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BMC Pulmonary Medicine Sep 2018Convenient approaches for accurate biopsy are extremely important to the diagnosis of lung cancer. We aimed to systematically review the clinical updates and development...
BACKGROUND
Convenient approaches for accurate biopsy are extremely important to the diagnosis of lung cancer. We aimed to systematically review the clinical updates and development trends of approaches for biopsy, i.e., CT-guided PTNB (Percutaneous Transthoracic Needle Biopsy), ENB (Electromagnetic Navigation Bronchoscopy), EBUS-TBNA (Endobroncheal Ultrasonography-Transbronchial Needle Aspiration), mediastinoscopy and CTC (Circulating Tumor Cell).
METHODS
Medline and manual searches were performed. We identified the relevant studies, assessed study eligibility, evaluated methodological quality, and summarized diagnostic yields and complications regarding CT-guided PTNB (22 citations), ENB(31 citations), EBUS-TBNA(66 citations), Mediastinoscopy(15 citations) and CTC (19 citations), respectively.
RESULTS
The overall sensitivity and specificity of CT-guided PTNB were reported to be 92.52% ± 3.14% and 97.98% ± 3.28%, respectively. The top two complications of CT-guided PTNB was pneumothorax (946/4170:22.69%) and hemorrhage (138/1949:7.08%). The detection rate of lung cancer by ENB increased gradually to 79.79% ± 15.34% with pneumothorax as the top one complication (86/1648:5.2%). Detection rate of EBUS-TBNA was 86.06% ± 9.70% with the top three complications, i.e., hemorrhage (53/8662:0.61%), pneumothorax (46/12432:0.37%) and infection (34/11250:0.30%). The detection rate of mediastinoscopy gradually increased to 92.77% ± 3.99% with .hoarseness as the refractory complication (4/2137:0.19%). Sensitivity and specificity of CTCs detection by using PCR (Polymerase Chain Reaction) were reported to be 78.81% ± 14.72% and 90.88% ± 0.53%, respectively.
CONCLUSION
The biopsy approaches should be chosen considering a variety of location and situation of lesions. CT-guided PTNB is effective to reach lung parenchyma, however, diagnostic accuracy and incidence of complications may be impacted by lesion size or needle path length. ENB has an advantage for biopsy of smaller and deeper lesions in lung parenchyma. ENB plus EBUS imaging can further improve the detection rate of lesion in lung parenchyma. EBUS-TBNA is relatively safer and mediastinoscopy provides more tissue acquisition and better diagnostic yield of 4R and 7th lymph node. CTC detection can be considered for adjuvant diagnosis.
Topics: Humans; Image-Guided Biopsy; Lung; Lung Neoplasms; Mediastinum; Sensitivity and Specificity
PubMed: 30176840
DOI: 10.1186/s12890-018-0713-6 -
Journal of Cardiovascular... Jun 2018Atrioesophageal fistula (AEF) is a dire complication of atrial fibrillation ablation. The diagnostic yield of computed tomography (CT) chest, the role and timing of...
INTRODUCTION
Atrioesophageal fistula (AEF) is a dire complication of atrial fibrillation ablation. The diagnostic yield of computed tomography (CT) chest, the role and timing of repeat testing, and the value of other investigations in the diagnosis of AEF is uncertain.
METHODS
We systematically reviewed published AEF cases to evaluate radiological, bedside, and biochemical investigations for AEF (registered on PROSPERO [CRD42017077493]).
RESULTS
Eighty-seven articles with 126 patients (median age, 59 years; male, 71%) were included in the analysis. CT chest was performed in 88% (111/126) and was abnormal in 87%. A clear diagnosis of AEF (fistula/perforation) was only detected in 35% (34/97). Other major findings included free air in mediastinum (26%), left atrium (LA), or LA wall (24%). In 11 patients with normal/nonspecific initial CT chest, major abnormalities were detected in 91% (10/11) of repeat CT chest performed 6 days (median; range, 4-22) after initial scan. Initial CT head was normal in 51%; diffuse air emboli was identified in 79% (22/28). Initial transthoracic echocardiography was normal in 61% of cases. The spectrum of radiological abnormalities included Air (mediastinum/LA), Effusion (pleural/pericardial), Fistula/Perforation, and Thickening (esophagus/LA) - "AEF-Tests." Esophagram demonstrated contrast extravasation in 87% (13/15). Blood culture was consistently positive (100%; 28/28), particularly for streptococcus species (93%; 26/28).
CONCLUSION
The diagnosis of AEF remains challenging. Clinicians should be aware of the limitations in the yield of CT chest, the variety of major abnormalities reported, the need for repeat testing, unique brain imaging findings, and the importance of positive blood cultures and raised inflammatory markers.
Topics: Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Biomarkers; Diagnosis, Differential; Echocardiography; Esophageal Fistula; Female; Fistula; Heart Atria; Heart Diseases; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Point-of-Care Testing; Predictive Value of Tests; Prognosis; Reproducibility of Results; Risk Factors; Tomography, X-Ray Computed
PubMed: 29603477
DOI: 10.1111/jce.13494 -
PloS One 2018To perform a systematic review of the effect of blood glucose levels on 2-Deoxy-2-[18F]fluoro-D-glucose (18F-FDG) uptake in normal organs. (Review)
Review
PURPOSE
To perform a systematic review of the effect of blood glucose levels on 2-Deoxy-2-[18F]fluoro-D-glucose (18F-FDG) uptake in normal organs.
METHODS
We searched the MEDLINE, EMBASE and Cochrane databases through 22 April 2017 to identify all relevant studies using the keywords "PET/CT" (positron emission tomography/computed tomography), "standardized uptake value" (SUV), "glycemia," and "normal." Analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Maximum and mean SUVs and glycemia were the main parameters analyzed. To objectively measure the magnitude of the association between glycemia and 18F-FDG uptake in different organs, we calculated the effect size (ES) and the coefficient of determination (R2) whenever possible.
RESULTS
The literature search yielded 225 results, and 14 articles met the inclusion criteria; studies included a total of 2714 (range, 51-557) participants. The brain SUV was related significantly and inversely to glycemia (ES = 1.26; R2 0.16-0.58). Although the liver and mediastinal blood pool were significantly affected by glycemia, the magnitudes of these associations were small (ES = 0.24-0.59, R2 = 0.01-0.08) and negligible (R2 = 0.02), respectively. Lung, bone marrow, tumor, spleen, fat, bowel, and stomach 18F-FDG uptakes were not influenced by glycemia. Individual factors other than glycemia can also affect 18F-FDG uptake in different organs, and body mass index appears to be the most important of these factors.
CONCLUSION
The impact of glycemia on SUVs in most organs is either negligible or too small to be clinically significant. The brain SUV was the only value largely affected by glycemia.
Topics: Biological Transport; Blood Glucose; Brain; Fluorodeoxyglucose F18; Humans; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals
PubMed: 29486008
DOI: 10.1371/journal.pone.0193140 -
Journal of Cardiothoracic and Vascular... Jun 2018This study was planned to pool existing data on outcome and to evaluate the efficacy of postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) in... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study was planned to pool existing data on outcome and to evaluate the efficacy of postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adult patients.
DESIGN
Systematic review of the literature and meta-analysis.
SETTING
Multi-institutional study.
PARTICIPANTS
Adult patients with acute heart failure immediately after cardiac surgery.
INTERVENTIONS
VA-ECMO after cardiac surgery. Studies evaluating only heart transplant patients were excluded from this analysis.
MEASUREMENTS AND MAIN RESULTS
A literature search was performed to identify studies published since 2000. Thirty-one studies reported on 2,986 patients (mean age, 58.1 years) who required postcardiotomy VA-ECMO. The weaning rate from VA-ECMO was 59.5% and hospital survival was 36.1% (95% CI 31.5-40.8). The pooled rate of reoperation for bleeding was 42.9%, major neurological event 11.3%, lower limb ischemia 10.8%, deep sternal wound infection/mediastinitis 14.7%, and renal replacement therapy 47.1%. The pooled mean number of transfused red blood cell units was 17.7 (95% CI 13.3-22.1). The mean stay in the intensive care unit was 13.3 days (95% CI 10.2-16.4). Survivors were significantly younger (mean, 55.7 v 63.6 years, p = 0.015) and their blood lactate level before starting VA-ECMO was lower (mean, 7.7 v 10.7 mmol/L, p = 0.028) than patients who died. One-year survival rate was 30.9% (95% CI 24.3-37.5).
CONCLUSIONS
Pooled data showed that VA-ECMO may salvage one-third of patients unresponsive to any other resuscitative treatment after adult cardiac surgery.
Topics: Adult; Cardiac Surgical Procedures; Extracorporeal Membrane Oxygenation; Heart Failure; Humans; Postoperative Complications; Survival Rate; Treatment Outcome
PubMed: 29158060
DOI: 10.1053/j.jvca.2017.08.048 -
Critical Reviews in Oncology/hematology Jan 2017Brentuximab vedotin (BV) is an antibody-drug conjucate (ADC) comprising a CD30-directed antibody, conjugated to the microtubule-disrupting agent MMAE via a protease... (Review)
Review
BACKGROUND
Brentuximab vedotin (BV) is an antibody-drug conjucate (ADC) comprising a CD30-directed antibody, conjugated to the microtubule-disrupting agent MMAE via a protease cleavable linker. BV is FDA approved for use in relapsed classical Hodgkin lymphoma (HL) and relapsed systemic anaplastic large cell lymphoma (sALCL). There are multiple publications for its utility in other malignancies such as diffuse large B-cell lymphoma (DLBCL), mycosis fungoides (MF), Sézary syndrome (SS), T-cell lymphomas (TCL), primary mediastinal lymphoma (PMBL), and post-transplant lymphoproliferative disorders (PTLD). We believe that BV could potentially provide a strong additional treatment option for patients suffering from NHL.
OBJECTIVE
Perform a systematic review on the use of BV in non-Hodgkin lymphoma (NHL) and other CD30 malignancies in humans.
DATA SOURCES
We searched various databases including PubMed (1946-2015), EMBASE (1947-2015), and Cochrane Central Register of Controlled Trials (1898-2015).
ELIGIBILITY CRITERIA
Inclusion criteria specified all studies and case reports of NHLs in which BV therapy was administered.
INCLUDED STUDIES
A total of 28 articles met these criteria and are summarized in this manuscript.
CONCLUSION
Our findings indicate that BV induces a variety of responses, largely positive in nature and variable between NHL subtypes. With additional, properly powered prospective studies, BV may prove to be a strong candidate in the treatment of various CD30 malignancies.
Topics: Antineoplastic Agents; Brentuximab Vedotin; Clinical Trials, Phase II as Topic; Humans; Immunoconjugates; Lymphoma, Non-Hodgkin; Neoplasm Recurrence, Local; Prospective Studies
PubMed: 28010897
DOI: 10.1016/j.critrevonc.2016.11.009 -
Blood Transfusion = Trasfusione Del... Jan 2017Deep sternal wound infection and bleeding are devastating complications following cardiac surgery, which may be reduced by topical application of autologous platelet... (Meta-Analysis)
Meta-Analysis Review
Deep sternal wound infection and bleeding are devastating complications following cardiac surgery, which may be reduced by topical application of autologous platelet gel. Systematic review identified seven comparative studies involving 4,692 patients. Meta-analysis showed significant reductions in all sternal wound infections (odds ratio 3.48 [1.08-11.23], p=0.04) and mediastinitis (odds ratio 2.69 [1.20-6.06], p=0.02) but not bleeding. No adverse events relating to the use of topical platelet-rich plasma were reported. The use of autologous platelet gel in cardiac surgery appears to provide significant reductions in serious sternal wound infections, and its use is unlikely to be associated with significant risk.
Topics: Cardiac Surgical Procedures; Humans; Platelet-Rich Plasma; Sternum; Surgical Wound Infection; Treatment Outcome; Wound Healing
PubMed: 27177403
DOI: 10.2450/2016.0231-15 -
Annals of Cardiothoracic Surgery Jan 2016Thymectomy is the mainstay of treatment for thymoma and other anterior mediastinal tumors, and is often utilized in the management of patients with myasthenia gravis... (Review)
Review
BACKGROUND
Thymectomy is the mainstay of treatment for thymoma and other anterior mediastinal tumors, and is often utilized in the management of patients with myasthenia gravis (MG). While traditionally approached through a median sternotomy, minimally invasive approaches to thymectomy have increasingly emerged. The present systematic review was conducted to compare perioperative and clinical outcomes following minimally invasive thymectomy (MIT) and open thymectomy (OT).
METHODS
Articles were obtained through a PubMed literature search. Comparative studies reporting clinical outcomes following MIT and OT were eligible for inclusion. We selected studies with full text availability, written in the English language, published after 2005 and with at least 15 patients in each arm. A descriptive analysis was performed.
RESULTS
Twenty studies were included, involving a total of 2,068 patients undergoing either MIT (n=838) or OT (n=1,230). Within individual studies, MIT and OT cohorts were well matched with regards to patient age and gender, but there was considerable variation across studies. Resected thymomas were consistently larger in OT groups, with mean diameter significantly larger in five studies (MIT, 29-52 mm; OT, 31-77 mm). MIT was consistently associated with a lower estimated blood loss (MIT, 20-200 mL; OT, 86-466 mL), chest tube duration (MIT, 1.3-4.1 days; OT, 2.4-5.3 days), and hospital length of stay (MIT, 1-10.6 days; OT, 4-14.6 days). There were no consistent differences in rates of perioperative complications, thymoma recurrence, MG complete stable remission, or 5-year survival.
CONCLUSIONS
In appropriately selected patients, MIT may reduce blood loss, chest tube duration, and hospital length of stay, with comparable clinical outcomes compared to OT via median sternotomy.
PubMed: 26904425
DOI: 10.3978/j.issn.2225-319X.2016.01.01 -
Surgical Oncology Sep 2015The uptake of minimally invasive esophagectomy (MIE) has increased vastly over the last decade, with proven short-term benefits over an open approach. The aim of this... (Comparative Study)
Comparative Study Meta-Analysis Review
The uptake of minimally invasive esophagectomy (MIE) has increased vastly over the last decade, with proven short-term benefits over an open approach. The aim of this pooled analysis was to compare clinical outcomes of Minimally Invasive Esophagectomy (MIE) performed in the prone and lateral decubitus positions. A systematic literature search (2000-2015) was undertaken for publications that compared patients who underwent MIE in the lateral decubitus (LD) or prone (PR) positions. Weighted mean difference (WMD) was calculated for the effect size of LD positioning on continuous variables and Pooled odds ratios (POR) for discrete variables. Ten relevant publications comprising 723 patients who underwent minimally invasive esophagectomy were included; 387 in the LD group and 336 in the PR group. There was no significant difference between the groups in terms of in-hospital mortality, total morbidity, anastomotic leak, chylothorax, laryngeal nerve palsy, average operative time, and length hospital stay. LD MIE was associated with a non-significant increase in pulmonary complications (POR = 1.65; 95% C.I. 0.93 to 2.92; P = 0.09), and significant increases in estimated blood loss (WMD = 36.03; 95% 14.37 to 57.69; P = 0.001) and a reduced average mediastinal lymph node harvest (WMD = -2.17; 95% C.I. -3.82 to -0.52; P = 0.01) when compared to prone MIE. Pooled analysis suggests that prone MIE is superior to lateral decubitus MIE with reduced pulmonary complications, estimated blood loss and increased mediastinal lymph node harvest. Further studies are needed to explain performance-shaping factors and their influence on oncological clearance and short-term outcomes.
Topics: Esophageal Neoplasms; Esophagectomy; Humans; Minimally Invasive Surgical Procedures; Patient Positioning; Prognosis; Survival Rate
PubMed: 26096374
DOI: 10.1016/j.suronc.2015.06.001 -
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue Dec 2014To evaluate the effectiveness of Percu Twist (PT) tracheostomy comparing with that of operative tracheostomy (OT) in intensive care unit (ICU). (Review)
Review
OBJECTIVE
To evaluate the effectiveness of Percu Twist (PT) tracheostomy comparing with that of operative tracheostomy (OT) in intensive care unit (ICU).
METHODS
Related data were retrieved from CBM, CNKI, Wanfang Data, VIP, PubMed, EMBASE, CENTRAL, and Web of Science from the time of their establishment to May 15th 2014, and the data of randomized controlled trials (RCTs) concerning PT and OT were selected. The risk of bias assessment and data extraction were performed by two independent reviewers. Meta analysis was conducted using RevMan 5.2 software.
RESULTS
A total of 12 RCTs were identified, and 893 patients in ICU were involved. The results of Meta-analysis showed that PT could significantly shorten the operation time [mean difference (MD)=-15.11, 95% confidence interval (95% CI)=-17.14 to -13.07, P<0.000 01], reduce the volume of blood loss (MD=-17.59, 95% CI=-21.90 to -13.28, P<0.000 01), reduce the size of incision (MD=-2.20, 95% CI=-2.57 to -1.82, P<0.000 01), shor ten the time of healing (MD=-3.60, 95% CI=-4.15 to -3.05, P<0.000 01), and reduce complications such as infection of the wound [odds ratio (OR)=0.20, 95%CI=0.10-0.44, P<0.000 1] and cutaneous emphysema/mediastinal emphysema (OR=0.22, 95% CI=0.10-0.47, P<0.000 1) compared with OT group. The funnel plot suggested that publication bias might be found among 12 researches.
CONCLUSIONS
PT was shown to be more effective than OT in ICU with lower incidence of complications. As number of RCT cases is still small with unsatis factory quality, further clinical use is warranted for a better assessment.
Topics: Humans; Intensive Care Units; Randomized Controlled Trials as Topic; Tracheostomy
PubMed: 25476083
DOI: 10.3760/cma.j.issn.2095-4352.2014.12.010