) in intravenous contrast-enhanced CT.Methods Randomized controlled trials (RCTs) of iodixanol or low-osmolar contrast media in intravenous contrastenhanced CT were searched in the database of VIP,CBM,CNKI,Wanfang,PubMed,EMBASE,Web of Science,Cochrane Library from their start year to July 2012.Screening and information extracted were did by two researchers independently.The quality of the included documents was evaluated by the criterion of Cochrane handbook.Revman software (version 5.0) of the Cochrane collaboration was used in data analysis.Results There was no significant difference in the incidence of contrast-induced nephropathy (CIN) among 6 trials recruited 907 patients between the iodixanol group and the LOCM group [RR =0.64,95％CI (0.31-1.32),P=0.22] by using serum creatinine increased by more than 44 μmol/L (0.5 mg/dl) as the diagnostic criteria.No considerable difference was existed by using serum creatinine increased by more than 25％ as the diagnostic criteria between the two groups [RR =0.79,95％CI (0.48-1.30),P =0.35].Subgroup analysis showed there was no obvious difference [RR =0.57,95％CI (0.30-1.10),P =0.09] between the two groups in patients with increased baseline of serum creatinine.No obvious difference were gained in normal baseline group [RR =1.28,95％CI (0.57-2.86),P =0.55].Conclusion Compared with low-osmolar contrast media,iodixanol is not associated with less CIN in intravenous contrast-enhanced CT.