The diagnostic accuracy of intraoperative frozen section biopsy for diagnosis of sentinel lymph node metastasis in breast cancer patients: a meta-analysis.

Sentinel lymph node (SLN) sampling is important for evaluating the nodal stage of breast cancer when the axillary nodes are clinically free of metastasis. The intraoperative frozen section (IFS) of SLN is used for lymph node assessment. This meta-analysis aims to provide evidence about the diagnostic accuracy and the applicability of IFS of SLN in breast cancer patients. Data were collected by searching PubMed, Cochrane, Scopus, and Web of Science electronic databases for trials matching our eligibility criteria. The statistical analysis included the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and pooled studies' diagnostic odds ratio outcomes. The analyses were conducted using the Open Meta-analyst software. This meta-analysis pooled the results of 110 studies. The overall sensitivity of IFS for SLN metastasis was 74.7%; 95% CI [72.0, 77.2], P < 0.001. It was 31.4% 95% CI [25.2, 38.3], P < 0.001 for the micro-metastasis, and 90.2%; 95% CI [86.5, 93.0], P < 0.001 for the macro-metastasis. The overall specificity was 99.4%; 95% CI [99.2, 99.6], P < 0.001. The overall positive likelihood ratio was 121.4; 95% CI [87.9, 167.6], P < 0.001, and the overall negative likelihood ratio was 0.226; 95% CI [0.186, 0.274], P < 0.001. The overall diagnostic odds ratio of IFS for diagnosing SLN metastasis was 569.5; 95% CI [404.2, 802.4], P < 0.001. The intraoperative frozen section of SLN has good sensitivity for diagnosing breast cancer macro-metastasis. However, the sensitivity is low for micro-metastasis. The specificity is very satisfactory.

Efficacy of dietary nitrate-rich beetroot juice supplementation in patients with chronic obstructive pulmonary disease (COPD): A systematic review and meta-analysis.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory lung disease causing airflow obstruction from the lungs reducing exercise tolerance. It is one of the leading causes of respiratory dysfunction worldwide. Nitric Oxide (NO) may have a significant role in this inflammatory reaction to improve exercise capacity. AIM: To evaluate the effect of dietary nitrate ingestion for COPD patients. METHODS: We searched Scopus, PubMed, Cochrane, and Web of Science databases till August 2020 and updated the search in December 2020 using relevant keywords. All search results were screened for eligibility. We extracted the data from the included articles and pooled them as mean difference (MD) with a 95% confidence interval (CI), using Review Manager software (ver. 5.4). RESULTS: A pooled analysis from eight included trials showed no significant difference between dietary nitrate-rich beetroot juice and placebo in systolic blood pressure, diastolic blood pressure, heart rate, 6-min walk test, cycling ergometry endurance time, and maximum rate of oxygen consumption (VO2). On the other hand, nitrate-rich beetroot juice significantly increased the Borg Rating of Perceived Exertion (RPE) scale more than the placebo (MD = -0.77; 95% CI [0.18, 1.37], P = 0.01). CONCLUSION: There is no significant effect of nitrate-rich beetroot juice on cardiovascular events as systolic, diastolic blood pressure, and heart rate, or exercise performance as 6-min walk test, and cycling ergometry endurance time, or maximum rate of oxygen consumption (VO2). On the other hand, nitrate-rich beetroot juice improves the Borg Rating of Perceived Exertion (RPE) scale reflecting an increased exercise and physical activity level.