Objectives: The study aimed to determine the most appropriate hearing screening test to identify disabling hearing loss for adults aged 65 years or older.Methods: This study included 577 older adults. Four hearing scr...Objectives: The study aimed to determine the most appropriate hearing screening test to identify disabling hearing loss for adults aged 65 years or older.Methods: This study included 577 older adults. Four hearing screening tests were considered in the study, including the Hearing Handicap Inventory for Elderly Screening(HHIE-s), three single question tests, the whisper test, and the finger rub test. The sensitivity and specificity of these tests referenced to the hearing threshold of disabling hearing loss were estimated.Results: Among all tests, only the single self-perception question(0.7064 for sensitivity;0.7225 for specificity) and whisper test(0.7833 for sensitivity;0.7708 for specificity) could obtain both sensitivity and specificity higher than 70% for adults aged ≥65 years.Conclusion: Overall, we suggest using the whisper test to identify disabling hearing loss(>40 dB HL at the better ear) for adults aged 65 years or older. However, if the conditions do not permit, the single selfperception question is also acceptable. Moreover, HHIE-s might not be a good test to detect disabling hearing loss for adults aged 80 years or older.展开更多
BACKGROUND Colorectal cancer(CRC)is a prevalent malignant tumor involving adenomas that develop into malignant lesions.Carcinoembryonic antigen(CEA)is a non-specific serum biomarker upregulated in CRC.The concentratio...BACKGROUND Colorectal cancer(CRC)is a prevalent malignant tumor involving adenomas that develop into malignant lesions.Carcinoembryonic antigen(CEA)is a non-specific serum biomarker upregulated in CRC.The concentration of CEA is modulated by tumor stage and grade,tumor site in the colon,ploidy status,and patient smoking status.This study aimed to evaluate current evidence regarding the diagnostic power of CEA levels in the early detection of CRC recurrence in adults.AIM To evaluate current evidence regarding the diagnostic power of CEA levels in the early detection of CRC recurrence in adults.METHODS A systematic search was performed using four databases:MEDLINE,Cochrane Trials,EMBASE,and the Web of Science.The inclusion criteria were as follows:Adult patients aged≥18 years who had completed CRC curative treatment and were followed up postoperatively;reporting the number of CRC recurrences as an outcome;and randomized,clinical,cohort,and case-control study designs.Studies that were not published in English and animal studies were excluded.The following data were extracted by three independent reviewers:Study design,index tests,follow-up,patient characteristics,and primary outcomes.All statistical analyses were performed using the RevMan 5.4.1.RESULTS A total of 3232 studies were identified,with 73 remaining following the elimination of duplicates.After screening on predetermined criteria,12 studies were included in the final analysis.At a reference standard of 5 mg/L,CEA detected only approximately half of recurrent CRCs,with a pooled sensitivity of 59%(range,33%–83%)and sensitivity of 89%(range,58%–97%).CONCLUSION CEA is a significant marker for CRC diagnosis.However,it has insufficient sensitivity and specificity to be used as a single biomarker of early CRC recurrence,with an essential proportion of false negatives.展开更多
BACKGROUND Hepatopulmonary syndrome (HPS) is an arterial oxygenation defect induced by intrapulmonary vascular dilatation (IPVD) in the setting of liver disease and/or portal hypertension.This syndrome occurs most oft...BACKGROUND Hepatopulmonary syndrome (HPS) is an arterial oxygenation defect induced by intrapulmonary vascular dilatation (IPVD) in the setting of liver disease and/or portal hypertension.This syndrome occurs most often in cirrhotic patients(4%-32%) and has been shown to be detrimental to functional status,quality of life,and survival.The diagnosis of HPS in the setting of liver disease and/or portal hypertension requires the demonstration of IPVD (i.e.,diffuse or localized abnormally dilated pulmonary capillaries and pulmonary and pleural arteriovenous communications) and arterial oxygenation defects,preferably by contrast-enhanced echocardiography and measurement of the alveolar-arterial oxygen gradient,respectively.AIM To compare brain and whole-body uptake of technetium for diagnosing HPS.METHODS Sixty-nine patients with chronic liver disease and/or portal hypertension were prospectively included.Brain uptake and whole-body uptake were calculated using the geometric mean of technetium counts in the brain and lungs and in the entire body and lungs,respectively.RESULTS Thirty-two (46%) patients had IPVD as detected by contrast-enhancedechocardiography.The demographics and clinical characteristics of the patients with and without IPVD were not significantly different with the exception of the creatinine level (0.71±0.18 mg/dL vs 0.83±0.23 mg/dL;P=0.041),alveolararterial oxygen gradient (23.2±13.3 mmHg vs 16.4±14.1 mmHg;P=0.043),and arterial partial pressure of oxygen (81.0±12.1 mmHg vs 90.1±12.8 mmHg;P=0.004).Whole-body uptake was significantly higher in patients with IPVD than in patients without IPVD (48.0%±6.1%vs 40.1%±8.1%;P=0.001).The area under the curve of whole-body uptake for detecting IPVD was significantly higher than that of brain uptake (0.75 vs 0.54;P=0.025).The optimal cut-off values of brain uptake and whole-body uptake for detecting IPVD were 5.7%and 42.5%,respectively,based on Youden’s index.The sensitivity,specificity,and accuracy of brain uptake> 5.7%and whole-body uptake> 42.5%for detecting IPVD were23%,89%,and 59%and 100%,52%,and 74%,respectively.CONCLUSION Whole-body uptake is superior to brain uptake for diagnosing HPS.展开更多
BACKGROUND Endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)is a safe and accurate technique to confirm the diagnosis of pancreatic cancers.Recently,numerous studies comparing the diagnostic efficacy o...BACKGROUND Endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)is a safe and accurate technique to confirm the diagnosis of pancreatic cancers.Recently,numerous studies comparing the diagnostic efficacy of smear cytology(SC)and liquid-based cytology(LBC)for pancreatic lesions yielded mixed results.AIM To compare and identify the better cytology method for EUS-FNA in pancreatic lesions.METHODS A comprehensive search of PubMed,Embase,and Cochrane was undertaken through July 18,2020.The primary endpoint was diagnostic accuracy(sensitivity and specificity).Secondary outcomes included sample adequacy and post procedure complications.In addition,factors affecting diagnostic efficacy were discussed.RESULTS Data on a total of 1121 comparisons from 10 studies met the inclusion criteria.Pooled rates of sensitivity for SC and LBC were 78%(67%-87%)vs 75%(67%-81%),respectively.In any case,both SC and LBC exhibited a high specificity close to 100%.Inadequate samples more often appeared in LBC compared with SC.However,the LBC samples exhibited a better visual field than SC.Very few post procedure complications were observed.CONCLUSION Our data suggested that for EUS-FNA in pancreatic lesions(particularly solid lesions),SC with Rapid On-Site Evaluation represents a superior diagnostic technique.If Rapid On-Site Evaluation is unavailable,LBC may replace smears.The diagnostic accuracy of LBC depends on different LBC techniques.展开更多
BACKGROUND Many studies evaluated magnification endoscopy(ME)to correlate changes on the gastric mucosal surface with Helicobacter pylori(H.pylori)infection.However,few studies validated these concepts with high-defin...BACKGROUND Many studies evaluated magnification endoscopy(ME)to correlate changes on the gastric mucosal surface with Helicobacter pylori(H.pylori)infection.However,few studies validated these concepts with high-definition endoscopy without ME.AIM To access the association between mucosal surface pattern under near focus technology and H.pylori infection status in a western population.METHODS Cross-sectional study including all patients referred to routine upper endoscopy.Endoscopic exams were performed using standard high definition(S-HD)followed by near focus(NF-HD)examination.Presence of erythema,erosion,atrophy,and nodularity were recorded during S-HD,and surface mucosal pattern was classified using NF-HD in the gastric body.Biopsies were taken for rapid urease test and histology.RESULTS One hundred and eighty-seven patients were analyzed from August to November 2019.Of those,47(25.1%)were H.pylori+,and 42(22.5%)had a previous H.pylori treatment.In the examination with S-HD,erythema had the best sensitivity for H.pylori detection(80.9%).Exudate(99.3%),nodularity(97.1%),and atrophy(95.7%)demonstrated better specificity values,but with low sensitivity(6.4%-19.1%).On the other hand,the absence of erythema was strongly associated with H.pylori-(negative predictive value=92%).With NF-HD,56.2%of patients presented type 1 pattern(regular arrangement of collecting venules,RAC),and only 5.7%of RAC+patients were H.pylori+.The loss of RAC presented 87.2%sensitivity for H.pylori detection,70.7%specificity,50%positive predictive value,and 94.3%negative predictive value,indicating that loss of RAC was suboptimal to confirm H.pylori infection,but when RAC was seen,H.pylori infection was unlikely.CONCLUSION The presence of RAC at the NF-HD exam and the absence of erythema at S-HD were highly predictive of H.pylori negative status.On the other hand,the loss of RAC had a suboptimal correlation with the presence of H.pylori.展开更多
Point-of-care ultrasonography(POCUS)for managing critically ill patients is increasingly performed by intensivists or emergency physicians.Results of needs surveys among intensivists reveal emphasis on basic cardiac,l...Point-of-care ultrasonography(POCUS)for managing critically ill patients is increasingly performed by intensivists or emergency physicians.Results of needs surveys among intensivists reveal emphasis on basic cardiac,lung and abdominal ultrasound,which are the commonest POCUS modalities in the intensive care unit.We therefore aim to describe the key diagnostic features of basic cardiac,lung and abdominal ultrasound as practised by intensivists or emergency physicians in terms of accuracy(sensitivity,specificity),clinical utility and limitations.We also aim to explore POCUS protocols that integrate basic cardiac,lung and abdominal ultrasound,and highlight areas for future research.展开更多
BACKGROUND Glycated albumin(GA),the non-enzymatic glycation product of albumin in plasma,became a glycemic marker in the beginning of the 21st century.The assay is not affected by hemoglobin levels and reflects the gl...BACKGROUND Glycated albumin(GA),the non-enzymatic glycation product of albumin in plasma,became a glycemic marker in the beginning of the 21st century.The assay is not affected by hemoglobin levels and reflects the glycemic status over a shorter period as compared to HbA1c measurements.Thus,GA may contributes as an intermediate glucose index in the current diabetes mellitus(DM)diagnostic system.AIM To search and summarize the available data on glycated albumin measurements required for the diagnosis of diabetes mellitus.METHODS Databases,including PubMed,Embase,Web of Science,and Cochrane Central Register of Controlled Trials(CENTRAL),among others,were systematically searched.The Quality Assessment of Diagnostic Accuracy Studies-2 tool was applied for the assessment of quality,and the bivariate model was used to pool the sensitivity and specificity.The hierarchical summary receiver operator characteristic curves(HSROC)model was utilized to estimate the summary receiver operating characteristics curve(SROC).Sensitivity analysis was performed to investigate the association of the study design and patient characteristics with the test accuracy and meta-regression to find the source of heterogeneity.RESULTS Three studies regarding gestational diabetes mellitus(GDM)and a meta-analysis of 16 non-GDM studies,comprising a total sample size of 12876,were included in the work.Results reveal that the average cut-off values of GA reported for the diagnosis of GDM diagnosis was much lower than those for non-GDM.For non-GDM cases,diagnosing DM with a circulating GA cut-off of 14.0%had a sensitivity of 0.766(95%CI:0.539,0.901),specificity of 0.687(95%CI:0.364,0.894),and area under the curve of 0.80(95%CI:0.76,0.83)for the SROC.The estimated SROC at different GA cut-off values for non-GDM exhibited that the average location parameter lambda of 16 non-GDM studies was 2.354(95%CI:2.002,2.707),and the scale parameter beta was-0.163(95%CI:-0.614,0.288).These non-GDM studies with various thresholds had substantial heterogeneity,which may be attributed to the type of DM,age,and body mass index as possible sources.CONCLUSION Glycated albumin in non-DM exhibits a moderate diagnostic accuracy.Further research on the diagnostic accuracy of GA for GDM and combinational measurements of GA and other assays is suggested.展开更多
Aims:Paediatric pressure ulcers are a serious problem to healthcare service.Thus,effective and early identification of the risk of developing pressure ulcer is essential.The Braden Q scale is a widely used tool in the...Aims:Paediatric pressure ulcers are a serious problem to healthcare service.Thus,effective and early identification of the risk of developing pressure ulcer is essential.The Braden Q scale is a widely used tool in the risk assessment of paediatric pressure ulcer,but its predictive power is controversial.Hence,we performed a meta-analysis to evaluate the predictive power of the Braden Q scale for pressure ulcer in hospitalised children and offer recommendations for clinical decision.Methods:Studies that evaluated the predictive power of the Braden Q scale were searched through databases in English and Chinese,including Medline,Cochrane Library,Embase,CINAHL,SinoMed,CNKI,Wangfang and VIP.The studies were screened by two independent reviewers.QUADAS-2 was used to assess the risk of bias of eligible studies.Demographic data and predictive value indices were extracted.The pooled sensitivity,specificity and receiver operating characteristics(ROC)were calculated by MetaDiSc 1.4 using random-effects models.Results:Cochran Q=26.13(P=0.0036)indicated the existence of heterogeneity;the I2 for pooled DOR was 61.7%,suggesting significant heterogeneity among the included studies.The pooled sensitivity and specificity were 0.73(95%CI:0.67-0.78)and 0.61(95%CI:0.59-0.63),respectively,yielding a combined DOR of 3.47(95%CI:2-6.01).The area under the ROC curve was 0.7078±0.0421,and the overall diagnostic accuracy(Q*)was 0.6591±0.0337.Sensitivity analysis showed the results were robust.Conclusion:The Braden Q scale has moderate predictive validity with medium sensitivity and low specificity for pressure ulcers in hospitalised children.Further development and modification of this tool for use in paediatric population are warranted.展开更多
Background:Health personnel face challenges in diagnosing vector-borne and other diseases of poverty in urban settings.There is a need to know what rapid diagnostic technologies are available,have been properly assess...Background:Health personnel face challenges in diagnosing vector-borne and other diseases of poverty in urban settings.There is a need to know what rapid diagnostic technologies are available,have been properly assessed,and are being implemented to improve control of these diseases in the urban context.This paper characterizes evidence on the field validation and implementation in urban areas of rapid diagnostics for vector-borne diseases and other diseases of poverty.Main body:A scoping review was conducted.Peer-reviewed and grey literature were searched using terms describing the targeted infectious diseases,diagnostics evaluations,rapid tests,and urban setting.The review was limited to studies published between 2000 and 2016 in English,Spanish,French,and Portuguese.Inclusion and exclusion criteria were refined post hoc to identify relevant literature regardless of study design and geography.A total of 179 documents of the 7806 initially screened were included in the analysis.Malaria(n=100)and tuberculosis(n=47)accounted for the majority of studies that reported diagnostics performance,impact,and implementation outcomes.Fewer studies,assessing mainly performance,were identified for visceral leishmaniasis(n=9),filariasis and leptospirosis(each n=5),enteric fever and schistosomiasis(each n=3),dengue and leprosy(each n=2),and Chagas disease,human African trypanosomiasis,and cholera(each n=1).Reported sensitivity of rapid tests was variable depending on several factors.Overall,specificities were high(>80%),except for schistosomiasis and cholera.Impact and implementation outcomes,mainly acceptability and cost,followed by adoption,feasibility,and sustainability of rapid tests are being evaluated in the field.Challenges to implementing rapid tests range from cultural to technical and administrative issues.Conclusions:Rapid diagnostic tests for vector-borne and other diseases of poverty are being used in the urban context with demonstrated impact on case detection.However,most evidence comes from malaria rapid diagnostics,with variable results.While rapid tests for tuberculosis and visceral leishmaniasis require further implementation studies,more evidence on performance of current tests or development of new alternatives is needed for dengue,Chagas disease,filariasis,leptospirosis,enteric fever,human African trypanosomiasis,schistosomiasis and cholera.展开更多
Objectives:Aim of the present paper is the study of the large unreported component,characterizing the SARS-CoV-2 epidemic event in Italy,taking advantage of the Istat survey.Particular attention is devoted to the sens...Objectives:Aim of the present paper is the study of the large unreported component,characterizing the SARS-CoV-2 epidemic event in Italy,taking advantage of the Istat survey.Particular attention is devoted to the sensitivity and specificity of the serological test and their effects.Methods:The model satisfactory reproduces the data of the Italian survey showing a relevant predictive power and relegating in a secondary position models which do not include,in the simulation,the presence of asymptomatic groups.The corrections due to the serological test sensitivity(in particular those ones depending on the symptoms onset)are crucial for a realistic analysis of the unreported(and asymptomatic)components.Results:The relevant presence of an unreported component during the second pandemic wave in Italy is confirmed and the ratio of reported to unreported cases is predicted to be roughly 1:4 in the last months of year 2020.A method to correct the serological data on the basis of the antibody sensitivity is suggested and systematically applied.The asymptomatic component is also studied in some detail and its amount quantified.A model analyses of the vaccination scenarios is performed confirming the relevance of a massive campaign(at least 80000 immunized per day)during the first six months of the year 2021,to obtain important immunization effects within August/September 2021.展开更多
文摘Objectives: The study aimed to determine the most appropriate hearing screening test to identify disabling hearing loss for adults aged 65 years or older.Methods: This study included 577 older adults. Four hearing screening tests were considered in the study, including the Hearing Handicap Inventory for Elderly Screening(HHIE-s), three single question tests, the whisper test, and the finger rub test. The sensitivity and specificity of these tests referenced to the hearing threshold of disabling hearing loss were estimated.Results: Among all tests, only the single self-perception question(0.7064 for sensitivity;0.7225 for specificity) and whisper test(0.7833 for sensitivity;0.7708 for specificity) could obtain both sensitivity and specificity higher than 70% for adults aged ≥65 years.Conclusion: Overall, we suggest using the whisper test to identify disabling hearing loss(>40 dB HL at the better ear) for adults aged 65 years or older. However, if the conditions do not permit, the single selfperception question is also acceptable. Moreover, HHIE-s might not be a good test to detect disabling hearing loss for adults aged 80 years or older.
基金supported by the National Natural Scientific Foundation of China(81472924,81620108026)the Fundamental Research Funds for the Central Universities in 2015
文摘BACKGROUND Colorectal cancer(CRC)is a prevalent malignant tumor involving adenomas that develop into malignant lesions.Carcinoembryonic antigen(CEA)is a non-specific serum biomarker upregulated in CRC.The concentration of CEA is modulated by tumor stage and grade,tumor site in the colon,ploidy status,and patient smoking status.This study aimed to evaluate current evidence regarding the diagnostic power of CEA levels in the early detection of CRC recurrence in adults.AIM To evaluate current evidence regarding the diagnostic power of CEA levels in the early detection of CRC recurrence in adults.METHODS A systematic search was performed using four databases:MEDLINE,Cochrane Trials,EMBASE,and the Web of Science.The inclusion criteria were as follows:Adult patients aged≥18 years who had completed CRC curative treatment and were followed up postoperatively;reporting the number of CRC recurrences as an outcome;and randomized,clinical,cohort,and case-control study designs.Studies that were not published in English and animal studies were excluded.The following data were extracted by three independent reviewers:Study design,index tests,follow-up,patient characteristics,and primary outcomes.All statistical analyses were performed using the RevMan 5.4.1.RESULTS A total of 3232 studies were identified,with 73 remaining following the elimination of duplicates.After screening on predetermined criteria,12 studies were included in the final analysis.At a reference standard of 5 mg/L,CEA detected only approximately half of recurrent CRCs,with a pooled sensitivity of 59%(range,33%–83%)and sensitivity of 89%(range,58%–97%).CONCLUSION CEA is a significant marker for CRC diagnosis.However,it has insufficient sensitivity and specificity to be used as a single biomarker of early CRC recurrence,with an essential proportion of false negatives.
基金Supported by National Key R and D Program of China,No.2017YFC0107800CAMS Initiative for Innovative Medicine,No.2016-12M-2-004
文摘BACKGROUND Hepatopulmonary syndrome (HPS) is an arterial oxygenation defect induced by intrapulmonary vascular dilatation (IPVD) in the setting of liver disease and/or portal hypertension.This syndrome occurs most often in cirrhotic patients(4%-32%) and has been shown to be detrimental to functional status,quality of life,and survival.The diagnosis of HPS in the setting of liver disease and/or portal hypertension requires the demonstration of IPVD (i.e.,diffuse or localized abnormally dilated pulmonary capillaries and pulmonary and pleural arteriovenous communications) and arterial oxygenation defects,preferably by contrast-enhanced echocardiography and measurement of the alveolar-arterial oxygen gradient,respectively.AIM To compare brain and whole-body uptake of technetium for diagnosing HPS.METHODS Sixty-nine patients with chronic liver disease and/or portal hypertension were prospectively included.Brain uptake and whole-body uptake were calculated using the geometric mean of technetium counts in the brain and lungs and in the entire body and lungs,respectively.RESULTS Thirty-two (46%) patients had IPVD as detected by contrast-enhancedechocardiography.The demographics and clinical characteristics of the patients with and without IPVD were not significantly different with the exception of the creatinine level (0.71±0.18 mg/dL vs 0.83±0.23 mg/dL;P=0.041),alveolararterial oxygen gradient (23.2±13.3 mmHg vs 16.4±14.1 mmHg;P=0.043),and arterial partial pressure of oxygen (81.0±12.1 mmHg vs 90.1±12.8 mmHg;P=0.004).Whole-body uptake was significantly higher in patients with IPVD than in patients without IPVD (48.0%±6.1%vs 40.1%±8.1%;P=0.001).The area under the curve of whole-body uptake for detecting IPVD was significantly higher than that of brain uptake (0.75 vs 0.54;P=0.025).The optimal cut-off values of brain uptake and whole-body uptake for detecting IPVD were 5.7%and 42.5%,respectively,based on Youden’s index.The sensitivity,specificity,and accuracy of brain uptake> 5.7%and whole-body uptake> 42.5%for detecting IPVD were23%,89%,and 59%and 100%,52%,and 74%,respectively.CONCLUSION Whole-body uptake is superior to brain uptake for diagnosing HPS.
文摘BACKGROUND Endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)is a safe and accurate technique to confirm the diagnosis of pancreatic cancers.Recently,numerous studies comparing the diagnostic efficacy of smear cytology(SC)and liquid-based cytology(LBC)for pancreatic lesions yielded mixed results.AIM To compare and identify the better cytology method for EUS-FNA in pancreatic lesions.METHODS A comprehensive search of PubMed,Embase,and Cochrane was undertaken through July 18,2020.The primary endpoint was diagnostic accuracy(sensitivity and specificity).Secondary outcomes included sample adequacy and post procedure complications.In addition,factors affecting diagnostic efficacy were discussed.RESULTS Data on a total of 1121 comparisons from 10 studies met the inclusion criteria.Pooled rates of sensitivity for SC and LBC were 78%(67%-87%)vs 75%(67%-81%),respectively.In any case,both SC and LBC exhibited a high specificity close to 100%.Inadequate samples more often appeared in LBC compared with SC.However,the LBC samples exhibited a better visual field than SC.Very few post procedure complications were observed.CONCLUSION Our data suggested that for EUS-FNA in pancreatic lesions(particularly solid lesions),SC with Rapid On-Site Evaluation represents a superior diagnostic technique.If Rapid On-Site Evaluation is unavailable,LBC may replace smears.The diagnostic accuracy of LBC depends on different LBC techniques.
文摘BACKGROUND Many studies evaluated magnification endoscopy(ME)to correlate changes on the gastric mucosal surface with Helicobacter pylori(H.pylori)infection.However,few studies validated these concepts with high-definition endoscopy without ME.AIM To access the association between mucosal surface pattern under near focus technology and H.pylori infection status in a western population.METHODS Cross-sectional study including all patients referred to routine upper endoscopy.Endoscopic exams were performed using standard high definition(S-HD)followed by near focus(NF-HD)examination.Presence of erythema,erosion,atrophy,and nodularity were recorded during S-HD,and surface mucosal pattern was classified using NF-HD in the gastric body.Biopsies were taken for rapid urease test and histology.RESULTS One hundred and eighty-seven patients were analyzed from August to November 2019.Of those,47(25.1%)were H.pylori+,and 42(22.5%)had a previous H.pylori treatment.In the examination with S-HD,erythema had the best sensitivity for H.pylori detection(80.9%).Exudate(99.3%),nodularity(97.1%),and atrophy(95.7%)demonstrated better specificity values,but with low sensitivity(6.4%-19.1%).On the other hand,the absence of erythema was strongly associated with H.pylori-(negative predictive value=92%).With NF-HD,56.2%of patients presented type 1 pattern(regular arrangement of collecting venules,RAC),and only 5.7%of RAC+patients were H.pylori+.The loss of RAC presented 87.2%sensitivity for H.pylori detection,70.7%specificity,50%positive predictive value,and 94.3%negative predictive value,indicating that loss of RAC was suboptimal to confirm H.pylori infection,but when RAC was seen,H.pylori infection was unlikely.CONCLUSION The presence of RAC at the NF-HD exam and the absence of erythema at S-HD were highly predictive of H.pylori negative status.On the other hand,the loss of RAC had a suboptimal correlation with the presence of H.pylori.
文摘Point-of-care ultrasonography(POCUS)for managing critically ill patients is increasingly performed by intensivists or emergency physicians.Results of needs surveys among intensivists reveal emphasis on basic cardiac,lung and abdominal ultrasound,which are the commonest POCUS modalities in the intensive care unit.We therefore aim to describe the key diagnostic features of basic cardiac,lung and abdominal ultrasound as practised by intensivists or emergency physicians in terms of accuracy(sensitivity,specificity),clinical utility and limitations.We also aim to explore POCUS protocols that integrate basic cardiac,lung and abdominal ultrasound,and highlight areas for future research.
文摘BACKGROUND Glycated albumin(GA),the non-enzymatic glycation product of albumin in plasma,became a glycemic marker in the beginning of the 21st century.The assay is not affected by hemoglobin levels and reflects the glycemic status over a shorter period as compared to HbA1c measurements.Thus,GA may contributes as an intermediate glucose index in the current diabetes mellitus(DM)diagnostic system.AIM To search and summarize the available data on glycated albumin measurements required for the diagnosis of diabetes mellitus.METHODS Databases,including PubMed,Embase,Web of Science,and Cochrane Central Register of Controlled Trials(CENTRAL),among others,were systematically searched.The Quality Assessment of Diagnostic Accuracy Studies-2 tool was applied for the assessment of quality,and the bivariate model was used to pool the sensitivity and specificity.The hierarchical summary receiver operator characteristic curves(HSROC)model was utilized to estimate the summary receiver operating characteristics curve(SROC).Sensitivity analysis was performed to investigate the association of the study design and patient characteristics with the test accuracy and meta-regression to find the source of heterogeneity.RESULTS Three studies regarding gestational diabetes mellitus(GDM)and a meta-analysis of 16 non-GDM studies,comprising a total sample size of 12876,were included in the work.Results reveal that the average cut-off values of GA reported for the diagnosis of GDM diagnosis was much lower than those for non-GDM.For non-GDM cases,diagnosing DM with a circulating GA cut-off of 14.0%had a sensitivity of 0.766(95%CI:0.539,0.901),specificity of 0.687(95%CI:0.364,0.894),and area under the curve of 0.80(95%CI:0.76,0.83)for the SROC.The estimated SROC at different GA cut-off values for non-GDM exhibited that the average location parameter lambda of 16 non-GDM studies was 2.354(95%CI:2.002,2.707),and the scale parameter beta was-0.163(95%CI:-0.614,0.288).These non-GDM studies with various thresholds had substantial heterogeneity,which may be attributed to the type of DM,age,and body mass index as possible sources.CONCLUSION Glycated albumin in non-DM exhibits a moderate diagnostic accuracy.Further research on the diagnostic accuracy of GA for GDM and combinational measurements of GA and other assays is suggested.
文摘Aims:Paediatric pressure ulcers are a serious problem to healthcare service.Thus,effective and early identification of the risk of developing pressure ulcer is essential.The Braden Q scale is a widely used tool in the risk assessment of paediatric pressure ulcer,but its predictive power is controversial.Hence,we performed a meta-analysis to evaluate the predictive power of the Braden Q scale for pressure ulcer in hospitalised children and offer recommendations for clinical decision.Methods:Studies that evaluated the predictive power of the Braden Q scale were searched through databases in English and Chinese,including Medline,Cochrane Library,Embase,CINAHL,SinoMed,CNKI,Wangfang and VIP.The studies were screened by two independent reviewers.QUADAS-2 was used to assess the risk of bias of eligible studies.Demographic data and predictive value indices were extracted.The pooled sensitivity,specificity and receiver operating characteristics(ROC)were calculated by MetaDiSc 1.4 using random-effects models.Results:Cochran Q=26.13(P=0.0036)indicated the existence of heterogeneity;the I2 for pooled DOR was 61.7%,suggesting significant heterogeneity among the included studies.The pooled sensitivity and specificity were 0.73(95%CI:0.67-0.78)and 0.61(95%CI:0.59-0.63),respectively,yielding a combined DOR of 3.47(95%CI:2-6.01).The area under the ROC curve was 0.7078±0.0421,and the overall diagnostic accuracy(Q*)was 0.6591±0.0337.Sensitivity analysis showed the results were robust.Conclusion:The Braden Q scale has moderate predictive validity with medium sensitivity and low specificity for pressure ulcers in hospitalised children.Further development and modification of this tool for use in paediatric population are warranted.
基金This study was funded by WHO/TDR Special program for Research and Training in Tropical Diseases and by Universidad del Valle,Cali-Colombia.
文摘Background:Health personnel face challenges in diagnosing vector-borne and other diseases of poverty in urban settings.There is a need to know what rapid diagnostic technologies are available,have been properly assessed,and are being implemented to improve control of these diseases in the urban context.This paper characterizes evidence on the field validation and implementation in urban areas of rapid diagnostics for vector-borne diseases and other diseases of poverty.Main body:A scoping review was conducted.Peer-reviewed and grey literature were searched using terms describing the targeted infectious diseases,diagnostics evaluations,rapid tests,and urban setting.The review was limited to studies published between 2000 and 2016 in English,Spanish,French,and Portuguese.Inclusion and exclusion criteria were refined post hoc to identify relevant literature regardless of study design and geography.A total of 179 documents of the 7806 initially screened were included in the analysis.Malaria(n=100)and tuberculosis(n=47)accounted for the majority of studies that reported diagnostics performance,impact,and implementation outcomes.Fewer studies,assessing mainly performance,were identified for visceral leishmaniasis(n=9),filariasis and leptospirosis(each n=5),enteric fever and schistosomiasis(each n=3),dengue and leprosy(each n=2),and Chagas disease,human African trypanosomiasis,and cholera(each n=1).Reported sensitivity of rapid tests was variable depending on several factors.Overall,specificities were high(>80%),except for schistosomiasis and cholera.Impact and implementation outcomes,mainly acceptability and cost,followed by adoption,feasibility,and sustainability of rapid tests are being evaluated in the field.Challenges to implementing rapid tests range from cultural to technical and administrative issues.Conclusions:Rapid diagnostic tests for vector-borne and other diseases of poverty are being used in the urban context with demonstrated impact on case detection.However,most evidence comes from malaria rapid diagnostics,with variable results.While rapid tests for tuberculosis and visceral leishmaniasis require further implementation studies,more evidence on performance of current tests or development of new alternatives is needed for dengue,Chagas disease,filariasis,leptospirosis,enteric fever,human African trypanosomiasis,schistosomiasis and cholera.
文摘Objectives:Aim of the present paper is the study of the large unreported component,characterizing the SARS-CoV-2 epidemic event in Italy,taking advantage of the Istat survey.Particular attention is devoted to the sensitivity and specificity of the serological test and their effects.Methods:The model satisfactory reproduces the data of the Italian survey showing a relevant predictive power and relegating in a secondary position models which do not include,in the simulation,the presence of asymptomatic groups.The corrections due to the serological test sensitivity(in particular those ones depending on the symptoms onset)are crucial for a realistic analysis of the unreported(and asymptomatic)components.Results:The relevant presence of an unreported component during the second pandemic wave in Italy is confirmed and the ratio of reported to unreported cases is predicted to be roughly 1:4 in the last months of year 2020.A method to correct the serological data on the basis of the antibody sensitivity is suggested and systematically applied.The asymptomatic component is also studied in some detail and its amount quantified.A model analyses of the vaccination scenarios is performed confirming the relevance of a massive campaign(at least 80000 immunized per day)during the first six months of the year 2021,to obtain important immunization effects within August/September 2021.
