Objective To assess the diagnostic accuracy of bowel sound analysis for irritable bowel syndrome(IBS)with a systematic review and meta-analysis.Methods We searched MEDLINE,Embase,the Cochrane Library,Web of Science,an...Objective To assess the diagnostic accuracy of bowel sound analysis for irritable bowel syndrome(IBS)with a systematic review and meta-analysis.Methods We searched MEDLINE,Embase,the Cochrane Library,Web of Science,and IEEE Xplore databases until September 2023.Cross-sectional and case-control studies on diagnostic accuracy of bowel sound analysis for IBS were identified.We estimated the pooled sensitivity,specificity,positive likelihood ratio,negative likeli-hood ratio,and diagnostic odds ratio with a 95% confidence interval(CI),and plotted a summary receiver operat-ing characteristic curve and evaluated the area under the curve.Results Four studies were included.The pooled diagnostic sensitivity,specificity,positive likelihood ratio,nega-tive likelihood ratio,and diagnostic odds ratio were 0.94(95%CI,0.87‒0.97),0.89(95%CI,0.81‒0.94),8.43(95%CI,4.81‒14.78),0.07(95%CI,0.03‒0.15),and 118.86(95%CI,44.18‒319.75),respectively,with an area under the curve of 0.97(95%CI,0.95‒0.98).Conclusions Computerized bowel sound analysis is a promising tool for IBS.However,limited high-quality data make the results'validity and applicability questionable.There is a need for more diagnostic test accuracy studies and better wearable devices for monitoring and analysis of IBS.展开更多
Objective:To assess the concordance of tumour grade in specimens obtained from diagnostic cystoscopic biopsy and transurethral resection of bladder tumour(TURBT)and explore the risk factors of upgrading.Methods:The me...Objective:To assess the concordance of tumour grade in specimens obtained from diagnostic cystoscopic biopsy and transurethral resection of bladder tumour(TURBT)and explore the risk factors of upgrading.Methods:The medical records of 205 outpatients who underwent diagnostic cystoscopic biopsy before initial TURBT were retrospectively reviewed.Comparative analysis of the tumour grade of biopsy and operation specimens was performed.Tumour grade changing from low-grade to high-grade with or without variant histology was defined as upgrading.Logistic regression an-alyses were performed to identify the risk factors of upgrading.Results:For the 205 patients,the concordance of tumour grade between specimens obtained from biopsy and operation was 0.639.The concordance for patients who were preoperatively diagnosed with low-grade and high-grade was 0.504 and 0.912,respectively.Univariate and multivariate logistic regression analyses showed that older age,tumour multifocality,high neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and low lymphocyte-to-monocyte ratio(LMR)were significantly associated with upgrading(odds ratio ranging from 0.412 to 4.364).The area under the curve of the different multivariate models was improved from 0.752 to 0.821,and decision curve analysis demonstrated a high net benefit when NLR,LMR,and PLR were added.Conclusion:Diagnostic cystoscopic biopsy may not accurately represent the true grade of primary bladder cancer,especially for outpatients with low-grade bladder cancer.Moreover,older age,tumour multifocality,high NLR,PLR,and low LMR are risk factors of upgrading,and systemic inflammatory markers improve the predictive ability.展开更多
BACKGROUND: To evaluate the diagnostic accuracy of clinical signs combined with the tongue blade test(TBT) to detect maxillary and mandibular fractures.METHODS: A cross-sectional study enrolled patients with maxillary...BACKGROUND: To evaluate the diagnostic accuracy of clinical signs combined with the tongue blade test(TBT) to detect maxillary and mandibular fractures.METHODS: A cross-sectional study enrolled patients with maxillary and mandibular injuries in the emergency department. Physical examination and the TBT were performed, followed by radiological imaging(facial X-ray or computed tomography [CT]). The diagnostic accuracy was calculated for individuals and a combination of clinical findings at predicting maxillary and mandibular fractures.RESULTS: A total of 98 patients were identified, of whom 31.6% had maxillary fractures and9.2% had mandibular fractures. The combination of malocclusion, tenderness on palpation and swelling with positive TBT had 100% specificity to detect maxillary and mandibular fractures. In the absence of malocclusion, the combination of tenderness on palpation and swelling with positive TBT produced a specificity of 97.8% for maxillary fracture and a specificity of 96.2% for mandibular fracture. A clinical decision tool consisting of malocclusion, tenderness on palpation, swelling and TBT revealed a specificity of 100% and a positive predictive value of 100%.CONCLUSION: The clinical decision tool is potentially useful to rule out mandibular fractures,thus preventing unnecessary radiation exposure.展开更多
Objective： To evaluate the clinical value of contrast-enhanced ultrasound（CEUS） in transthoracic biopsy of anterior-medial mediastinal lesions.Methods： A total of 123 patients with anterior or middle mediastinum l...Objective： To evaluate the clinical value of contrast-enhanced ultrasound（CEUS） in transthoracic biopsy of anterior-medial mediastinal lesions.Methods： A total of 123 patients with anterior or middle mediastinum lesions required ultrasound guided transthoracic biopsy for pathological diagnosis. Among them, 72 patients received CEUS examinations before biopsy. After CEUS, 8 patients were excluded from biopsy and the rest 64 patients underwent biopsy（CEUS group）. During the same period, 51 patients received biopsy without CEUS examination（US group）. The ultrasonography characteristics, the number of biopsy puncture attempts, diagnostic accuracy rate and the incidence of complications were recorded and compared between the two groups.Results： A large portion of necrosis area or superficial large vessels was found in 8 patients, so the biopsy was cancelled. The internal necrosis was demonstrated in 43.8% of the lesions in CEUS group and in 11.8% of US group（P0.001）. For thymic carcinoma, CEUS increased the detection rate of internal necrosis and pericardial effusion than conventional ultrasound（62.5% vs. 18.8%, P=0.012; 56.3% vs. 12.5%, P=0.023）. The average number of punctures in CEUS group and US group was 2.36±0.70 and 2.21±0.51 times, respectively（P0.05）. The diagnostic accuracy rate of biopsy in CEUS group（96.9%, 62/64） was significantly higher than that in US group（84.3%, 43/51）（P=0.022）. In US group, 2 patients suffered from mediastinal bleeding（3.9%）, while no major complications occurred in CEUS group.Conclusions： CEUS examination provided important information before transthoracic mediastinum biopsy and improved diagnostic accuracy rate in biopsy of anterior and middle mediastinum lesions than conventional ultrasound.展开更多
AIM: To improve the diagnostic accuracy in patients with symptoms and signs of appendicitis, but without confirmative computed tomography (CT) findings.
Objective To prospectively investigate the diagnostic accuracy for coronary artery stenosis of prospectively electrocardiogram-triggered spiral acquisition mode (high pitch mode) dual-source computed tomography corona...Objective To prospectively investigate the diagnostic accuracy for coronary artery stenosis of prospectively electrocardiogram-triggered spiral acquisition mode (high pitch mode) dual-source computed tomography coronary angiography (CTCA) in patients with relatively higher heart rates (HR) compared with catheter coronary angiography (CCA). Methods Forty-seven consecutive patients with relatively higher HR (>65 and <100 bpm) (20 male, 27 female; age 55±10 years) who both underwent dual-source CTCA and CCA were prospectively included in this study. All patients were performed CTCA using high pitch mode setting at 20%-30% of the R-R interval for the image acquisition. All coronary segments were evaluated by two blinded and independent observers with regard to image quality on a three-point scale (1: excellent to 3: non-diagnostic) and for the presence of significant coronary stenoses (defined as diameter narrowing exceeding 50%). Considered CCA as the standard of reference, the sensitivity, specificity, positive predictive value and negative predictive value were calculated. Radiation dose values were calculated using the dose-length product. Results Image quality was rated as being score 1 in 92.4% of segments, score 2 in 6.1% of segmentsand score 3 in 1.5% of segments. The average image quality score per segment was 1.064±0.306. The HR variability of patients with image score 1, 2 and 3 were 2.29±1.06 bpm, 5.17±1.37 bpm, 8.88±1.53 bpm, respectively. The average HR variability of patients with different image scores were significantly different (F=170.402, P=0.001). The sensitivity, specificity, positive and negative predictive values were 92.6%, 97.0%, 87.6%, 98.3%, respectively, per segment and 90.0%, 95.2%, 85.3%, 96.9%, respectively, per vessel and 100%, 63.6%, 90.0%, 100%, respectively, per patient. The effective radiation dose was on average 0.86±0.16 mSv. Conclusion In patients with HR more than 65 bpm and below 100 bpm without cardiac arrhythmia, the prospectively electrocardiogram-gated high-pitch spiral acquisition mode with image acquired timing set at 20%-30% of the R-R interval provides a high diagnostic accuracy for the assessment of coronary stenoses combined with a 1.5% of non-diagnostic coronary segments and a radiation dose below 1 mSv.展开更多
Objective The present study aimed to determine the accuracy of real-time tissue elastography （RTE） for the diagnosis of breast cancer. Methods The search was conducted in the PubMed, Web of Science, Cochrane Librar...Objective The present study aimed to determine the accuracy of real-time tissue elastography （RTE） for the diagnosis of breast cancer. Methods The search was conducted in the PubMed, Web of Science, Cochrane Library, and China Biology Medicine databases from inception through December 31, 2014, without language restrictions. The meta-analysis was conducted using STATA version 12.0 and Meta-Disc version 1.4. We calculated the summary statistics for sensitivity （Sen）, specificity （Spe）, positive and negative likelihood ratio （LR＋/LR–）, diagnostic odds ratio （DOR）, and summary receiver operating characteristic （SROC） curve. Results Ten studies that met al inclusion criteria were included in the meta-analysis. A total of 608 ma-lignant breast lesions and 1292 benign breast tumors were assessed. Al breast lesions were histological y confirmed after RTE. The pooled Sen was 0.83 （95% CI = 0.79–0.86）; the pooled Spe was 0.86 （95% CI = 0.84–0.88）. The pooled LR＋ was 9.87 （95% CI = 2.66–36.71）; the pooled LR– was 0.20 （95% CI = 0.17–0.23）. The pooled DOR of RTE for the diagnosis of breast cancer was 62.21 （95% CI = 33.88–114.24）. The area under the SROC curve was 0.9334 （standard error = 0.00125）. We found no evidence of publica-tion bias （t = –0.57, P = 0.582）. Conclusion RTE may have high diagnostic accuracy for the dif erential diagnosis of benign and malig-nant breast tumors. RTE may be a good tool for breast cancer diagnosis.展开更多
Objective According to literature,cancer patients have the highest incidence of malnutrition among hospital patients(40%-80%).Despite this high prevalence,this condition is still under-diagnosed.The aim of this study ...Objective According to literature,cancer patients have the highest incidence of malnutrition among hospital patients(40%-80%).Despite this high prevalence,this condition is still under-diagnosed.The aim of this study was to conduct a systematic literature review and meta-analysis to assess the diagnostic performance of the Malnutrition Screening Tool(MST),a simple tool that can be applied in a busy setting where a comprehensive assessment at screening would be impractical.Methods PubMed,EMBASE and Cochrane central register of controlled trials were systematically searched to identify records relevant to the research question.The QUADAS-2 was used to assess the quality of each included study and the meta-analysis was conducted using the hierarchical bivariate model in STATA.Results Seven records were included in this study and the overall sensitivity specificity,diagnostic odds ratio(DOR).The pooled sensitivity and specificity generated after the meta-analysis in STATA were 0.78(95%CI:0.64-0.88)and 0.82(95%CI:0.76-0.87),respectively.The corresponding DOR was 16.33(95%CI:7.08-37.67).The positive likelihood ratio(LR+)was+4.39(95%CI:3.02-6.38),and the negative likelihood ratio(LR-)were 0.27(95%CI:0.16-0.47)and the 1/LR-3.72(2.14-6.46).Conclusion These results showed that the MST provides weak diagnostic evidence when used to screen for malnutrition in adult cancer patients.展开更多
The ongoing coronavirus disease 2019(COVID-19)pandemic continues to present diagnostic challenges.The use of thoracic radiography has been studied as a method to improve the diagnostic accuracy of COVID-19.The‘Living...The ongoing coronavirus disease 2019(COVID-19)pandemic continues to present diagnostic challenges.The use of thoracic radiography has been studied as a method to improve the diagnostic accuracy of COVID-19.The‘Living’Cochrane Systematic Review on the diagnostic accuracy of imaging tests for COVID-19 is continuously updated as new information becomes available for study.In the most recent version,published in March 2021,a meta-analysis was done to determine the pooled sensitivity and specificity of chest X-ray(CXR)and lung ultrasound(LUS)for the diagnosis of COVID-19.CXR gave a sensitivity of 80.6%(95%CI:69.1-88.6)and a specificity of 71.5%(95%CI:59.8-80.8).LUS gave a sensitivity rate of 86.4%(95%CI:72.7-93.9)and specificity of 54.6%(95%CI:35.3-72.6).These results differed from the findings reported in the recent article in this journal where they cited the previous versions of the study in which a metaanalysis for CXR and LUS could not be performed.Additionally,the article states that COVID-19 could not be distinguished,using chest computed tomography(CT),from other respiratory diseases.However,the latest review version identifies chest CT as having a specificity of 80.0%(95%CI:74.9-84.3),which is much higher than the previous version which indicated a specificity of 61.1%(95%CI:42.3-77.1).Therefore,CXR,chest CT and LUS have the potential to be used in conjunction with other methods in the diagnosis of COVID-19.展开更多
<strong>Objective:</strong> To assess the diagnostic accuracy and predictive values of clinical symptoms in patients with suspected mild COVID-19 to identify target groups for self-isolation and outpatient...<strong>Objective:</strong> To assess the diagnostic accuracy and predictive values of clinical symptoms in patients with suspected mild COVID-19 to identify target groups for self-isolation and outpatient treatment without additional testing. <strong>Methods:</strong> We conducted an open-label prospective study in patients aged 18 to 72 years with suspected mild COVID-19. The clinical diagnosis was based on the acute onset of such symptoms as olfactory dysfunction, hyperthermia, myalgia, nasal congestion, nasal discharge, cough, rhinolalia, sore throat, without pneumonia in persons in contact with a confirmed case of COVID-19. The physician assessed clinical symptoms using a 4-point scale. The patient self-assessed clinical symptoms using a ten-point visual analogue scale (VAS). All enrolled patients underwent laboratory testing to confirm the diagnosis of COVID-19. <strong>Results:</strong> Of the 120 patients underwent testing, the diagnosis of mild COVID-19 was confirmed in 96 patients and ruled out in 24 patients. When assessing symptoms by a physician according to the correlation analysis, hyperthermia, myalgia, nasal congestion and rhinolalia have a positive predictive value with a significance level of more than 0.6. When self-assessing symptoms by a patient, fever, myalgia and nasal congestion have a diagnostic accuracy with a significance level of more than 0.5. Nasal discharge, cough and sore throat have negative predictive values. <strong>Conclusion: </strong>The presence of these symptoms in patients with an acute onset of the disease can help to make a clinical diagnosis of coronavirus disease and identify target groups for self-isolation and outpatient treatment without additional testing. Highly suspect asymptomatic patients are not considered as those who have possible mild COVID-19 infection.展开更多
Background Resuscitation can sometimes be futile and making a do-not-resuscitate(DNR)decision is in the best interest of the patient.The electronic poor outcome screening(ePOS)score was developed to predict 6-month po...Background Resuscitation can sometimes be futile and making a do-not-resuscitate(DNR)decision is in the best interest of the patient.The electronic poor outcome screening(ePOS)score was developed to predict 6-month poor outcomes of critically ill patients.We explored the diagnostic accuracy of the ePOS score in predicting DNR decisions in the intensive care unit(ICU).Methods This study was conducted at the ICU of a tertiary referral hospital in Saudi Arabia between March and May 2023.Prospectively,we calculated ePOS scores for all eligible consecutive admissions after 48 h in the ICU and recorded the DNR orders.The ability of the score to predict DNR was explored using logistic regression.Youden's ideal cut-off value was calculated using the DeLong method,and different diagnostic accuracy measures were generated with corresponding 95%confidence intervals(CIs).Results We enrolled 857 patients,125 received a DNR order and 732 did not.The average ePOS score of DNR and non-DNR patients was 28.2±10.7 and 15.2±9.7,respectively.ePOS score,as a predictor of DNR order,had an area under receiver operator characteristic(AUROC)curve of 81.8%(95%CI:79.0 to 84.3,P<0.001).Youden's ideal cut-off value>17 was associated with a sensitivity of 87.2(95%CI:80.0 to 92.5,P<0.001),specificity of 63.9(95%CI:60.3 to 67.4,P<0.001),positive predictive value of 29.2(95%CI:24.6 to 33.8,P<0.001),negative predictive value of 96.7(95%CI:95.1 to 98.3,P<0.001),and diagnostic odds ratio 12.1(95%CI:7.0 to 20.8,P<0.001).Conclusions In this study,the ePOS score performed well as a diagnostic test for patients who will be labeled as DNR during their ICU stay.A cut-off score>17 may help guide clinical decisions to withhold or commence resuscitative measures.展开更多
BACKGROUND Helicobacter pylori(H.pylori)infection has been well-established as a significant risk factor for several gastrointestinal disorders.The urea breath test(UBT)has emerged as a leading non-invasive method for...BACKGROUND Helicobacter pylori(H.pylori)infection has been well-established as a significant risk factor for several gastrointestinal disorders.The urea breath test(UBT)has emerged as a leading non-invasive method for detecting H.pylori.Despite numerous studies confirming its substantial accuracy,the reliability of UBT results is often compromised by inherent limitations.These findings underscore the need for a rigorous statistical synthesis to clarify and reconcile the diagnostic accuracy of the UBT for the diagnosis of H.pylori infection.AIM To determine and compare the diagnostic accuracy of 13C-UBT and 14C-UBT for H.pylori infection in adult patients with dyspepsia.METHODS We conducted an independent search of the PubMed/MEDLINE,EMBASE,and Cochrane Central databases until April 2022.Our search included diagnostic accuracy studies that evaluated at least one of the index tests(^(13)C-UBT or ^(14)C-UBT)against a reference standard.We used the QUADAS-2 tool to assess the methodo-logical quality of the studies.We utilized the bivariate random-effects model to calculate sensitivity,specificity,positive and negative test likelihood ratios(LR+and LR-),as well as the diagnostic odds ratio(DOR),and their 95%confidence intervals.We conducted subgroup analyses based on urea dosing,time after urea administration,and assessment technique.To investigate a possible threshold effect,we conducted Spearman correlation analysis,and we generated summary receiver operating characteristic(SROC)curves to assess heterogeneity.Finally,we visually inspected a funnel plot and used Egger’s test to evaluate publication bias.endorsing both as reliable diagnostic tools in clinical practice.CONCLUSION In summary,our study has demonstrated that ^(13)C-UBT has been found to outperform the ^(14)C-UBT,making it the preferred diagnostic approach.Additionally,our results emphasize the significance of carefully considering urea dosage,assessment timing,and measurement techniques for both tests to enhance diagnostic precision.Nevertheless,it is crucial for researchers and clinicians to evaluate the strengths and limitations of our findings before implementing them in practice.展开更多
Tian et al investigated the diagnostic value of serum vascular endothelial growth factor(VEGF)and interleukin-17(IL-17)in primary hepatocellular carcinoma(PHC).Their retrospective study,published in the World Journal ...Tian et al investigated the diagnostic value of serum vascular endothelial growth factor(VEGF)and interleukin-17(IL-17)in primary hepatocellular carcinoma(PHC).Their retrospective study,published in the World Journal of Gastrointestinal Surgery,revealed that the serum levels of VEGF and IL-17 are significantly elevated in PHC patients compared with healthy controls.These biomarkers are closely associated with pathological features such as tumor metastasis and clinical tumor node metastasis stage.A receiver operating characteristic analysis further confirmed the diagnostic efficacy thereof,suggesting that VEGF and IL-17 could serve as valuable tools for early detection and treatment guidance.This study underscores the potential of integrating these biomarkers into clinical practice to increase diagnostic accuracy and improve patient management in PHC.展开更多
This study explores the diagnostic value of combining the Padua score with the thrombotic biomarker tissue plasminogen activator inhibitor-1(tPAI-1)for assessing the risk of deep vein thrombosis(DVT)in patients with p...This study explores the diagnostic value of combining the Padua score with the thrombotic biomarker tissue plasminogen activator inhibitor-1(tPAI-1)for assessing the risk of deep vein thrombosis(DVT)in patients with pulmonary heart disease.These patients often exhibit symptoms similar to venous thrombosis,such as dyspnea and bilateral lower limb swelling,complicating differential diagnosis.The Padua Prediction Score assesses the risk of venous thromboembolism(VTE)in hospitalized patients,while tPAI-1,a key fibrinolytic system inhibitor,indicates a hypercoagulable state.Clinical data from hospitalized patients with cor pulmonale were retrospectively analyzed.ROC curves compared the diagnostic value of the Padua score,tPAI-1 levels,and their combined model for predicting DVT risk.Results showed that tPAI-1 levels were significantly higher in DVT patients compared to non-DVT patients.The Padua score demonstrated a sensitivity of 82.61%and a specificity of 55.26%at a cutoff value of 3.The combined model had a significantly higher AUC than the Padua score alone,indicating better discriminatory ability in diagnosing DVT risk.The combination of the Padua score and tPAI-1 detection significantly improves the accuracy of diagnosing DVT risk in patients with pulmonary heart disease,reducing missed and incorrect diagnoses.This study provides a comprehensive assessment tool for clinicians,enhancing the diagnosis and treatment of patients with cor pulmonale complicated by DVT.Future research should validate these findings in larger samples and explore additional thrombotic biomarkers to optimize the predictive model.展开更多
In this editorial,we discuss the article in the World Journal of Gastroenterology.The article conducts a meta-analysis of the diagnostic accuracy of the urea breath test(UBT),a non-invasive method for detecting Helico...In this editorial,we discuss the article in the World Journal of Gastroenterology.The article conducts a meta-analysis of the diagnostic accuracy of the urea breath test(UBT),a non-invasive method for detecting Helicobacter pylori(H.pylori)infection in humans.It is based on radionuclide-labeled urea.Various methods,both invasive and non-invasive,are available for diagnosing H.pylori infection,inclu-ding endoscopy with biopsy,serology for immunoglobulin titers,stool antigen analysis,and UBT.Several guidelines recommend UBTs as the primary choice for diagnosing H.pylori infection and for reexamining after eradication therapy.It is used to be the first choice non-invasive test due to their high accuracy,specificity,rapid results,and simplicity.Moreover,its performance remains unaffected by the distribution of H.pylori in the stomach,allowing a high flow of patients to be tested.Despite its widespread use,the performance characteristics of UBT have been inconsistently described and remain incompletely defined.There are two UBTs available with Food and Drug Administration approval:The 13C and 14C tests.Both tests are affordable and can provide real-time results.Physicians may prefer the 13C test because it is non-radioactive,compared to 14C which uses a radioactive isotope,especially in young children and pregnant women.Although there was heterogeneity among the studies regarding the diagnostic accuracy of both UBTs,13C-UBT consistently outperforms the 14C-UBT.This makes the 13C-UBT the preferred diagnostic approach.Furthermore,the provided findings of the meta-analysis emphasize the significance of precise considerations when choosing urea dosage,assessment timing,and measurement techniques for both the 13C-UBT and 14C-UBT,to enhance diagnostic precision.展开更多
Background:It is crucial to differentiate accurately glioma recurrence and pseudoprogression which have entirely different prognosis and require different treatment strategies.This study aimed to assess the diagnostic...Background:It is crucial to differentiate accurately glioma recurrence and pseudoprogression which have entirely different prognosis and require different treatment strategies.This study aimed to assess the diagnostic accuracy of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)as a tool for distinguishing glioma recurrence and pseudoprogression.Methods:According to particular criteria of inclusion and exclusion,related studies up to May 1,2019,were thoroughly searched from several databases including PubMed,Embase,Cochrane Library,and Chinese biomedical databases.The quality assessment of diagnostic accuracy studies was applied to evaluate the quality of the included studies.By using the"mada"package in R,the heterogeneity,overall sensitivity,specificity,and diagnostic odds ratio were calculated.Moreover,funnel plots were used to visualize and estimate the publication bias in this study.The area under the summary receiver operating characteristic(SROC)curve was computed to display the diagnostic efficiency of DCE-MRI.Results:In the present meta-analysis,a total of 11 studies covering 616 patients were included.The results showed that the pooled sensitivity,specificity,and diagnostic odds ratio were 0.792(95%confidence interval[CI]0.707-0.857),0.779(95%CI 0.715-0.832),and 16.219(97.5%CI 9.123-28.833),respectively.The value of the area under the SROC curve was 0.846.In addition,the SROC curve showed high sensitivities(>0.6)and low false positive rates(<0.5)from most of the included studies,which suggest that the results of our study were reliable.Furthermore,the funnel plot suggested the existence of publication bias.Conclusions:While the DCE-MRI is not the perfect diagnostic tool for distinguishing glioma recurrence and pseudoprogression,it was capable of improving diagnostic accuracy.Hence,further investigations combining DCE-MRI with other imaging modalities are required to establish an efficient diagnostic method for glioma patients.展开更多
Background Impaired coronary flow reserve （CFR） in patients with hypertension may be caused by epicardial coronary stenosis or microvascular dysfunction. Antihypertensive treatment has been shown to improve coronary...Background Impaired coronary flow reserve （CFR） in patients with hypertension may be caused by epicardial coronary stenosis or microvascular dysfunction. Antihypertensive treatment has been shown to improve coronary microvascular dysfunction. The aim of this study was to evaluate the impact of uncontrolled blood pressure （BP） on diagnostic accuracy of CFR for detecting significant coronary stenosis. Methods A total of 98 hypertensive patients scheduled for coronary angiography （CAG） due to chest pain were studied. Of them, 45 patients had uncontrolled BP （defined as the office BP 〉140/90 mmHg （1 mmHg=0.133 kPa） in general hypertensive patients, or ≥130/80 mmHg in hypertensive individuals with diabetes mellitus）, and the remaining 53 patients had well-controlled BP. CFR was measured in the left anterior descending coronary artery （LAD） during adenosine triphosphate-induced hyperemia by non-invasive transthoracic Doppler echocardiography （TTDE） within 48 hours prior to CAG. Significant LAD stenosis was defined as 〉70% luminal narrowing. Diagnostic accuracy of CFR for detecting significant coronary stenosis was analyzed with a receiver operating characteristic analysis. Results CFR was significantly lower in patients with uncontrolled BP than in those with well-controlled BP （2.1±0.6 vs. 2.6±0.9, P〈0.01）. Multivariate linear regression analysis of the study showed that the value of CFR was independently associated with the angiographically determined degree of LAD stenosis （β= -0.445, P 〈0.0001） and the presence of uncontrolled BP （β= -0.272, P=0.014）. With a receiver operating characteristic analysis, CFR 〈2.2 was the optimal cut-off value for detecting LAD stenosis in all hypertensive patients （AUC 0.83, 95% CI 0.75-0.91） with a sensitivity of 75%, a specificity of 78%, and an accuracy of 77%. A significant reduction of diagnostic specificity was observed in patients with uncontrolled BP compared with those with well-controlled BP （67% vs. 93%, P=0.031）. Conclusions CFR measurement by TTDE is valuable in the diagnosis of significant coronary stenosis in hypertensive patients. However, the diagnostic specificity is reduced in patients with uncontrolled BP.展开更多
Background and Aims:Microvascular invasion(MVI)is a major risk factor for the early recurrence of hepatocel-lular carcinoma(HCC)and it seriously worsens the prog-nosis.Accurate preoperative evaluation of the presence ...Background and Aims:Microvascular invasion(MVI)is a major risk factor for the early recurrence of hepatocel-lular carcinoma(HCC)and it seriously worsens the prog-nosis.Accurate preoperative evaluation of the presence of MVI could greatly benefit the treatment management and prognosis prediction of HCC patients.The study aim was to evaluate the diagnostic performance of the apparent dif-fusion coefficient(ADC),a quantitative parameter for the preoperative diagnosis MVI in HCC patients.Methods:Original articles about diffusion-weighted imaging(DWI)and/or intravoxel incoherent motion(IVIM)conducted on a 3.0 or 1.5 Tesla magnetic resonance imaging(MRI)system indexed through January 17,2021were collected from MED-LINE/PubMed,Web of Science,EMBASE,and the Cochrane Library.Methodological quality was evaluated using Quality Assessment of Diagnostic Accuracy Studies 2(QUADAS-2).The pooled sensitivity,specificity,and summary area un-der the receiver operating characteristic curve(AUROC)were calculated,and meta-regression analysis was per-formed using a bivariate random effects model through a meta-analysis.Results:Nine original articles with a total of 988 HCCs were included.Most studies had low bias risk and minimal applicability concerns.The pooled sensitivity,specificity and AUROC of the ADC value were 73%,70%,and 0.78,respectively.The time interval between the index test and the reference standard was identified as a pos-sible source of heterogeneity by subgroup meta-regression analysis.Conclusions:Meta-analysis showed that the ADC value had moderate accuracy for predicting MVI in HCC.The time interval accounted for the heterogeneity.展开更多
Background:Malaria is a major world health issue and its continued burden is due,in part,to difficulties in the diagnosis of the illness.The World Health Organization recommends confirmatory testing using microscopy-b...Background:Malaria is a major world health issue and its continued burden is due,in part,to difficulties in the diagnosis of the illness.The World Health Organization recommends confirmatory testing using microscopy-based techniques or rapid diagnostic tests(RDT)for all cases of suspected malaria.In regions where Plasmodium species are indigenous,there are multiple etiologies of fever leading to misdiagnoses,especially in populations where HIV is prevalent and children.To determine the frequency of malaria infection in febrile patients over an 8-month period at the Regional Hospital in Bamenda,Cameroon,we evaluated the clinical efficacy of the Flourescence and Staining Technology(FAST)Malaria stain and ParaLens AdvanceTM microscopy system(FM)and compared it with conventional bright field microscopy and Giemsa stain(GS).Methods:Peripheral blood samples from 522 patients with a clinical diagnosis of“suspected malaria”were evaluated using GS and FM methods.A nested PCR assay was the gold standard to compare the two methods.PCR positivity,sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were determined.Results:Four hundred ninety nine samples were included in the final analysis.Of these,30 were positive via PCR(6.01%)with a mean PPV of 19.62%and 27.99%for GS and FM,respectively.The mean NPV was 95.01%and 95.28%for GS and FM,respectively.Sensitivity was 26.67%in both groups and specificity was 92.78%and 96.21%for GS and FM,respectively.An increased level of diagnostic discrepancy was observed between technicians based upon skill level using GS,which was not seen with FM.Conclusions:The frequency of malarial infections confirmed via PCR among patients presenting with fever and other symptoms of malaria was dramatically lower than that anticipated based upon physicians’clinical suspicions.A correlation between technician skill and accuracy of malaria diagnosis using GS was observed that was less pronounced using FM.Additionally,FM increased the specificity and improved the PPV,suggesting this relatively low cost approach could be useful in resource-limited environments.Anecdotally,physicians were reluctant to not treat all patients symptomatically before results were known and in spite of a negative microscopic diagnosis,highlighting the need for further physician education to avoid this practice of overtreatment.A larger study in an area with a known high prevalence is being planned to compare the two microscopy methods against available RDTs.展开更多
Routine use of Magnetic Resonance Imaging (MRI) as screening test after </span><span style="font-family:Verdana;">clinical diagnosis for meniscal and/or anterior cruciate ligament</span><...Routine use of Magnetic Resonance Imaging (MRI) as screening test after </span><span style="font-family:Verdana;">clinical diagnosis for meniscal and/or anterior cruciate ligament</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(ACL) has a detrimental effect on patients in limited resourced countries. This study was done to compare accuracy of clinical examination and that of (MRI) on diagnosing meniscal and or</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">(ACL) tears. </span><b><span style="font-family:Verdana;">Methodology</span></b><span style="font-family:Verdana;">: A cross-sectional-descriptive </span></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">study was done on 57 knees of patients. Clinical examination, MRI and then diagnostic arthroscopy, as the gold standard, were done to all the cases. Results were recorded;the accuracies of MRI and clinical examination were evaluated and their results were compared. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Median age of patients was 40 </span><span style="font-family:Verdana;">years. Clinical examination had sensitivity of 93.62% and specificity of 40% f</span><span style="font-family:Verdana;">or diagnosing meniscal tears;and sensitivity of 100%;and specificity of 97.67% for diagnosing ACL tear. MRI had sensitivity of 85.11%, and specificity of 40% for meniscal tear diagnosis and 71% and 100% respectively for ACL tear diagnosis. Diagnostic accuracy was 84.21% for meniscal and 98.24% for ACL tears by clinical examination and by MRI w</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 77.19% and 92.98% respectively. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Clinical examination has higher accuracy than MRI on diagnosing both ACL and meniscal tear. Thus patients may be scheduled for diagnostic and interventional arthroscopy if clinical examination reveals </span><span style="font-family:Verdana;">meniscal and or ACL injuries. MRI use should be reserved when clinical e</span><span style="font-family:Verdana;">valuation is inconclusive or cannot be done.展开更多
基金funded by the National Natural Science Foundation of China(No.32170788)National High Level Hospital Clinical Research Funding(No.2022-PUMCH-B-023)Beijing Natural Science Foundation(No.7232123).
文摘Objective To assess the diagnostic accuracy of bowel sound analysis for irritable bowel syndrome(IBS)with a systematic review and meta-analysis.Methods We searched MEDLINE,Embase,the Cochrane Library,Web of Science,and IEEE Xplore databases until September 2023.Cross-sectional and case-control studies on diagnostic accuracy of bowel sound analysis for IBS were identified.We estimated the pooled sensitivity,specificity,positive likelihood ratio,negative likeli-hood ratio,and diagnostic odds ratio with a 95% confidence interval(CI),and plotted a summary receiver operat-ing characteristic curve and evaluated the area under the curve.Results Four studies were included.The pooled diagnostic sensitivity,specificity,positive likelihood ratio,nega-tive likelihood ratio,and diagnostic odds ratio were 0.94(95%CI,0.87‒0.97),0.89(95%CI,0.81‒0.94),8.43(95%CI,4.81‒14.78),0.07(95%CI,0.03‒0.15),and 118.86(95%CI,44.18‒319.75),respectively,with an area under the curve of 0.97(95%CI,0.95‒0.98).Conclusions Computerized bowel sound analysis is a promising tool for IBS.However,limited high-quality data make the results'validity and applicability questionable.There is a need for more diagnostic test accuracy studies and better wearable devices for monitoring and analysis of IBS.
基金This study was supported by the Clinical Research Award of the First Affiliated Hospital of Xi'an Jiaotong University,China(No.XJTU1AF-CRF-2015-002 to DH).
文摘Objective:To assess the concordance of tumour grade in specimens obtained from diagnostic cystoscopic biopsy and transurethral resection of bladder tumour(TURBT)and explore the risk factors of upgrading.Methods:The medical records of 205 outpatients who underwent diagnostic cystoscopic biopsy before initial TURBT were retrospectively reviewed.Comparative analysis of the tumour grade of biopsy and operation specimens was performed.Tumour grade changing from low-grade to high-grade with or without variant histology was defined as upgrading.Logistic regression an-alyses were performed to identify the risk factors of upgrading.Results:For the 205 patients,the concordance of tumour grade between specimens obtained from biopsy and operation was 0.639.The concordance for patients who were preoperatively diagnosed with low-grade and high-grade was 0.504 and 0.912,respectively.Univariate and multivariate logistic regression analyses showed that older age,tumour multifocality,high neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and low lymphocyte-to-monocyte ratio(LMR)were significantly associated with upgrading(odds ratio ranging from 0.412 to 4.364).The area under the curve of the different multivariate models was improved from 0.752 to 0.821,and decision curve analysis demonstrated a high net benefit when NLR,LMR,and PLR were added.Conclusion:Diagnostic cystoscopic biopsy may not accurately represent the true grade of primary bladder cancer,especially for outpatients with low-grade bladder cancer.Moreover,older age,tumour multifocality,high NLR,PLR,and low LMR are risk factors of upgrading,and systemic inflammatory markers improve the predictive ability.
文摘BACKGROUND: To evaluate the diagnostic accuracy of clinical signs combined with the tongue blade test(TBT) to detect maxillary and mandibular fractures.METHODS: A cross-sectional study enrolled patients with maxillary and mandibular injuries in the emergency department. Physical examination and the TBT were performed, followed by radiological imaging(facial X-ray or computed tomography [CT]). The diagnostic accuracy was calculated for individuals and a combination of clinical findings at predicting maxillary and mandibular fractures.RESULTS: A total of 98 patients were identified, of whom 31.6% had maxillary fractures and9.2% had mandibular fractures. The combination of malocclusion, tenderness on palpation and swelling with positive TBT had 100% specificity to detect maxillary and mandibular fractures. In the absence of malocclusion, the combination of tenderness on palpation and swelling with positive TBT produced a specificity of 97.8% for maxillary fracture and a specificity of 96.2% for mandibular fracture. A clinical decision tool consisting of malocclusion, tenderness on palpation, swelling and TBT revealed a specificity of 100% and a positive predictive value of 100%.CONCLUSION: The clinical decision tool is potentially useful to rule out mandibular fractures,thus preventing unnecessary radiation exposure.
基金supported by Beijing Municipal Health System Special Funds of High-Level Medical Personnel Construction (No. 2013-3-086)the Natural Science Foundation of Beijing (No. 7152031)Beijing Baiqianwan Talents Project
文摘Objective： To evaluate the clinical value of contrast-enhanced ultrasound（CEUS） in transthoracic biopsy of anterior-medial mediastinal lesions.Methods： A total of 123 patients with anterior or middle mediastinum lesions required ultrasound guided transthoracic biopsy for pathological diagnosis. Among them, 72 patients received CEUS examinations before biopsy. After CEUS, 8 patients were excluded from biopsy and the rest 64 patients underwent biopsy（CEUS group）. During the same period, 51 patients received biopsy without CEUS examination（US group）. The ultrasonography characteristics, the number of biopsy puncture attempts, diagnostic accuracy rate and the incidence of complications were recorded and compared between the two groups.Results： A large portion of necrosis area or superficial large vessels was found in 8 patients, so the biopsy was cancelled. The internal necrosis was demonstrated in 43.8% of the lesions in CEUS group and in 11.8% of US group（P0.001）. For thymic carcinoma, CEUS increased the detection rate of internal necrosis and pericardial effusion than conventional ultrasound（62.5% vs. 18.8%, P=0.012; 56.3% vs. 12.5%, P=0.023）. The average number of punctures in CEUS group and US group was 2.36±0.70 and 2.21±0.51 times, respectively（P0.05）. The diagnostic accuracy rate of biopsy in CEUS group（96.9%, 62/64） was significantly higher than that in US group（84.3%, 43/51）（P=0.022）. In US group, 2 patients suffered from mediastinal bleeding（3.9%）, while no major complications occurred in CEUS group.Conclusions： CEUS examination provided important information before transthoracic mediastinum biopsy and improved diagnostic accuracy rate in biopsy of anterior and middle mediastinum lesions than conventional ultrasound.
文摘AIM: To improve the diagnostic accuracy in patients with symptoms and signs of appendicitis, but without confirmative computed tomography (CT) findings.
基金Supported by the Ministry of Science and Technology of Inner Mongolia, China (20110504)
文摘Objective To prospectively investigate the diagnostic accuracy for coronary artery stenosis of prospectively electrocardiogram-triggered spiral acquisition mode (high pitch mode) dual-source computed tomography coronary angiography (CTCA) in patients with relatively higher heart rates (HR) compared with catheter coronary angiography (CCA). Methods Forty-seven consecutive patients with relatively higher HR (>65 and <100 bpm) (20 male, 27 female; age 55±10 years) who both underwent dual-source CTCA and CCA were prospectively included in this study. All patients were performed CTCA using high pitch mode setting at 20%-30% of the R-R interval for the image acquisition. All coronary segments were evaluated by two blinded and independent observers with regard to image quality on a three-point scale (1: excellent to 3: non-diagnostic) and for the presence of significant coronary stenoses (defined as diameter narrowing exceeding 50%). Considered CCA as the standard of reference, the sensitivity, specificity, positive predictive value and negative predictive value were calculated. Radiation dose values were calculated using the dose-length product. Results Image quality was rated as being score 1 in 92.4% of segments, score 2 in 6.1% of segmentsand score 3 in 1.5% of segments. The average image quality score per segment was 1.064±0.306. The HR variability of patients with image score 1, 2 and 3 were 2.29±1.06 bpm, 5.17±1.37 bpm, 8.88±1.53 bpm, respectively. The average HR variability of patients with different image scores were significantly different (F=170.402, P=0.001). The sensitivity, specificity, positive and negative predictive values were 92.6%, 97.0%, 87.6%, 98.3%, respectively, per segment and 90.0%, 95.2%, 85.3%, 96.9%, respectively, per vessel and 100%, 63.6%, 90.0%, 100%, respectively, per patient. The effective radiation dose was on average 0.86±0.16 mSv. Conclusion In patients with HR more than 65 bpm and below 100 bpm without cardiac arrhythmia, the prospectively electrocardiogram-gated high-pitch spiral acquisition mode with image acquired timing set at 20%-30% of the R-R interval provides a high diagnostic accuracy for the assessment of coronary stenoses combined with a 1.5% of non-diagnostic coronary segments and a radiation dose below 1 mSv.
文摘Objective The present study aimed to determine the accuracy of real-time tissue elastography （RTE） for the diagnosis of breast cancer. Methods The search was conducted in the PubMed, Web of Science, Cochrane Library, and China Biology Medicine databases from inception through December 31, 2014, without language restrictions. The meta-analysis was conducted using STATA version 12.0 and Meta-Disc version 1.4. We calculated the summary statistics for sensitivity （Sen）, specificity （Spe）, positive and negative likelihood ratio （LR＋/LR–）, diagnostic odds ratio （DOR）, and summary receiver operating characteristic （SROC） curve. Results Ten studies that met al inclusion criteria were included in the meta-analysis. A total of 608 ma-lignant breast lesions and 1292 benign breast tumors were assessed. Al breast lesions were histological y confirmed after RTE. The pooled Sen was 0.83 （95% CI = 0.79–0.86）; the pooled Spe was 0.86 （95% CI = 0.84–0.88）. The pooled LR＋ was 9.87 （95% CI = 2.66–36.71）; the pooled LR– was 0.20 （95% CI = 0.17–0.23）. The pooled DOR of RTE for the diagnosis of breast cancer was 62.21 （95% CI = 33.88–114.24）. The area under the SROC curve was 0.9334 （standard error = 0.00125）. We found no evidence of publica-tion bias （t = –0.57, P = 0.582）. Conclusion RTE may have high diagnostic accuracy for the dif erential diagnosis of benign and malig-nant breast tumors. RTE may be a good tool for breast cancer diagnosis.
文摘Objective According to literature,cancer patients have the highest incidence of malnutrition among hospital patients(40%-80%).Despite this high prevalence,this condition is still under-diagnosed.The aim of this study was to conduct a systematic literature review and meta-analysis to assess the diagnostic performance of the Malnutrition Screening Tool(MST),a simple tool that can be applied in a busy setting where a comprehensive assessment at screening would be impractical.Methods PubMed,EMBASE and Cochrane central register of controlled trials were systematically searched to identify records relevant to the research question.The QUADAS-2 was used to assess the quality of each included study and the meta-analysis was conducted using the hierarchical bivariate model in STATA.Results Seven records were included in this study and the overall sensitivity specificity,diagnostic odds ratio(DOR).The pooled sensitivity and specificity generated after the meta-analysis in STATA were 0.78(95%CI:0.64-0.88)and 0.82(95%CI:0.76-0.87),respectively.The corresponding DOR was 16.33(95%CI:7.08-37.67).The positive likelihood ratio(LR+)was+4.39(95%CI:3.02-6.38),and the negative likelihood ratio(LR-)were 0.27(95%CI:0.16-0.47)and the 1/LR-3.72(2.14-6.46).Conclusion These results showed that the MST provides weak diagnostic evidence when used to screen for malnutrition in adult cancer patients.
文摘The ongoing coronavirus disease 2019(COVID-19)pandemic continues to present diagnostic challenges.The use of thoracic radiography has been studied as a method to improve the diagnostic accuracy of COVID-19.The‘Living’Cochrane Systematic Review on the diagnostic accuracy of imaging tests for COVID-19 is continuously updated as new information becomes available for study.In the most recent version,published in March 2021,a meta-analysis was done to determine the pooled sensitivity and specificity of chest X-ray(CXR)and lung ultrasound(LUS)for the diagnosis of COVID-19.CXR gave a sensitivity of 80.6%(95%CI:69.1-88.6)and a specificity of 71.5%(95%CI:59.8-80.8).LUS gave a sensitivity rate of 86.4%(95%CI:72.7-93.9)and specificity of 54.6%(95%CI:35.3-72.6).These results differed from the findings reported in the recent article in this journal where they cited the previous versions of the study in which a metaanalysis for CXR and LUS could not be performed.Additionally,the article states that COVID-19 could not be distinguished,using chest computed tomography(CT),from other respiratory diseases.However,the latest review version identifies chest CT as having a specificity of 80.0%(95%CI:74.9-84.3),which is much higher than the previous version which indicated a specificity of 61.1%(95%CI:42.3-77.1).Therefore,CXR,chest CT and LUS have the potential to be used in conjunction with other methods in the diagnosis of COVID-19.
文摘<strong>Objective:</strong> To assess the diagnostic accuracy and predictive values of clinical symptoms in patients with suspected mild COVID-19 to identify target groups for self-isolation and outpatient treatment without additional testing. <strong>Methods:</strong> We conducted an open-label prospective study in patients aged 18 to 72 years with suspected mild COVID-19. The clinical diagnosis was based on the acute onset of such symptoms as olfactory dysfunction, hyperthermia, myalgia, nasal congestion, nasal discharge, cough, rhinolalia, sore throat, without pneumonia in persons in contact with a confirmed case of COVID-19. The physician assessed clinical symptoms using a 4-point scale. The patient self-assessed clinical symptoms using a ten-point visual analogue scale (VAS). All enrolled patients underwent laboratory testing to confirm the diagnosis of COVID-19. <strong>Results:</strong> Of the 120 patients underwent testing, the diagnosis of mild COVID-19 was confirmed in 96 patients and ruled out in 24 patients. When assessing symptoms by a physician according to the correlation analysis, hyperthermia, myalgia, nasal congestion and rhinolalia have a positive predictive value with a significance level of more than 0.6. When self-assessing symptoms by a patient, fever, myalgia and nasal congestion have a diagnostic accuracy with a significance level of more than 0.5. Nasal discharge, cough and sore throat have negative predictive values. <strong>Conclusion: </strong>The presence of these symptoms in patients with an acute onset of the disease can help to make a clinical diagnosis of coronavirus disease and identify target groups for self-isolation and outpatient treatment without additional testing. Highly suspect asymptomatic patients are not considered as those who have possible mild COVID-19 infection.
文摘Background Resuscitation can sometimes be futile and making a do-not-resuscitate(DNR)decision is in the best interest of the patient.The electronic poor outcome screening(ePOS)score was developed to predict 6-month poor outcomes of critically ill patients.We explored the diagnostic accuracy of the ePOS score in predicting DNR decisions in the intensive care unit(ICU).Methods This study was conducted at the ICU of a tertiary referral hospital in Saudi Arabia between March and May 2023.Prospectively,we calculated ePOS scores for all eligible consecutive admissions after 48 h in the ICU and recorded the DNR orders.The ability of the score to predict DNR was explored using logistic regression.Youden's ideal cut-off value was calculated using the DeLong method,and different diagnostic accuracy measures were generated with corresponding 95%confidence intervals(CIs).Results We enrolled 857 patients,125 received a DNR order and 732 did not.The average ePOS score of DNR and non-DNR patients was 28.2±10.7 and 15.2±9.7,respectively.ePOS score,as a predictor of DNR order,had an area under receiver operator characteristic(AUROC)curve of 81.8%(95%CI:79.0 to 84.3,P<0.001).Youden's ideal cut-off value>17 was associated with a sensitivity of 87.2(95%CI:80.0 to 92.5,P<0.001),specificity of 63.9(95%CI:60.3 to 67.4,P<0.001),positive predictive value of 29.2(95%CI:24.6 to 33.8,P<0.001),negative predictive value of 96.7(95%CI:95.1 to 98.3,P<0.001),and diagnostic odds ratio 12.1(95%CI:7.0 to 20.8,P<0.001).Conclusions In this study,the ePOS score performed well as a diagnostic test for patients who will be labeled as DNR during their ICU stay.A cut-off score>17 may help guide clinical decisions to withhold or commence resuscitative measures.
基金Supported by Scientific Initiation Scholarship Programme(PIBIC)of the Bahia State Research Support Foundationthe Doctorate Scholarship Program of the Coordination of Improvement of Higher Education Personnel+1 种基金the Scientific Initiation Scholarship Programme(PIBIC)of the National Council for Scientific and Technological Developmentand the CNPq Research Productivity Fellowship.
文摘BACKGROUND Helicobacter pylori(H.pylori)infection has been well-established as a significant risk factor for several gastrointestinal disorders.The urea breath test(UBT)has emerged as a leading non-invasive method for detecting H.pylori.Despite numerous studies confirming its substantial accuracy,the reliability of UBT results is often compromised by inherent limitations.These findings underscore the need for a rigorous statistical synthesis to clarify and reconcile the diagnostic accuracy of the UBT for the diagnosis of H.pylori infection.AIM To determine and compare the diagnostic accuracy of 13C-UBT and 14C-UBT for H.pylori infection in adult patients with dyspepsia.METHODS We conducted an independent search of the PubMed/MEDLINE,EMBASE,and Cochrane Central databases until April 2022.Our search included diagnostic accuracy studies that evaluated at least one of the index tests(^(13)C-UBT or ^(14)C-UBT)against a reference standard.We used the QUADAS-2 tool to assess the methodo-logical quality of the studies.We utilized the bivariate random-effects model to calculate sensitivity,specificity,positive and negative test likelihood ratios(LR+and LR-),as well as the diagnostic odds ratio(DOR),and their 95%confidence intervals.We conducted subgroup analyses based on urea dosing,time after urea administration,and assessment technique.To investigate a possible threshold effect,we conducted Spearman correlation analysis,and we generated summary receiver operating characteristic(SROC)curves to assess heterogeneity.Finally,we visually inspected a funnel plot and used Egger’s test to evaluate publication bias.endorsing both as reliable diagnostic tools in clinical practice.CONCLUSION In summary,our study has demonstrated that ^(13)C-UBT has been found to outperform the ^(14)C-UBT,making it the preferred diagnostic approach.Additionally,our results emphasize the significance of carefully considering urea dosage,assessment timing,and measurement techniques for both tests to enhance diagnostic precision.Nevertheless,it is crucial for researchers and clinicians to evaluate the strengths and limitations of our findings before implementing them in practice.
文摘Tian et al investigated the diagnostic value of serum vascular endothelial growth factor(VEGF)and interleukin-17(IL-17)in primary hepatocellular carcinoma(PHC).Their retrospective study,published in the World Journal of Gastrointestinal Surgery,revealed that the serum levels of VEGF and IL-17 are significantly elevated in PHC patients compared with healthy controls.These biomarkers are closely associated with pathological features such as tumor metastasis and clinical tumor node metastasis stage.A receiver operating characteristic analysis further confirmed the diagnostic efficacy thereof,suggesting that VEGF and IL-17 could serve as valuable tools for early detection and treatment guidance.This study underscores the potential of integrating these biomarkers into clinical practice to increase diagnostic accuracy and improve patient management in PHC.
基金Sichuan Province Medical Research Project Plan(Project No.S21113)。
文摘This study explores the diagnostic value of combining the Padua score with the thrombotic biomarker tissue plasminogen activator inhibitor-1(tPAI-1)for assessing the risk of deep vein thrombosis(DVT)in patients with pulmonary heart disease.These patients often exhibit symptoms similar to venous thrombosis,such as dyspnea and bilateral lower limb swelling,complicating differential diagnosis.The Padua Prediction Score assesses the risk of venous thromboembolism(VTE)in hospitalized patients,while tPAI-1,a key fibrinolytic system inhibitor,indicates a hypercoagulable state.Clinical data from hospitalized patients with cor pulmonale were retrospectively analyzed.ROC curves compared the diagnostic value of the Padua score,tPAI-1 levels,and their combined model for predicting DVT risk.Results showed that tPAI-1 levels were significantly higher in DVT patients compared to non-DVT patients.The Padua score demonstrated a sensitivity of 82.61%and a specificity of 55.26%at a cutoff value of 3.The combined model had a significantly higher AUC than the Padua score alone,indicating better discriminatory ability in diagnosing DVT risk.The combination of the Padua score and tPAI-1 detection significantly improves the accuracy of diagnosing DVT risk in patients with pulmonary heart disease,reducing missed and incorrect diagnoses.This study provides a comprehensive assessment tool for clinicians,enhancing the diagnosis and treatment of patients with cor pulmonale complicated by DVT.Future research should validate these findings in larger samples and explore additional thrombotic biomarkers to optimize the predictive model.
文摘In this editorial,we discuss the article in the World Journal of Gastroenterology.The article conducts a meta-analysis of the diagnostic accuracy of the urea breath test(UBT),a non-invasive method for detecting Helicobacter pylori(H.pylori)infection in humans.It is based on radionuclide-labeled urea.Various methods,both invasive and non-invasive,are available for diagnosing H.pylori infection,inclu-ding endoscopy with biopsy,serology for immunoglobulin titers,stool antigen analysis,and UBT.Several guidelines recommend UBTs as the primary choice for diagnosing H.pylori infection and for reexamining after eradication therapy.It is used to be the first choice non-invasive test due to their high accuracy,specificity,rapid results,and simplicity.Moreover,its performance remains unaffected by the distribution of H.pylori in the stomach,allowing a high flow of patients to be tested.Despite its widespread use,the performance characteristics of UBT have been inconsistently described and remain incompletely defined.There are two UBTs available with Food and Drug Administration approval:The 13C and 14C tests.Both tests are affordable and can provide real-time results.Physicians may prefer the 13C test because it is non-radioactive,compared to 14C which uses a radioactive isotope,especially in young children and pregnant women.Although there was heterogeneity among the studies regarding the diagnostic accuracy of both UBTs,13C-UBT consistently outperforms the 14C-UBT.This makes the 13C-UBT the preferred diagnostic approach.Furthermore,the provided findings of the meta-analysis emphasize the significance of precise considerations when choosing urea dosage,assessment timing,and measurement techniques for both the 13C-UBT and 14C-UBT,to enhance diagnostic precision.
文摘Background:It is crucial to differentiate accurately glioma recurrence and pseudoprogression which have entirely different prognosis and require different treatment strategies.This study aimed to assess the diagnostic accuracy of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)as a tool for distinguishing glioma recurrence and pseudoprogression.Methods:According to particular criteria of inclusion and exclusion,related studies up to May 1,2019,were thoroughly searched from several databases including PubMed,Embase,Cochrane Library,and Chinese biomedical databases.The quality assessment of diagnostic accuracy studies was applied to evaluate the quality of the included studies.By using the"mada"package in R,the heterogeneity,overall sensitivity,specificity,and diagnostic odds ratio were calculated.Moreover,funnel plots were used to visualize and estimate the publication bias in this study.The area under the summary receiver operating characteristic(SROC)curve was computed to display the diagnostic efficiency of DCE-MRI.Results:In the present meta-analysis,a total of 11 studies covering 616 patients were included.The results showed that the pooled sensitivity,specificity,and diagnostic odds ratio were 0.792(95%confidence interval[CI]0.707-0.857),0.779(95%CI 0.715-0.832),and 16.219(97.5%CI 9.123-28.833),respectively.The value of the area under the SROC curve was 0.846.In addition,the SROC curve showed high sensitivities(>0.6)and low false positive rates(<0.5)from most of the included studies,which suggest that the results of our study were reliable.Furthermore,the funnel plot suggested the existence of publication bias.Conclusions:While the DCE-MRI is not the perfect diagnostic tool for distinguishing glioma recurrence and pseudoprogression,it was capable of improving diagnostic accuracy.Hence,further investigations combining DCE-MRI with other imaging modalities are required to establish an efficient diagnostic method for glioma patients.
文摘Background Impaired coronary flow reserve （CFR） in patients with hypertension may be caused by epicardial coronary stenosis or microvascular dysfunction. Antihypertensive treatment has been shown to improve coronary microvascular dysfunction. The aim of this study was to evaluate the impact of uncontrolled blood pressure （BP） on diagnostic accuracy of CFR for detecting significant coronary stenosis. Methods A total of 98 hypertensive patients scheduled for coronary angiography （CAG） due to chest pain were studied. Of them, 45 patients had uncontrolled BP （defined as the office BP 〉140/90 mmHg （1 mmHg=0.133 kPa） in general hypertensive patients, or ≥130/80 mmHg in hypertensive individuals with diabetes mellitus）, and the remaining 53 patients had well-controlled BP. CFR was measured in the left anterior descending coronary artery （LAD） during adenosine triphosphate-induced hyperemia by non-invasive transthoracic Doppler echocardiography （TTDE） within 48 hours prior to CAG. Significant LAD stenosis was defined as 〉70% luminal narrowing. Diagnostic accuracy of CFR for detecting significant coronary stenosis was analyzed with a receiver operating characteristic analysis. Results CFR was significantly lower in patients with uncontrolled BP than in those with well-controlled BP （2.1±0.6 vs. 2.6±0.9, P〈0.01）. Multivariate linear regression analysis of the study showed that the value of CFR was independently associated with the angiographically determined degree of LAD stenosis （β= -0.445, P 〈0.0001） and the presence of uncontrolled BP （β= -0.272, P=0.014）. With a receiver operating characteristic analysis, CFR 〈2.2 was the optimal cut-off value for detecting LAD stenosis in all hypertensive patients （AUC 0.83, 95% CI 0.75-0.91） with a sensitivity of 75%, a specificity of 78%, and an accuracy of 77%. A significant reduction of diagnostic specificity was observed in patients with uncontrolled BP compared with those with well-controlled BP （67% vs. 93%, P=0.031）. Conclusions CFR measurement by TTDE is valuable in the diagnosis of significant coronary stenosis in hypertensive patients. However, the diagnostic specificity is reduced in patients with uncontrolled BP.
基金The work was supported by the National Natural Science Foundation of China(Nos.82071876,61871276)Beijing Natural Science Foundation(No.7184199)+1 种基金and Heilongjiang province Science Foundation for Youths(No.QC201807)Beijing Municipal Administration of Hospitals’Youth Programme(No.QML20200108).
文摘Background and Aims:Microvascular invasion(MVI)is a major risk factor for the early recurrence of hepatocel-lular carcinoma(HCC)and it seriously worsens the prog-nosis.Accurate preoperative evaluation of the presence of MVI could greatly benefit the treatment management and prognosis prediction of HCC patients.The study aim was to evaluate the diagnostic performance of the apparent dif-fusion coefficient(ADC),a quantitative parameter for the preoperative diagnosis MVI in HCC patients.Methods:Original articles about diffusion-weighted imaging(DWI)and/or intravoxel incoherent motion(IVIM)conducted on a 3.0 or 1.5 Tesla magnetic resonance imaging(MRI)system indexed through January 17,2021were collected from MED-LINE/PubMed,Web of Science,EMBASE,and the Cochrane Library.Methodological quality was evaluated using Quality Assessment of Diagnostic Accuracy Studies 2(QUADAS-2).The pooled sensitivity,specificity,and summary area un-der the receiver operating characteristic curve(AUROC)were calculated,and meta-regression analysis was per-formed using a bivariate random effects model through a meta-analysis.Results:Nine original articles with a total of 988 HCCs were included.Most studies had low bias risk and minimal applicability concerns.The pooled sensitivity,specificity and AUROC of the ADC value were 73%,70%,and 0.78,respectively.The time interval between the index test and the reference standard was identified as a pos-sible source of heterogeneity by subgroup meta-regression analysis.Conclusions:Meta-analysis showed that the ADC value had moderate accuracy for predicting MVI in HCC.The time interval accounted for the heterogeneity.
基金Support for this study was via a grant to SG from Kansas City University of Medicine and Biosciences and support for the stain and LED microscopes was to CM from QBC Diagnostics and the University of Missouri-Kansas CityAdditional funding for supplies was provided from QBC and additional support for education and training of personnel in Cameroon was a gift to CM from the Shumaker Foundation,Kansas City.
文摘Background:Malaria is a major world health issue and its continued burden is due,in part,to difficulties in the diagnosis of the illness.The World Health Organization recommends confirmatory testing using microscopy-based techniques or rapid diagnostic tests(RDT)for all cases of suspected malaria.In regions where Plasmodium species are indigenous,there are multiple etiologies of fever leading to misdiagnoses,especially in populations where HIV is prevalent and children.To determine the frequency of malaria infection in febrile patients over an 8-month period at the Regional Hospital in Bamenda,Cameroon,we evaluated the clinical efficacy of the Flourescence and Staining Technology(FAST)Malaria stain and ParaLens AdvanceTM microscopy system(FM)and compared it with conventional bright field microscopy and Giemsa stain(GS).Methods:Peripheral blood samples from 522 patients with a clinical diagnosis of“suspected malaria”were evaluated using GS and FM methods.A nested PCR assay was the gold standard to compare the two methods.PCR positivity,sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were determined.Results:Four hundred ninety nine samples were included in the final analysis.Of these,30 were positive via PCR(6.01%)with a mean PPV of 19.62%and 27.99%for GS and FM,respectively.The mean NPV was 95.01%and 95.28%for GS and FM,respectively.Sensitivity was 26.67%in both groups and specificity was 92.78%and 96.21%for GS and FM,respectively.An increased level of diagnostic discrepancy was observed between technicians based upon skill level using GS,which was not seen with FM.Conclusions:The frequency of malarial infections confirmed via PCR among patients presenting with fever and other symptoms of malaria was dramatically lower than that anticipated based upon physicians’clinical suspicions.A correlation between technician skill and accuracy of malaria diagnosis using GS was observed that was less pronounced using FM.Additionally,FM increased the specificity and improved the PPV,suggesting this relatively low cost approach could be useful in resource-limited environments.Anecdotally,physicians were reluctant to not treat all patients symptomatically before results were known and in spite of a negative microscopic diagnosis,highlighting the need for further physician education to avoid this practice of overtreatment.A larger study in an area with a known high prevalence is being planned to compare the two microscopy methods against available RDTs.
文摘Routine use of Magnetic Resonance Imaging (MRI) as screening test after </span><span style="font-family:Verdana;">clinical diagnosis for meniscal and/or anterior cruciate ligament</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">(ACL) has a detrimental effect on patients in limited resourced countries. This study was done to compare accuracy of clinical examination and that of (MRI) on diagnosing meniscal and or</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">(ACL) tears. </span><b><span style="font-family:Verdana;">Methodology</span></b><span style="font-family:Verdana;">: A cross-sectional-descriptive </span></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">study was done on 57 knees of patients. Clinical examination, MRI and then diagnostic arthroscopy, as the gold standard, were done to all the cases. Results were recorded;the accuracies of MRI and clinical examination were evaluated and their results were compared. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Median age of patients was 40 </span><span style="font-family:Verdana;">years. Clinical examination had sensitivity of 93.62% and specificity of 40% f</span><span style="font-family:Verdana;">or diagnosing meniscal tears;and sensitivity of 100%;and specificity of 97.67% for diagnosing ACL tear. MRI had sensitivity of 85.11%, and specificity of 40% for meniscal tear diagnosis and 71% and 100% respectively for ACL tear diagnosis. Diagnostic accuracy was 84.21% for meniscal and 98.24% for ACL tears by clinical examination and by MRI w</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">as</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 77.19% and 92.98% respectively. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Clinical examination has higher accuracy than MRI on diagnosing both ACL and meniscal tear. Thus patients may be scheduled for diagnostic and interventional arthroscopy if clinical examination reveals </span><span style="font-family:Verdana;">meniscal and or ACL injuries. MRI use should be reserved when clinical e</span><span style="font-family:Verdana;">valuation is inconclusive or cannot be done.
