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World Journal of Surgical Oncology Feb 2021Xpert Bladder Cancer is a detection method developed in recent years, designed with the functions of integrating sample automatically, nucleic acid amplification, and... (Review)
Review
BACKGROUND
Xpert Bladder Cancer is a detection method developed in recent years, designed with the functions of integrating sample automatically, nucleic acid amplification, and target sequence detection. It is a urine assay targeting five mRNAs (CRH, IGF2, UPK1B, ANXA10, and ABL1). The purpose of this article is to review the accuracy of Xpert Bladder Cancer in the follow-up diagnosis of bladder cancer and evaluate the role of Xpert Bladder Cancer in detecting the recurrence of non-muscle-invasive bladder cancer in the round.
METHODS
In the database of Embase, PubMed, Web of Science, and Cochrane Library, the articles published up to October 13, 2020, were searched and screened based on the exclusion and inclusion criteria, and data were extracted from the included studies. The sensitivity, specificity, negative likelihood ratio, positive likelihood ratio summary of receiver operating characteristic curves, and diagnostic odds ratio were combined by the Meta-DiSc 1.4 software. The Stata 12.0 software was used to obtain the assessment of publication bias.
RESULTS
A total of 8 articles involving eight fourfold tables were finally identified. The pooled sensitivity and specificity of Xpert Bladder Cancer in the diagnosis of bladder cancer were 0.71 and 0.81, respectively. The positive likelihood ratio and negative likelihood ratio were 3.74 and 0.34, respectively. The area under the curve was 0.8407. The diagnostic odds ratio was 11.99. Deeks' funnel plot asymmetry test manifested no publication bias.
CONCLUSIONS
In summary, Xpert Bladder Cancer presents high accuracy and specificity in monitoring bladder cancer compared with cystoscopy. More researches are still required to further confirm this conclusion.
Topics: Carcinoma; Humans; Neoplasm Recurrence, Local; Prognosis; RNA, Messenger; Sensitivity and Specificity; Urinary Bladder Neoplasms
PubMed: 33563292
DOI: 10.1186/s12957-021-02154-0 -
Journal of Tissue Viability Aug 2021To investigate the effect of support surface usage and positions on interface pressure during surgery. (Randomized Controlled Trial)
Randomized Controlled Trial
AIM OF THE STUDY
To investigate the effect of support surface usage and positions on interface pressure during surgery.
MATERIALS AND METHODS
This randomized controlled experimental study was conducted between October 2018 and June 2019. The study included patients who had planned surgery in supine and prone positions. The sample size was 72 patients. Patients were assigned to three groups (gel support surface, viscoelastic support surface and standard operating table) according to the determined randomization table. During the surgery, the pressure in the patients' body was recorded. The statistics program IBM SPSS Statistics 25.0 packaged software was used in the analyses of data.
RESULTS
There was no statistically significant difference between the total body average interface pressure (mmHg) values between the supporting surfaces in the prone position. There was a statistically significant difference between the total body average interface pressure (mmHg) values between the support surfaces in the supine position, and the average interface pressure measured on the viscoelastic foam support surface was significantly lower than the gel support surface and the standard operating table.
CONCLUSION
In the study, the use of viscoelastic foam support surface was found to be more effective than the use of a standard operating table and gel support surface. Viscoelastic foam support surface is recommended for patients at risk for pressure injury in the operating room.
Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Operating Rooms; Operating Tables; Patient Positioning; Pressure; Pressure Ulcer; Prone Position
PubMed: 33994285
DOI: 10.1016/j.jtv.2021.04.006 -
European Journal of Clinical... Sep 2021Drug protocols in intensive care units may require the concomitant administration of many drugs as patients' venous accesses are often limited. A major challenge for... (Review)
Review
PURPOSE
Drug protocols in intensive care units may require the concomitant administration of many drugs as patients' venous accesses are often limited. A major challenge for clinicians is to limit the risk of simultaneously infusing incompatible drugs. Incompatibilities can lead to the formation of particles and inactivation of drugs, whose consequences on the body have already been indicated. Our objective was to assess current strategies to counter the risk of incompatible infusions and control the resulting clinical consequences.
METHODS
This review was independently conducted by three investigators in respect of the PRISMA statement. Three online databases were consulted. Full-text articles, notes, or letters written in English or French, published or in press between the 1990s and the end of February 2020, with clinical study design, were eligible. Parameters of interest were mainly number and size of particles, and a number of observed/avoided incompatibilities.
RESULTS
All in all, 382 articles were screened, 17 meeting all the acceptance criteria. The strategies outlined and assessed were filtration, the use of multi-lumen devices, the purging of infusion lines, incompatibility tables and databases, and the use of standard operating procedures.
CONCLUSION
Although many strategies have been developed in recent years to address drug incompatibility risks, clinical data is still lacking. All studies with in vitro design were excluded although some current innovative strategies, like niosomes, should be considered and studied by means of clinical data in the future.
Topics: Clinical Protocols; Drug Incompatibility; Filtration; Humans; Infusions, Intravenous; Intensive Care Units
PubMed: 33768303
DOI: 10.1007/s00228-021-03112-1 -
International Journal of Cancer Mar 2023Gestational trophoblastic neoplasia (GTN) patients are treated according to the eight-variable International Federation of Gynaecology and Obstetrics (FIGO) scoring...
Gestational trophoblastic neoplasia (GTN) patients are treated according to the eight-variable International Federation of Gynaecology and Obstetrics (FIGO) scoring system, that aims to predict first-line single-agent chemotherapy resistance. FIGO is imperfect with one-third of low-risk patients developing disease resistance to first-line single-agent chemotherapy. We aimed to generate simplified models that improve upon FIGO. Logistic regression (LR) and multilayer perceptron (MLP) modelling (n = 4191) generated six models (M1-6). M1, all eight FIGO variables (scored data); M2, all eight FIGO variables (scored and raw data); M3, nonimaging variables (scored data); M4, nonimaging variables (scored and raw data); M5, imaging variables (scored data); and M6, pretreatment hCG (raw data) + imaging variables (scored data). Performance was compared to FIGO using true and false positive rates, positive and negative predictive values, diagnostic odds ratio, receiver operating characteristic (ROC) curves, Bland-Altman calibration plots, decision curve analysis and contingency tables. M1-6 were calibrated and outperformed FIGO on true positive rate and positive predictive value. Using LR and MLP, M1, M2 and M4 generated small improvements to the ROC curve and decision curve analysis. M3, M5 and M6 matched FIGO or performed less well. Compared to FIGO, most (excluding LR M4 and MLP M5) had significant discordance in patient classification (McNemar's test P < .05); 55-112 undertreated, 46-206 overtreated. Statistical modelling yielded only small gains over FIGO performance, arising through recategorisation of treatment-resistant patients, with a significant proportion of under/overtreatment as the available data have been used a priori to allocate primary chemotherapy. Streamlining FIGO should now be the focus.
Topics: Pregnancy; Female; Humans; Gestational Trophoblastic Disease; Retrospective Studies; Models, Statistical
PubMed: 36346113
DOI: 10.1002/ijc.34352 -
Journal of Vascular Surgery Aug 2019Iliac conduits (ICs) are used for challenging iliac access during endovascular aortic aneurysm repair (EVAR) with contradictory reports of safety and increased surgical...
OBJECTIVE
Iliac conduits (ICs) are used for challenging iliac access during endovascular aortic aneurysm repair (EVAR) with contradictory reports of safety and increased surgical complications, morbidity, and mortality in national database reviews. The objective of this study was to examine outcomes related to IC placement before or concomitant with EVAR at a high-volume single center.
METHODS
A retrospective analysis of patients who underwent IC placement for endovascular aortic repair from 2006 to 2016 was conducted. Planned and unplanned, as well as staged and concomitant IC for EVAR, thoracic EVAR, and fenestrated/branched EVAR were included. Categorical factors were described using frequencies and percentages. Continuous measures were summarized in comparative tables. Comparisons between the planned and unplanned groups, concomitant and staged groups, and between those with and without a postoperative event were performed using Pearson χ tests, two-sample t-tests, and Wilcoxon rank-sum tests.
RESULTS
A total of 137 patients underwent IC placement, of which 9 were bilateral procedures, for a total of 144 IC placements. IC placement was necessary in 14 EVARs (9.7%), 38 thoracic EVARs (26.4%), and 92 fenestrated/branched EVARs (63.9%). The 30-day related mortality was 2.1% (n = 3). Perioperative morbidities included return to the operating room in five patients (5.6%) for bleeding (n = 4) and graft thrombosis (n = 1), 4 myocardial infarctions (2.8%), 5 episodes of respiratory failure (3.5%), 12 wound complications (8.3%), and 7 renal injuries (4.9%), of which 3 had progression to dialysis (2.1%). Other complications included return to the operating room for endoleak reintervention (n = 3) and late graft infection (n = 1 [0.7%]). There were 112 ICs (77.8%) planned and 65 (45.1%) were staged. Staged ICs were less likely to have postoperative complications (P < .001), respiratory failure (P < .05), infectious complications (P < .05), and postoperative cerebrovascular accidents (P < .05). ICs were done to accommodate 20F to 24F sheath sizes in 131 instances (91.0%). Factors associated with unplanned IC placement were iliac rupture and an inability to advance the endograft in arteries deemed size-appropriate preoperatively (P < .001). Unplanned ICs were associated with higher estimated blood loss (P < .001), operating room transfusion volume (P < .001), and overall complication rates (P < .05). Women (P < .05), preoperative chronic kidney disease (P < .05), and concomitant IC placement (P < .001) were associated with higher overall complication rates. Operative time, estimated blood loss, and operating room transfusion volume were associated with increased rate of complications in comparison between all subgroups (P < .05).
CONCLUSIONS
ICs are a safe and viable option for high-risk patients with challenging iliac artery access for EVVAR. ICs are best performed in a planned fashion or in a staged manner, when feasible.
Topics: Aged; Aged, 80 and over; Aortic Aneurysm; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Databases, Factual; Endovascular Procedures; Female; Hospitals, High-Volume; Humans; Iliac Artery; Male; Postoperative Complications; Prosthesis Design; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 30598354
DOI: 10.1016/j.jvs.2018.10.099 -
Ultrasound in Obstetrics & Gynecology :... Jun 2018To determine the accuracy of ophthalmic artery Doppler in pregnancy for the prediction of pre-eclampsia (PE). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine the accuracy of ophthalmic artery Doppler in pregnancy for the prediction of pre-eclampsia (PE).
METHODS
MEDLINE, EMBASE, CINAHL and The Cochrane Library were searched for relevant citations without language restrictions. Two reviewers independently selected studies that evaluated the accuracy of ophthalmic artery Doppler to predict the development of PE and extracted data to construct 2 × 2 tables. Individual patient data were obtained from the authors if available. A bivariate random-effects model was used for the quantitative synthesis of data. Logistic regression analysis was employed to generate receiver-operating characteristics (ROC) curves and obtain optimal cut-offs for each investigated parameter, and a bivariate analysis was employed using predetermined cut-offs to obtain sensitivity and specificity values and generate summary ROC curves.
RESULTS
A total of 87 citations matched the search criteria of which three studies, involving 1119 pregnancies, were included in the analysis. All included studies had clear description of the index and reference tests, avoidance of verification bias and adequate follow-up. Individual patient data were obtained for all three included studies. First diastolic peak velocity of ophthalmic artery Doppler at a cut-off of 23.3 cm/s showed modest sensitivity (61.0%; 95% CI, 44.2-76.1%) and specificity (73.2%; 95% CI, 66.9-78.7%) for the prediction of early-onset PE (area under the ROC curve (AUC), 0.68; 95% CI, 0.61-0.76). The first diastolic peak velocity had a much lower sensitivity (39.0%; 95% CI, 20.6-61.0%), a similar specificity (73.2%; 95% CI, 66.9-78.7%) and a lower AUC (0.58; CI, 0.52-0.65) for the prediction of late-onset PE. The pulsatility index of the ophthalmic artery did not show a clinically useful sensitivity or specificity at any cut-off for early- or late-onset PE. Peak ratio above 0.65 showed a similar diagnostic accuracy to that of the first diastolic peak velocity with an AUC of 0.67 (95% CI, 0.58-0.77) for early-onset PE and 0.57 (95% CI, 0.51-0.63) for late-onset disease.
CONCLUSIONS
Ophthalmic artery Doppler is a simple, accurate and objective technique with a standalone predictive value for the development of early-onset PE equivalent to that of uterine artery Doppler evaluation. The relationship between ophthalmic Doppler indices and PE cannot be a consequence of trophoblast invasion and may be related to maternal hemodynamic adaptation to pregnancy. The findings of this review justify efforts to elucidate the effectiveness and underlying mechanism whereby two seemingly unrelated maternal vessels can be used for the prediction of a disease considered a 'placental disorder'. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Female; Humans; Ophthalmic Artery; Pre-Eclampsia; Pregnancy; ROC Curve; Sensitivity and Specificity; Ultrasonography, Prenatal
PubMed: 29330892
DOI: 10.1002/uog.19002 -
Gynecologic Oncology Dec 2015Recent reviews on the sentinel lymph node (SLN) procedure in cervical cancer have shown that bilateral SLN detection and ultra staging are safe and superior options... (Review)
Review
OBJECTIVE
Recent reviews on the sentinel lymph node (SLN) procedure in cervical cancer have shown that bilateral SLN detection and ultra staging are safe and superior options compared to a unilateral detection, frozen section and H&E analysis. So far, nobody identified a subgroup of patients in whom a SLN procedure may replace pelvic lymph node dissection (PLND).
METHODS
We searched PubMed, Embase, CINAHL and Cochrane from inception up to November 26, 2014. Studies reporting SLN detection, and/or histological outcome of the SLN were included. Methodological quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool by two independent reviewers. Data to complete 2×2 contingency tables were obtained, and patient-, study- and technique characteristics were extracted. Results were pooled and plotted in forest plots.
RESULTS
Forty-seven studies (4130 patients) were analyzed. Pooled data of diagnostic accuracy on ultra staging (18 studies; 1275 patients) showed a sensitivity of 94% (95% CI 80-99%) and negative predictive values ranging between 91 and 100%. After ultra staging, 19 false negative results remained. Prerequisites such as early FIGO stage (IA2, IB1, IIA primary tumor size <40mm), no suspicious pre-, and per-operative lymph nodes, and bilateral negative SLNs after ultra staging resulted in 1 remaining false negative result among 1257 patients (0.08%). Pooled data on a combined tracer in early stage cervical cancer patients with primary tumor size <20mm (6 studies; 276 patients) resulted in 87% bilateral SLN detection.
CONCLUSIONS
Early stage cervical cancer patients (FIGO IA2, IB1, IIA primary tumor size <40mm) who have no suspicious pre-, and per-operative lymph nodes, and have bilateral negative SLNs after ultra staging, have a residual risk of 0.08% (1/1257) on occult metastases. On the basis of these results we recommend not to perform a full PLND in these patients.
Topics: False Negative Reactions; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Neoplasm Staging; Pelvis; Predictive Value of Tests; Sentinel Lymph Node Biopsy; Uterine Cervical Neoplasms
PubMed: 26416173
DOI: 10.1016/j.ygyno.2015.09.076 -
Therapeutics and Clinical Risk... 2023For the diagnosis of pediatric osteomyelitis, the sensitivity, specificity, and predictive value of erythrocyte sedimentation rate (ESR) were evaluated in this study. (Review)
Review
OBJECTIVE
For the diagnosis of pediatric osteomyelitis, the sensitivity, specificity, and predictive value of erythrocyte sedimentation rate (ESR) were evaluated in this study.
METHODS
A systematic computer-based search was performed for relevant articles focusing on the ESR diagnosis of pediatric osteomyelitis in PubMed, Embase, and the Cochrane Library with an inclusion criteria: 1) the diagnostic utility of ESR for diagnosing osteomyelitis patients under the age of 18;2) two-by-two contingency tables can be obtained. Case reports, review papers, and animal experiments were excluded.
RESULTS
The diagnostic meta-analysis included 8 studies involving 348 children with osteomyelitis, all of whom were tested for ESR. Diagnostic meta-analysis revealed a sensitivity and specificity of 0.90, 95% confidence interval (CI) (0.86-0.93), and 0.50 (95% CI,0.47-0.54) for ESR in pediatric osteomyelitis diagnosis, respectively. The positive likelihood ratio (LR), negative LR, and diagnostic odds ratio were 1.38,(95% CI,1.08-1.78), 0.46, (95% CI,0.26-0.73), and 3.20, (95% CI,1.33-7.69), respectively. The area under the curve (AUC) was determined to be 0.80 based on the summary receiver operating characteristic curve (SROC).
CONCLUSION
The literature on the use of ESR in pediatric osteomyelitis diagnosis was thoroughly reviewed in this study. It was also found that ESR may be useful as a biomarker for pediatric osteomyelitis diagnosis. Due to its low specificity, it should be used in combination with other markers such as C-reactive protein, neutrophil percentage, and white blood cell count.
PubMed: 38089965
DOI: 10.2147/TCRM.S440996 -
HardwareX Sep 2023Traditionally, surgical head immobilization for neurobiological research with large animals is achieved using stereotaxic frames. Despite their widespread use, these...
Traditionally, surgical head immobilization for neurobiological research with large animals is achieved using stereotaxic frames. Despite their widespread use, these frames are bulky, expensive, and inflexible, ultimately limiting surgical access and preventing research groups from practicing surgical approaches used to treat humans. Here, we designed a mobile, low-cost, three-pin skull clamp for performing a variety of neurosurgical procedures on non-human primates. Modeled after skull clamps used to operate on humans, our system was designed with added adjustability to secure heads with small or irregular geometries for innovative surgical approaches. The system has six degrees of freedom with skull pins attached to setscrews for independent, fine-tuned depth adjustment. Unlike other conventional skull clamps which require additional mounting fixtures, our system has an integrated tray with mounting bracket for easy use on most operating room tables. Our system has successfully secured primate heads in the supine and lateral position, allowing surgeons to match surgical approaches currently practiced when operating on humans. The system also expands the opportunity for researchers to utilize imaged-guided robotic surgery techniques. Overall, we hope that our system can serve as an adaptable, affordable, and robust surgery platform for any laboratory performing neurobiological research with large animal models.
PubMed: 37680492
DOI: 10.1016/j.ohx.2023.e00472 -
Neurology. Clinical Practice Jun 2023To evaluate the diagnostic accuracy of the ambulatory EEG (aEEG) at detecting interictal epileptiform discharges (IEDs)/seizures compared with routine EEG (rEEG) and...
BACKGROUND AND OBJECTIVE
To evaluate the diagnostic accuracy of the ambulatory EEG (aEEG) at detecting interictal epileptiform discharges (IEDs)/seizures compared with routine EEG (rEEG) and repetitive/second rEEG in patients with a first single unprovoked seizure (FSUS). We also evaluated the association between IED/seizures on aEEG and seizure recurrence within 1 year of follow-up.
METHODS
We prospectively evaluated 100 consecutive patients with FSUS at the provincial Single Seizure Clinic. They underwent 3 sequential EEG modalities: first rEEG, second rEEG, and aEEG. Clinical epilepsy diagnosis was ascertained based on the 2014 International League Against Epilepsy definition by a neurologist/epileptologist at the clinic. An EEG-certified epileptologist/neurologist interpreted all 3 EEGs. All patients were followed up for 52 weeks until they had either second unprovoked seizure or maintained single seizure status. Accuracy measures (sensitivity, specificity, negative and positive predictive values, and likelihood ratios), receiver operating characteristic (ROC) analysis, and area under the curve (AUC) were used to evaluate the diagnostic accuracy of each EEG modality. Life tables and the Cox proportional hazard model were used to estimate the probability and association of seizure recurrence.
RESULTS
Ambulatory EEG captured IED/seizures with a sensitivity of 72%, compared with 11% for the first rEEG and 22% for the second rEEG. The diagnostic performance of the aEEG was statistically better (AUC: 0.85) compared with the first rEEG (AUC: 0.56) and second rEEG (AUC: 0.60). There were no statistically significant differences between the 3 EEG modalities regarding specificity and positive predictive value. Finally, IED/seizure on the aEEG was associated with more than 3 times the hazard of seizure recurrence.
DISCUSSION
The overall diagnostic accuracy of aEEG at capturing IED/seizures in people presenting with FSUS was higher than the first and second rEEGs. We also found that IED/seizures on the aEEG were associated with an increased risk of seizure recurrence.
CLASSIFICATION OF EVIDENCE
This study provides Class I evidence supporting that, in adults with First Single Unprovoked Seizure (FSUS), 24-h ambulatory EEG has increased sensitivity when compared with routine and repeated EEG.
PubMed: 37197370
DOI: 10.1212/CPJ.0000000000200160