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Journal of Clinical Medicine Apr 2024Accurate prenatal diagnosis of cleft lip and palate is essential to discuss severity prediction, perform appropriate parental counseling, and, at last, establish... (Review)
Review
Accurate prenatal diagnosis of cleft lip and palate is essential to discuss severity prediction, perform appropriate parental counseling, and, at last, establish long-term treatment planning. The aim of this systematic review was to analyze the accuracy of various imaging techniques for the prenatal diagnosis of cleft lip and palate, assess the pregnancy phase for orofacial clefts diagnosis, and study the different cleft types in terms of diagnostic methods, timing, and predictability. A search of the PubMed, EMBASE, Scopus, and Web of Science databases was conducted to identify potentially relevant studies published until January 2024. The quality of the selected articles was assessed using the Newcastle-Ottawa scale for methodological quality assessment of cohort studies and the QUADAS-2 scale for diagnostic test studies. A total of 18 studies met the eligibility criteria and were included in the review. The findings of this review indicate that the majority of studies showed improved diagnostic accuracy when supplementary techniques, such as 3D ultrasound or magnetic resonance imaging, were added to 2D ultrasound. The implementation of magnetic resonance imaging as a standard procedure could significantly improve the precision of diagnosing cleft lip and palate. Therefore, the diagnostic technique used will play a crucial role in the accuracy of the diagnosis.
PubMed: 38610855
DOI: 10.3390/jcm13072090 -
Hypertension (Dallas, Tex. : 1979) Jul 2024Atrial fibrillation (AF) is often asymptomatic and undiagnosed. As AF and hypertension often coexist, opportunistic AF detection during routine automated blood pressure... (Meta-Analysis)
Meta-Analysis
Atrial Fibrillation Screening During Routine Automated Office, Home, and Ambulatory Blood Pressure Measurement: A Diagnostic Test Accuracy Systematic Review and Meta-Analysis.
BACKGROUND
Atrial fibrillation (AF) is often asymptomatic and undiagnosed. As AF and hypertension often coexist, opportunistic AF detection during routine automated blood pressure (BP) measurement appears to be an attractive screening method.
METHODS
A systematic literature search was conducted to identify studies assessing the diagnostic test accuracy of office, home, or 24-hour ambulatory BP measuring devices with AF detection algorithms versus reference electrocardiography. Analyses were performed per participant (AF status based on several BP readings; most office/home devices) or per reading (AF status based on individual readings; all ambulatory devices). A meta-analysis stratified by device type (office/home/ambulatory) was conducted to calculate pooled measures of diagnostic accuracy. Sensitivity/meta-regression analyses were also performed.
RESULTS
Among 3096 records initially retrieved, 23 diagnostic test accuracy studies were included. Data derived from 11 093 individuals (weighted age 69 years, males 56%, hypertensives 79%, diabetics 24%, and AF prevalence 17%) indicated a pooled sensitivity 0.97 (95% CI, 0.92-0.99), specificity 0.93 (95% CI, 0.90-0.95), and accuracy 0.93 (95% CI, 0.89-0.95), with generally consistent results using office, home, or ambulatory BP devices (slightly lower specificity with the latter). The positive and negative predictive values were 0.70 (95% CI, 0.60-0.80) and 0.99 (95% CI, 0.98-1.00), respectively. Sensitivity analyses indicated lower specificity in studies implementing reading versus participant analyses. Most studies presented a low risk of bias and minor applicability concerns.
CONCLUSIONS
There is considerable and consistent evidence suggesting high diagnostic accuracy of AF detection algorithms implemented in automated BP monitors during routine BP measurements in and out of the office. AF diagnosis requires verification (electrocardiography) before treatment is administered.
Topics: Humans; Atrial Fibrillation; Blood Pressure Monitoring, Ambulatory; Hypertension; Mass Screening; Blood Pressure Determination; Sensitivity and Specificity; Algorithms; Office Visits; Female; Male; Electrocardiography
PubMed: 38602099
DOI: 10.1161/HYPERTENSIONAHA.123.22563 -
International Braz J Urol : Official... 2024Success rates in endourological procedures, notably percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), have demonstrated suboptimal outcomes, leading to more... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Success rates in endourological procedures, notably percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), have demonstrated suboptimal outcomes, leading to more reinterventions and radiation exposure. Recently, the use of intraoperative computed tomography (ICT) scans has been hypothesized as a promising solution for improving outcomes in endourology procedures. With this considered, we conducted a comprehensive systematic review and meta-analysis encompassing all available studies that evaluate the impact of the use of intraoperative CT scans on surgical outcomes compared to conventional fluoroscopic-guided procedures.
METHODS
This systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were systematically searched up to December of 2023. This study aimed to directly compare the use of an ICT scan with the standard non-ICT-guided procedure. The primary endpoint of interest was success rate, and the secondary endpoints were complications and reintervention rates, while radiation exposure was also evaluated. Data extraction and quality assessment were performed following Cochrane recommendations. Data was presented as an Odds ratio with 95%CI across trials and a random-effects model was selected for pooling of data.
RESULTS
A comprehensive search yielded 533 studies, resulting in the selection of 3 cohorts including 327 patients (103 ICT vs 224 in non-ICT). Primary outcome was significantly higher in the experimental group versus the control group (84.5% vs 41.4% respectively, 307 patients; 95% CI [3.61, 12.72]; p<0.00001; I2=0). Reintervention rates also decreased from 32.6% in the control to 12.6% in the ICT group (OR 0.34; 95%CI [0.12,0.94]; p =0.04; I2= 48%), whereas complication rates did not exhibit significant differences. Radiation exposure was also significantly reduced in two of the included studies.
CONCLUSION
This meta-analysis highlights a favorable outcome with intraoperative CT scan use in PCNL procedures, showing a considerable increase in SFR when compared to standard fluoroscopy and nephroscopy. Despite limited studies, our synthesis underscores the potential of ICT scans to significantly reduce residual stones and their consequences for endourology patients, as reinterventions and follow-up ionizing radiation studies.
Topics: Humans; Kidney Calculi; Nephrolithotomy, Percutaneous; Kidney; Ureteroscopy; Tomography; Treatment Outcome
PubMed: 38598828
DOI: 10.1590/S1677-5538.IBJU.2024.0092 -
Physical and Engineering Sciences in... Jun 2024Healthy cornea guarantees the refractive power of the eye and the protection of the inner components, but injury, trauma or pathology may impair the tissue shape and/or... (Review)
Review
Healthy cornea guarantees the refractive power of the eye and the protection of the inner components, but injury, trauma or pathology may impair the tissue shape and/or structural organization and therefore its material properties, compromising its functionality in the ocular visual process. It turns out that biomechanical research assumes an essential role in analysing the morphology and biomechanical response of the cornea, preventing pathology occurrence, and improving/optimising treatments. In this review, ex vivo, in vivo and in silico methods for the corneal mechanical characterization are reported. Experimental techniques are distinct in testing mode (e.g., tensile, inflation tests), samples' species (human or animal), shape and condition (e.g., healthy, treated), preservation methods, setup and test protocol (e.g., preconditioning, strain rate). The meaningful results reported in the pertinent literature are discussed, analysing differences, key features and weaknesses of the methodologies adopted. In addition, numerical techniques based on the finite element method are reported, incorporating the essential steps for the development of corneal models, such as geometry, material characterization and boundary conditions, and their application in the research field to extend the experimental results by including further relevant aspects and in the clinical field for diagnostic procedure, treatment and planning surgery. This review aims to analyse the state-of-art of the bioengineering techniques developed over the years to study the corneal biomechanics, highlighting their potentiality to improve diagnosis, treatment and healing process of the corneal tissue, and, at the same, pointing out the current limits in the experimental equipment and numerical tools that are not able to fully characterize in vivo corneal tissues non-invasively and discourage the use of finite element models in daily clinical practice for surgical planning.
Topics: Cornea; Humans; Biomechanical Phenomena; Computer Simulation; Animals; Finite Element Analysis; Models, Biological
PubMed: 38598066
DOI: 10.1007/s13246-024-01403-2 -
World Neurosurgery Jun 2024Stroke is a leading cause of death in the United States, with significant economic and human costs. Early diagnosis and rapid treatment are critical for preventing...
BACKGROUND
Stroke is a leading cause of death in the United States, with significant economic and human costs. Early diagnosis and rapid treatment are critical for preventing stroke-related morbidity and mortality. However, accessibility to neurointerventional medical centers remains a challenge for many Americans, highlighting the need for innovative solutions to improve stroke management.
METHODS
This systematic review adhered to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines and included 5 medical databases to identify relevant studies on robotically assisted cerebral angiography (RCA). Studies focusing on in-human robotic intracranial cerebral angiography were included. A bias assessment was conducted using appropriate tools for randomized controlled trials (RCTs) and non-RCTs.
RESULTS
A total of 7 studies met the inclusion criteria, with 1 RCT and 6 non-RCTs included in the analysis. Robotic systems such as CorPath GRX, Magellan robot, YDHB-NS01, VIR-2 (vascular interventional robot), and RobEnt were evaluated. The studies reported various success rates, procedure times, and complications associated with robotically assisted procedures. Overall, the robotic interventions demonstrated promising results in terms of safety and efficacy, with comparable outcomes to manual methods. Despite the promising findings, several limitations were identified, including technical issues with the robotic systems, the high costs, and limited long-term data. Future research should focus on standardizing protocols, conducting larger trials with longer follow-up periods, and assessing cost-effectiveness to determine the role of RCA in clinical practice.
CONCLUSIONS
RCA shows potential as a valuable tool in neuroendovascular interventions. Addressing the technical challenges and conducting further research will be crucial to fully realize the clinical benefits of this innovative technology and improve patient outcomes in stroke management.
Topics: Humans; Cerebral Angiography; Endovascular Procedures; Robotic Surgical Procedures; Stroke; Treatment Outcome
PubMed: 38593910
DOI: 10.1016/j.wneu.2024.04.012 -
Journal of Clinical Medicine Mar 2024The early and accurate stratification of intracranial cerebral artery stenosis (ICAS) is critical to inform treatment management and enhance the prognostic outcomes in... (Review)
Review
The Diagnostic Accuracy of Transcranial Color-Coded Doppler Ultrasound Technique in Stratifying Intracranial Cerebral Artery Stenoses in Cerebrovascular Disease Patients: A Systematic Review and Meta-Analysis.
The early and accurate stratification of intracranial cerebral artery stenosis (ICAS) is critical to inform treatment management and enhance the prognostic outcomes in patients with cerebrovascular disease (CVD). Digital subtraction angiography (DSA) is an invasive and expensive procedure but is the gold standard for the diagnosis of ICAS. Over recent years, transcranial color-coded Doppler ultrasound (TCCD) has been suggested to be a useful imaging method for accurately diagnosing ICAS. However, the diagnostic accuracy of TCCD in stratifying ICASs among patients with CVD remains unclear. Therefore, this systematic review and meta-analysis aimed at evaluating the diagnostic accuracy of TCCD in the stratification of intracranial steno-occlusions among CVD patients. A total of six databases-Embase, CINAHL, Medline, PubMed, Google Scholar, and Web of Science (core collection)-were searched for studies that assessed the diagnostic accuracy of TCCD in stratifying ICASs. The meta-analysis was performed using Meta-DiSc 1.4. The Quality Assessment of Diagnostic Accuracy Studies tool version 2 (QUADAS-2) assessed the risk of bias. Eighteen studies met all of the eligibility criteria. TCCD exhibited a high pooled diagnostic accuracy in stratifying intracranial steno-occlusions in patients presenting with CVD when compared to DSA as a reference standard (sensitivity = 90%; specificity = 87%; AUC = 97%). Additionally, the ultrasound parameters peak systolic velocity (PSV) and mean flow velocity (MFV) yielded a comparable diagnostic accuracy of "AUC = 0.96". In conclusion, TCCD could be a noble, safe, and accurate alternative imaging technique to DSA that can provide useful diagnostic information in stratifying intracranial steno-occlusions in patients presenting with CVD. TCCD should be considered in clinical cases where access to DSA is limited.
PubMed: 38592335
DOI: 10.3390/jcm13051507 -
Respiration; International Review of... 2024Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC), a novel technique, has been reported to improve the diagnostic value of endobronchial... (Meta-Analysis)
Meta-Analysis Comparative Study
Endobronchial Ultrasound-Guided Transbronchial Mediastinal Cryobiopsy versus Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Mediastinal Disorders: A Meta-Analysis.
INTRODUCTION
Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC), a novel technique, has been reported to improve the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal lesions in recent studies. Current literature suggests that this procedure has greater diagnostic efficacy compared to conventional EBUS-TBNA. This systematic review and meta-analysis aimed to evaluate the diagnostic yield and complications associated with EBUS-TMC in comparison to EBUS-TBNA, thereby exploring the potential of this novel technique in enhancing the diagnostic utility for mediastinal lesions.
METHODS
A comprehensive literature review was conducted by searching the PubMed, Embase, and Google Scholar databases for articles published from inception to December 31, 2023. The objective of this review was to evaluate the utilization of EBUS-TMC in diagnosing mediastinal disease, while also assessing the quality of each study using the QUADAS-2 tool. The diagnostic yield estimates were subjected to a meta-analysis utilizing inverse variance weighting. Furthermore, a comprehensive analysis of the complications associated with this procedure was performed.
RESULTS
The meta-analysis included 10 studies involving a total of 538 patients. The findings of the meta-analysis demonstrated that EBUS-TMC yielded an overall diagnostic rate of 89.59% (482/538), while EBUS-TBNA yielded a rate of 77.13% (415/538). The calculated inverse variance-weighted odds ratio was 2.63 (95% confidence interval, 1.86-3.72; p < 0.0001), and I2 value was 11%, indicating a statistically significant difference between the two techniques. The associated complications consisted of pneumothorax, pneumomediastinum, mediastinitis, and bleeding, with an incidence of 0.74% (4/538), 0.37% (2/538), 0.0% (0/538), and 1.12% (6/538), respectively. Moreover, the funnel plot displayed no discernible publication bias. Further subgroup analysis revealed a notable improvement in the diagnosis value for lymphoma (86.36% vs. 27.27%, p = 0.0006) and benign disorder (87.62% vs. 60.00%, p < 0.0001).
CONCLUSION
This review of the current available studies indicated that EBUS-TMC enhanced overall diagnostic yields compared to EBUS-TBNA, particularly for diagnosing benign disease and lymphoma. This procedure was not associated with any serious complications.
Topics: Humans; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Mediastinal Diseases; Mediastinum; Cryosurgery; Bronchoscopy; Mediastinal Neoplasms
PubMed: 38588649
DOI: 10.1159/000538609 -
Canadian Association of Radiologists... Apr 2024This systematic review aims to assess existing research concerning the use of robotic systems to execute percutaneous lung biopsy. A systematic review was performed... (Review)
Review
This systematic review aims to assess existing research concerning the use of robotic systems to execute percutaneous lung biopsy. A systematic review was performed and identified 4 studies involving robotic systems used for lung biopsy. Outcomes assessed were operation time, radiation dose to patients and operators, technical success rate, diagnostic yield, and complication rate. One hundred and thirteen robot-guided percutaneous lung biopsies were included. Technical success and diagnostic yield were close to 100%, comparable to manual procedures. Technical accuracy, illustrated by needle positioning, showed less frequent needle adjustments in robotic guidance than in manual guidance ( < .001): 2.7 ± 2.6 (range 1-4) versus 6 ± 4 (range 2-12). Procedure time ranged from comparable to reduced by 35% on average (20.1 ± 11.3 minutes vs 31.4 ± 10.2 minutes, = .001) compared to manual procedures. Patient irradiation ranged from comparable to reduced by an average of 40% (324 ± 114.5 mGy vs 541.2 ± 446.8 mGy, = .001). There was no significant difference in reported complications between manual biopsy and biopsies that utilized robotic guidance. Robotic systems demonstrate promising results for percutaneous lung biopsy. These devices provide adequate accuracy in probe placement and could both reduce procedural duration and mitigate radiation exposure to patients and practitioners. However, this review underscores the need for larger, controlled trials to validate and extend these findings.
PubMed: 38581355
DOI: 10.1177/08465371241242758 -
Preventive Veterinary Medicine May 2024Bovine tuberculosis (bovine TB) is a chronic wasting disease of cattle caused primarily by Mycobacterium bovis. Controlling bovine TB requires highly sensitive,... (Meta-Analysis)
Meta-Analysis
Bovine tuberculosis (bovine TB) is a chronic wasting disease of cattle caused primarily by Mycobacterium bovis. Controlling bovine TB requires highly sensitive, specific, quick, and reliable diagnostic methods. This systematic review and meta-analysis evaluated molecular diagnostic tests for M. bovis detection to inform the selection of the most viable assay. On a per-test basis, loop-mediated isothermal amplification (LAMP) showed the highest overall sensitivity of 99.0% [95% CI: 86.2%-99.9%] and specificity of 99.8% [95% CI: 96.2%-100.00%]. Quantitative real-time polymerase chain reaction (qPCR) outperformed conventional PCR and nested PCR (nPCR) with a diagnostic specificity of 96.6% [95% CI: 88.9%-99.0%], while the diagnostic sensitivity of 70.8% [95% CI: 58.6-80.5%] was comparable to that of nPCR at 71.4% [95% CI: 60.7-80.2%]. Test sensitivity was higher with the input of milk samples (90.9% [95% CI: 56.0%-98.7%]), while specificity improved with tests based on major M. bovis antigens (97.8% [95% CI: 92.3%-99.4%]), the IS6110 insertion sequence (95.4% [95% CI: 87.6%-98.4%]), and the RD4 gene (90.7% [95% CI: 52.2%-98.9%]). The design of the currently available molecular diagnostic assays, while mostly based on nonspecific gene targets, prevents them from being accurate enough to diagnose M. bovis infections in cattle, despite their promise. Future assay development should focus on the RD4 region since it is the only target identified by genome sequence data as being distinctive for detecting M. bovis. The availability of a sufficiently accurate diagnostic test combined with the routine screening of milk samples can decrease the risk of zoonotic transmissions of M. bovis.
Topics: Cattle; Animals; Mycobacterium bovis; Tuberculosis, Bovine; Pathology, Molecular; Sensitivity and Specificity; Real-Time Polymerase Chain Reaction; Cattle Diseases
PubMed: 38574490
DOI: 10.1016/j.prevetmed.2024.106190 -
Clinical Neurology and Neurosurgery May 2024Extraparenchymal localization of neurocysticercosis (NCC) is rare in non-endemic areas. A case of mixed (intraventricular, IV, and subarachnoid basal, SAB) NCC was... (Review)
Review
OBJECTIVE
Extraparenchymal localization of neurocysticercosis (NCC) is rare in non-endemic areas. A case of mixed (intraventricular, IV, and subarachnoid basal, SAB) NCC was surgically treated using the neuroendoscope and a systematic review of the literature was performed with the aim to analyze the use of this instrument in the management of the extraparenchymal forms of the parasitic disease.
MATERIALS AND METHODS
Medline and Embase databases were searched for studies where the neuroendoscope was used for the management of IV/SAB NCC cysts, either for the cerebrospinal fluid diversion or cyst removal. Cyst location, complete removal, cyst breakage during removal, intraoperative and postoperative complications, administration of antihelmintic therapy, outcome and follow-up period were extracted from the articles.
RESULTS
281 patients were treated by means of the neuroendoscope. 254 patients who were described in retrospective cohort studies, came all from endemic areas, with no significant difference between sexes. Mean age at surgery was 30.7 years. Of all cysts reported in retrospective studies, 37.9% were located in the fourth ventricle. An attempt of cyst removal was described in the 84.6% of cases and an endoscopic third ventriculostomy was performed in another 76.4%. A small number of complications were reported intraoperatively (9.1%) obtaining, but a good recovery was achieved at follow-up. Only 17 ventriculoperitoneal shunts were placed after the first procedure, defining a low risk of postoperative hydrocephalus even in case of partial cyst removal.
CONCLUSION
Neuroendoscopic removal of an extraparenchymal NCC cyst is a safe procedure that should be preferred for lateral and third ventricle localization and, in a specialized centre, even for a localization in the fourth ventricle if feasible. It is also efficient because of the possibility of performing an internal CSF diversion concomitantly to cyst removal, avoiding the complication registered with VPS. The need for cysticidal treatment after surgery should be addressed in a prospective study.
Topics: Humans; Neurocysticercosis; Neuroendoscopy; Adult; Subarachnoid Space; Male; Female; Fourth Ventricle; Ventriculostomy
PubMed: 38569248
DOI: 10.1016/j.clineuro.2024.108268