Hepatocellular carcinoma (HCC) can be diagnosed without pathologic confirmation in high-risk patients. Therefore, it is necessary to compare current imaging criteria for noninvasive-diagnosis of HCC.
...To systematically compare performance of 2018 European Association for the Study of the Liver (EASL) criteria and Liver Imaging Reporting and Data System (LI-RADS) for noninvasive-diagnosis of HCC.
Systematic review and meta-analysis.
Eight studies with 2232 observations, including 1617 HCCs.
1.5 T, 3.0 T/T2-weighted, unenhanced T1-weighted in-/opposed-phases, multiphase T1-weighted imaging.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two reviewers independently reviewed and extracted data, including patient characteristics, index test, reference standard and outcomes, from studies intraindividually comparing the sensitivities and specificities of 2018 EASL-criteria and LR-5 of LI-RADS for HCC. Risk of bias and concerns regarding applicability were evaluated using QUADAS-2 tool. Subgroup analysis was performed based on observation size (≥20 mm, 10-19 mm).
Bivariate random-effects model to calculate pooled per-observation sensitivity and specificity of both imaging criteria, and pooled estimates of intraindividual paired data were compared considering the correlation. Forest and linked-receiver-operating-characteristic plots were drawn, and study heterogeneity was assessed using Q-test and Higgins-index. Publication bias was evaluated by Egger's test. A P-value <0.05 was considered statistically significant, except for heterogeneity (P < 0.10).
The sensitivity for HCC did not differ significantly between the imaging-based diagnosis using EASL-criteria (61%; 95% CI, 50%-73%) and LR-5 (64%; 95% CI, 53%-76%; P = 0.165). The specificities were also not significantly different between EASL-criteria (92%; 95% CI, 89%-94%) and LR-5 (94%; 95% CI, 91%-96%; P = 0.257). In subgroup analysis, no statistically significant differences were identified in the pooled performances between the two criteria for observations ≥20 mm (sensitivity P = 0.065; specificity P = 0.343) or 10-19 mm (sensitivity P > 0.999; specificity P = 0.851). There was no publication bias for EASL (P = 0.396) and LI-RADS (P = 0.526).
In the present meta-analysis of paired comparisons, the pooled sensitivities and specificities were not significantly different between 2018 EASL-criteria and LR-5 of LI-RADS for noninvasive-diagnosis of HCC.
3.
Stage 2.
Early diagnosis and treatment of bacterial meningitis in children are essential, due to the high mortality and morbidity rates. However, lumbar puncture is often difficult, and cerebrospinal fluid ...(CSF) culture takes time. This meta-analysis aims to determine the diagnostic accuracy of blood procalcitonin for detecting bacterial meningitis in children. We conducted a systematic search on electronic databases to identify relevant studies. Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated, and a hierarchical summary receiver operating characteristic curve and area under the curve (AUC) were determined. Eighteen studies with 1462 children were included in the analysis. The pooled sensitivity, specificity, and the DOR of blood procalcitonin for detecting bacterial meningitis were 0.87 (95% confidence interval (CI): 0.78–0.93); 0.85 (95% CI: 0.75–0.91), and 35.85 (95% CI: 10.68–120.28), respectively. The AUC for blood procalcitonin was 0.921. Blood procalcitonin also showed higher diagnostic accuracy for detecting bacterial meningitis than other conventional biomarkers, including serum C-reactive protein and leukocyte count, CSF leukocyte and neutrophil count, and CSF protein and glucose levels. Blood procalcitonin can be a good supplemental biomarker with high diagnostic accuracy in detecting bacterial meningitis in children.
Anxiety, depression, and insomnia are highly prevalent among migraineurs and are associated with negative health consequences. Anxiety and depression, however, unlike insomnia, are usually ...underdiagnosed, due to less self-reporting of these two conditions. The aim of the present study was to evaluate the risk of anxiety and depression in migraineurs with self-reported insomnia, using a general population-based sample. We used data from a nationwide population-based survey on headache and sleep, the Korean Headache-Sleep Study. Of all 2,695 participants, 143 (5.3%), 268 (10.0%), 116 (4.3%), and 290 (10.8%) were classified as having migraine, anxiety, depression, and self-reported insomnia, respectively. The risk of anxiety (odds ratio OR = 7.0, 95% confidence interval CI = 3.0-16.7) and depression (OR = 3.3, 95% CI = 1.3-8.5) was significantly increased in migraineurs with self-reported insomnia. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for anxiety in migraineurs with self-reported insomnia were 46.5%, 89.0%, 64.5%, and 79.5%, respectively. For depression, the sensitivity, specificity, PPV, and NPV were 41.7%, 82.4%, 32.3%, and 87.5%, respectively. Self-reported insomnia is likely to be comorbid with anxiety and depression in migraineurs and could thus be a useful predictor of anxiety and depression in migraine.
Although many case reports have described patients with proton pump inhibitor (PPI)-induced hypomagnesemia, the impact of PPI use on hypomagnesemia has not been fully clarified through comparative ...studies. We aimed to evaluate the association between the use of PPI and the risk of developing hypomagnesemia by conducting a systematic review with meta-analysis.
We conducted a systematic search of MEDLINE, EMBASE, and the Cochrane Library using the primary keywords "proton pump," "dexlansoprazole," "esomeprazole," "ilaprazole," "lansoprazole," "omeprazole," "pantoprazole," "rabeprazole," "hypomagnesemia," "hypomagnesaemia," and "magnesium." Studies were included if they evaluated the association between PPI use and hypomagnesemia and reported relative risks or odds ratios or provided data for their estimation. Pooled odds ratios with 95% confidence intervals were calculated using the random effects model. Statistical heterogeneity was assessed with Cochran's Q test and I2 statistics.
Nine studies including 115,455 patients were analyzed. The median Newcastle-Ottawa quality score for the included studies was seven (range, 6-9). Among patients taking PPIs, the median proportion of patients with hypomagnesemia was 27.1% (range, 11.3-55.2%) across all included studies. Among patients not taking PPIs, the median proportion of patients with hypomagnesemia was 18.4% (range, 4.3-52.7%). On meta-analysis, pooled odds ratio for PPI use was found to be 1.775 (95% confidence interval 1.077-2.924). Significant heterogeneity was identified using Cochran's Q test (df = 7, P<0.001, I2 = 98.0%).
PPI use may increase the risk of hypomagnesemia. However, significant heterogeneity among the included studies prevented us from reaching a definitive conclusion.
Background
Various parameters are used to predict perioperative surgical outcomes. However, no comprehensive studies in gastrectomy have been conducted. This study aimed to compare the performance of ...each parameter in patients with gastric cancer.
Methods
The medical records of 1032 gastric cancer patients who underwent curative gastrectomy between 2009 and 2015 were reviewed. Laboratory values and associated parameters (neutrophil count, lymphocyte count, platelet count, albumin level, Prognostic Nutritional Index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and Systemic Immune-Inflammation Index) as well as body weight-related data and associated parameters body mass index (BMI), percentage of weight loss, Nutritional Risk Screening 2002 assessment, the Malnutrition Universal Screening Tool, and the Nutritional Risk Index were measured and calculated. The study end points were major complications, operative mortality, prolonged hospital stay, overall survival (OS), and recurrence-free survival (RFS).
Results
Multivariable logistic regression analysis showed that male gender, total gastrectomy, advanced-stage gastric cancer, and low albumin level were risk factors for major complications. Old age, total gastrectomy, advanced-stage cancer, and high BMI were risk factors for operative mortality. Old age, open approach, and total gastrectomy were risk factors for prolonged hospital stay. Multivariable Cox proportional hazards models showed that old age, total gastrectomy, advanced-stage cancer, and high neutrophil count were unfavorable risk factors for OS. Old age, advanced-stage cancer, high neutrophil count, and high BMI were unfavorable risk factors for RFS.
Conclusions
Albumin level, BMI, and neutrophil count are the most useful parameters for predicting short- and long-term surgical outcomes. Compared with complex parameters, simple-to-measure parameters are better for predicting surgical outcomes for gastric cancer patients.
Solid malignancies are associated with the development of Pneumocystis jirovecii pneumonia (PJP). This study aimed to evaluate the risk factors for PJP among patients with lung cancer. This ...retrospective case-control study compared patients who had lung cancer with PJP (n = 112) or without PJP (n = 336) matched according to age, sex, histopathology, and stage. PJP definition was based on (i) positive PCR or direct immunofluorescence results for pneumocystis, (ii) clinical symptoms and radiological abnormalities that were consistent with a pneumonic process, and (iii) received targeted PJP treatment. The development of PJP was associated with radiotherapy (RTx), concurrent chemoradiotherapy (CCRTx), lymphopenia, and prolonged high-dose steroid therapy (20 mg of prednisolone equivalent per day for ≥3 weeks). Multivariate analysis revealed independent associations with prolonged high-dose steroid therapy (odds ratio OR: 1.96, 95% confidence interval CI: 1.06-3.63; p = 0.032) and CCRTx (OR: 2.09, 95% CI: 1.27-3.43; p = 0.004). Steroid use was frequently related to RTx pneumonitis or esophagitis (29 patients, 43.3%). Prolonged high-dose steroid therapy and CCRTx were risk factors for PJP development among patients with lung cancer. As these patients had a poor prognosis, clinicians should consider PJP prophylaxis for high-risk patients with lung cancer.
Objective
To investigate the association between physician‐diagnosed diabetes mellitus (DM) and chronic rhinosinusitis (CRS) phenotypes in a national population‐based study.
Study Design
...Retrospective cross‐sectional study.
Setting
Population‐based survey data were collected by the Korean National Health and Nutrition Survey between January 2008 and December 2012.
Participants and Methods
A total of 34 670 participants aged over 19 years were enrolled in the Korea National Health and Nutrition Examination Surveys from 2008 to 2012. The relationship of CRS prevalence, with and without nasal polyps, with physician‐diagnosed DM and non‐DM were assessed. Differences in sinonasal symptoms between patients with and without DM were analysed in this cross‐sectional study.
Results
A significant association was observed between DM and CRS with nasal polyps after adjustment for multiple variables. No substantial association was observed between DM and CRS without nasal polyps. Among patients with CRS, olfactory dysfunction for >3 months was significantly more frequent in the DM group than in the non‐DM group.
Conclusion
We demonstrated significant associations between DM and CRS with nasal polyps and olfactory dysfunction among patients with CRS in a large national clinical cohort study. The direct mechanism of the association between DM and CRS with nasal polyps should be further investigated to clarify the pathogenesis of CRS with nasal polyps.
•NPIs are affecting not only COVID-19, but also several other infectious diseases•We investigated whether RSV and IFV are epidemic in the winter of 2020-21 in Korea.•No RSV and IFV winter epidemics ...were observed in a surveillance–based analysis.•The positivity of IFV was almost zero, but there were some sporadic RSV cases.•No IFV epidemics were observed in surveillance data from 13 other countries.
We investigated whether non-pharmaceutical interventions (NPIs) reduce winter-prevalent respiratory viral infections represented by a respiratory syncytial virus (RSV) and influenza virus (IFV) during the winter in Korea.
The Korean Influenza and Respiratory Virus Monitoring System database was used. From January 2016 through January 2021, the weekly positivity of respiratory viruses and the weekly number of hospitalizations with acute respiratory infections were collected. The NPI period was defined as February 2020–January 2021. We analyzed whether hospitalization and sample positivity by respiratory viruses changed after NPIs. Bayesian structural time–series models and Poisson analyses were used. Data from other countries/regions reporting positive rates of RSV and IFV were also investigated.
Compared with the pre-NPI period, the positive rates of RSV and IFV decreased significantly to 19% and 6%, and 23% and 6% of the predicted value. Also, hospitalization significantly decreased to 9% and 8%, and 10% and 5% of the predicted value. The positive rates of IFV in 14 countries during the NPI period were almost 0, whereas sporadic outbreaks of RSV occurred in some countries.
No RSV and IFV winter epidemics were observed during the 2020–2021 season in Korea.
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Background
The Clinical Frailty Scale (CFS) is a representative frailty assessment tool in medicine. This systematic review and meta‐analysis aimed to examine whether frailty defined based on the CFS ...could adequately predict short‐term mortality in emergency department (ED) patients.
Methods
The PubMed, EMBASE, and Cochrane libraries were searched for eligible studies until December 23, 2021. We included studies in which frailty was measured by the CFS and short‐term mortality was reported for ED patients. All studies were screened by two independent researchers. Sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) values were calculated based on the data extracted from each study. Additionally, the diagnostic odds ratio (DOR) was calculated for effect size analysis, and the area under the curve (AUC) of summary receiver operating characteristics was calculated. Outcomes were in‐hospital and 1‐month mortality rate for patients with the CFS scores of ≥5, ≥6, and ≥7.
Results
Overall, 17 studies (n = 45,022) were included. Although there was no evidence of publication bias, a high degree of heterogeneity was observed. For the CFS score of ≥5, the PLR, NLR, and DOR values for in‐hospital mortality were 1.446 (95% confidence interval CI 1.325–1.578), 0.563 (95% CI 0.355–0.893), and 2.728 (95% CI 1.872–3.976), respectively. In addition, the pooled statistics for 1‐month mortality were 1.566 (95% CI 1.241–1.976), 0.582 (95% CI 0.430–0.789), and 2.696 (95% CI 1.673–4.345), respectively. Subgroup analysis of trauma patients revealed that the CFS score of ≥5 could adequately predict in‐hospital mortality (PLR 1.641, 95% CI 1.242–2.170; NLR 0.580, 95% CI 0.461–0.729; DOR 2.883, 95% CI 1.994–4.168). The AUC values represented sufficient to good diagnostic accuracy.
Conclusions
Evidence that is published to date suggests that the CFS is an accurate and reliable tool for predicting short‐term mortality in emergency patients.
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