Objective To evaluate the diagnostic value of human heart-type fatty acid-binding protein for early detection of acute myocardial infarction (AMI). Methods Studies involving this biomarker were identified from MEDLINE, EMbase, CBM and VIP (1970 to 2006). Relevant journals (1980 to 2006) were also handsearched. The quality of the included studies was assessed using the QUADAS tool. Data extraction and analysis were conducted by software of EXCEL2003 and Metadisc. Results We included 13 studies, which were heterogeneous (P=0, I2=58.5%). Five studies (n=396) included in the group assessed the test at the first three hours after chest pain onset. These studies were homogeneous (P= 0.49, I2=0). The pooled sensitivity was 0.86 ( 95%CI 0.80 to 0.91), the pooled specificity was 0.76( 95%CI 0.80 to 0.91), and the area under the curve was 0.88 (SE=0.032 3). In the group of 0 to 6 hours after chest pain onset, 10 included studies (n=1 175) were heterogeneous (P=0, I2=69%). The pooled sensitivity was 0.86 (95%CI 0.83 to 0.89), the pooled specificity was 0.79 (95%CI 0.76 to 0.82), and the area under the curve was 0.92 (SE=0.019). In the group of 6 to 12 hours after chest pain onset, 4 included studies (n=215) were homogeneous (P=0.56, I2=0). The pooled sensitivity was 0.97 (95%CI 0.91 to 0.99), the pooled specificity was 0.52 (95%CI 0.42 to 0.61), and the area under the curve was 0.810 with (SE=0.152 2). In the group of 0 to 12 hours after chest pain, 11 included studies (n=1 352) were heterogeneous (P=0.56, I2=59%). The pooled sensitivity was 0.88 (95%CI 0.84 to 0.89), the pooled specificity was 0.75 (95%CI 0.71 to 0.78), and the areas under the curve was 0.91 (SE=0.016 4). Conclusions In this systematic review, we found that H-FABP has an acceptable diagnostic accuracy within 3 hours after the onset of symptoms, and within 12 hours after the onset of symptoms, H-FABP has a high diagnostic efficacy. So H-FABP may be a new symbol for the early diagnosis of AMI.
ObjectiveTo investigate the morphology of brain regions undergoing multiple sclerosis (MS) MRI, and furthermore, to investigate possible diagnostic values of MRI for MS. MethodsMRI images of 42 MS patients (34 females and 8 males, aged between 35 and 81 years old, averaging at 58) who visited the hospital during the time from December 2007 to December 2013 were collected and analyzed. Routine T1, T2 and fluid attenuated inversion recovery (FLAIR) scans were performed on all the 42 patients. Sagittal T1, T2 and FLAIR scans were performed when necessary. Contrast-enhanced MRI was performed on 9 of the 42 patients. The abnormal findings from MRI scans of all the 42 patients were analyzed. The analysis was further concluded to yield general characteristics of MS patients under MRI. ResultsA total of 286 lesions were identified in 42 patients. Ninety (31.6%) of the 286 lesions (seen in 35 patients) were found to locate around lateral ventricles; 67 (23.4%) at centrum semiovale (seen in 29 patients); 59 (20.6%) in deep white matter (seen in 28 patients); 46 (16.1%) around corpus callosum (seen in 30 patients); 21 (7.3%) in brain stem, basal ganglia and cerebellar hemispheres (seen in 9 patients); and 3 (1.0%) at cervical spinal cord. In routine MRI images, the lesions showed up as low T1 signal, high T2 signal and high FLAIR signal with the shape of ovoid or round. No mass effect was observed in lesions. In the contrast-enhanced MRI images, the 25 observed lesions showed mild enhancements with the shape of ring, semi-ring and arc. ConclusionCertain characteristic features can be observed in MS MRI images. MRI is an effective diagnostic method for multiple sclerosis diagnosis.
ObjectiveTo evaluate the value of 120 kV portal venous phase images combined with iodine maps created from dual-source dual-energy CT (DECT) for the diagnosis of pancreatic necrosis in the early stage of acute pancreatitis. MethodsThis prospective study enrolled 17 patients who underwent abdominal dual-source DECT within 72 hours from the onset of acute pancreatitis. All patients had received treatment in West China Hospital from May 2014 to August 2014. Comparison of the diagnostic value of 120 kV portal venous phase images alone and 120 kV portal venous phase images combined with iodine maps created from dual-source DECT was performed. ResultsSix of the 17 patients were found the presence of pancreatic necrosis (4 patients without obvious necrosis in the early stage developed to pancreatic necrosis, and 2 patients with the presence of necrosis in the early stage improved). The sensitivity, specificity, and accuracy of 120 kV portal venous phase images for the diagnosis of pancreatic necrosis were 50.0% (3/6), 100% (11/11), and 82.4% (14/17), respectively, and it had a good diagnostic value (AUC=0.856, P=0.018). The sensitivity, specificity, and accuracy of 120 kV portal venous phase images combined with iodine maps created from dual-source DECT for predicting pancreatic necrosis were 100% (6/6), 90.9% (10/11), and 94.1% (16/17), respectively, and this method had good value too (AUC=0.977, P=0.002), which higher than that of 120 kV portal venous phase images (P=0.002). ConclusionsThe 120 kV portal venous phase images combined with iodine maps created from dual-source DECT is helpful to improve subjective judgment in the diagnosis of pancreatic necrosis in the early stage of acute pancreatitis. It also contributes to the display of hypo-perfusion area of the pancreatic parenchyma, and has higher diagnostic value.
ObjectivesTo systematically review the value of cross-linked carboxy-terminal telopeptide of type I collagen (ICTP) in the diagnosis of bone metastases of lung cancer.MethodsThe Cochrane Library, PubMed, EMbase, WanFang Data and CBM databases were electronically searched to collect studies on ICTP in the diagnosis of lung cancer bone metastases from inception to November 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies by QUADAS-2 standard. Meta-analysis was performed by using Meta-Disc 1.4 software.ResultsA total of 8 studies involving 781 patients were included. The results of meta-analysis showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio and area under the curve of summary receiver operating characteristics were 71% (95%CI 0.65 to 0.76), 80% (95%CI 0.76 to 0.84), 3.79 (95%CI 2.31 to 6.21), 0.35 (95%CI 0.25 to 0.49), 14.67 (95%CI 6.99 to 30.81) and 0.860 3, respectively.ConclusionsICTP cooperate with imaging tests may be accurate and practical in diagnosis of bone metastases of lung cancer. Due to the limited quality and quantity of included studies, the above results should be validated by more studies.
ObjectivesTo systematically review the diagnostic value of GerdQ questionnaire for diagnosing the gastro-oesophageal reflux disease (GERD).MethodsPubMed, Web of Science, EBMR, CNKI, CBM, VIP and WanFang Data databases were searched to collect studies on the diagnostic value the GerdQ questionnaire in diagnosing the GERD from inception to January 1st 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using Meta-Disc 1.4 software. We used the Stata 12.0 software to assess the publication bias with funnel plots.ResultsA total of 20 studies were enrolled, including 7 978 patients. Among them, 4 848 patients were confirmed with GERD. The results of meta-analysis showed that: a) The pooled sensitivity, specificity, +LR, −LR, and DOR were 0.79 (95%CI 0.78 to 0.81), 0.66 (95%CI 0.65 to 0.68), 2.28 (95%CI 1.77 to 2.94), 0.37 (95%CI 0.27 to 0.52) and 6.34 (95%CI 3.59, 11.19), SROC(AUC) was 0.789 3, and Q* was 0.726 6. b) When the cut-off was 7, the diagnostic accuracy of GerdQ questionnaire for the GERD was the highest, and that of 9 was the second. c) The diagnostic accuracy of GerdQ questionnaire was higher when it was used in China.ConclusionsGerdQ questionnaire has a moderate accuracy for the diagnosis of GERD, which can be a useful complementary tool for diagnosing GERD, and can be popularized in clinical settings. Due to limitation of quantity and quality of included studies, the above conclusions requires verification by more high quality studies.
ObjectivesTo investigate the diagnostic value of different diffusion-weighted MRI (DWI) models between two Gaussian DWI models including mono-exponential and bi-exponential, and the non-Gaussian kurtosis model in poorly differentiated pancreatic ductal adenocarcinoma.MethodsSubjects comprised 52 patients with poorly differentiated pancreatic ductal adenocarcinoma which had been confirmed by surgery. All patients underwent DWI (1.5T, multi-b values: 0, 50, 100, 150, 200, 500, 800, 1000, 1 500, 2 000s/mm2). Mean values of DWI-derived metrics ADCstandard, ADCslow, ADCfast, f, MD, MK and ADCstandard were calculated from regions of interest in all tumours and non-tumorous parenchyma and compared. ANOVA and Mann Whitney U test was used to compare the MRI paremeters. ROC was used to evaluate the diagnostic efficiency.ResultsMean ADCstandard, ADCfast, f and MK values showed significant differences between tumours and non-tumorous parenchyma (P<0.05). AUC for ADCstandard, MD, ADCfast and f were 0.705, 0.665, 0.648, 0.614, respectively. The ROC curve integrated with ADCstandard and MD had better diagnostic efficiency (AUC was about 0.754).ConclusionsADCstandard, ADCfast, f and MK values can differentiate tumours from non-tumorous parenchyma. The combination of Gaussion distribution model and non-Gaussion distribution model has the potential to increase the diagnostic accuracy of DWI in patients with pancreatic ductal adenocarcinoma.
ObjectiveTo investigate the correlation between macular cherry red spot (CS) and severity of neurological manifestations in Chinese children with sialidosis (SD) type I. MethodsA evidence-based medical study. "China", "Sialidosis" and "Sialidoses" were used as Chinese and English search terms. The literature was searched in CNKI, Wanfang and PubMed. The cases were all from China and matched the diagnostic criteria. According to the presence or absence of CS in the fundus, the SD children were divided into a group with CS (+) and a group without CS (−), and the correlation between the occurrence of ocular CS and neurological manifestations was compared with meta-analysis by RevMan 5.3 software. ResultsSixty-eight studies were initially retrieved according to the search strategy, and 17 studies were finally included, and 5 studies with CS+ and CS− were meta-analyzed. Among the 43 patients, 28 were male and 15 were female, with a median age of 12 years. Visual impairment was observed in 37 cases (90.2%, 37/41, 2 cases not recorded), and CS was present in 24 cases (55.8%, 24/43). The most common neurological manifestation was myoclonus (97.7%, 42/43), followed by cerebellar ataxia (95.1%, 39/41, 2 cases not recorded) and seizures (91.4%, 32/35, 8 cases not recorded). Pathogenic NEU1 gene mutations were detected in 42 cases and one case was undocumented. The incidence of seizure in group CS+ (100%, 20/20) was higher than that in group CS− (80%, 12/15). Meta-analysis showed that there was no statistically significant difference between the incidence of myoclonus or ataxia [relative risk (RR)=1.13, 95% confidence interval (CI) 0.79-1.63, P=0.49] and seizure (RR=1.13, 95% CI 0.84-2.06, P=0.24) among the children in the CS+ and CS− groups. ConclusionsThe incidence of ocular CS in Chinese children with type I SD was 55.8%. There was no correlation with neurological manifestations, however the incidence of seizure was significantly higher in patients with CS than in others without CS.
ObjectiveTo assess the diagnostic performance of serum anti-toxocara immunoglobulin G (anti-T-IgG) in ocular toxocariasis (OT) patients. MethodsA diagnostic tests. A total of 109 patients (109 eyes) with clinically-suspected OT who treated in Department of Ophthalmology of Xuzhou First People’s Hospital from June 2015 to December 2022 were included. Patients were divided into two groups, 76 with OT and 33 with non-OT, according to the clinical manifestations and Goldmann-Witmer coefficient. Paired serum and intraocular fluid samples from each patient were collected and analyzed for specific anti-T-IgG using enzyme linked immunosorbent assay. Mann-Whitney test was performed for comparison between groups. The area under the receiver operating characteristic curve (ROC) was used to assess the diagnostic performance of serum anti-T-IgG. Kappa analysis was performed to examine the consistency of serum or intraocular fluid anti-T-IgG positive rate with OT diagnostic result. Spearman’s rank correlation test was performed to assess the association. ResultsCompared with the non-OT group, the proportions of children and history of exposure to cats and dogs (χ2=9.785, 12.026) were significantly higher in OT group, and the differences were statistically significant (P＜0.01). The positive rate (χ2=24.551) and U value (Z=−4.379) of serum anti-T-IgG in OT group were higher than those in non-OT group, and the differences were statistically significant (P＜0.000 1). The recommended serum anti-T-IgG cut-off value of 11 U had 0.72 sensitivity, 0.79 specificity, 0.89 positive predictive value, 0.55 negative predictive value, and 0.77 area under the ROC with 95% confidence interval (CI) 0.669-0.860. Correlation analysis showed that serum anti-T-IgG was positively correlated with intraocular fluid anti-T-IgG (rs=0.520, 95%CI 0.363-0.648, P＜0.000 1). The Kappa values of serum and intraocular fluid anti-T-IgG positive rate with OT diagnosis were 0.457 (95%CI 0.292-0.622) and 0.711 (95%CI 0.582-0.840), respectively. The Kappa value of serum anti-T-IgG positive rate with OT diagnosis was lower than that of intraocular fluid. ConclusionThe sensitivity and specificity of serum anti-T-IgG and the consistency between serum anti-T-IgG positive rate and OT diagnosis are low, suggesting that serum anti-T-IgG level cannot be used as a basis for OT diagnosis.
ObjectiveTo observe the multi-modal fundus imaging features of subretinal drusenoid deposit (SDD) in age-related macular degeneration (AMD), and observe image features. MethodsA prospective clinical study. From December 2019 to December 2023, 65 patients (104 eyes) with a diagnosis of AMD-SDD by spectral domain optical coherence tomography (SD-OCT) examination in Shandong Eye Hospital were included. All eyes were examined by best corrected visual acuity (BCVA), traditional color fundus photography (CFP), ultra-wide-angle scanning laser fundus imaging (UWF), multicolor scanning laser fundus imaging (MC) and SD-OCT. The standard MC images were obtained by using Spectralis HRA+OCT for MC examination. The multi-mode image characteristics of SDD were analyzed retrospectively. Area under curve (AUC) was used to evaluate the sensitivity and specificity of CFP, MC and UWF in detecting SDD. ResultsAmong 65 patients with SDD, 29 cases of males (52 eyes) and 36 cases of females (52 eyes) was included. There were 26 patients with unilateral SDD and 39 patients with bilateral SDD. The average age was (71.74±10.97) years. The early, middle and late stages of AMD were 31 (29.8%, 31/104), 24 (23.1%, 24/104), 49 (47.1%, 49/104) eyes, respectively. The SDD detected by CFP, MC and UWF was 76 (73.1%, 76/104), 94 (90.4%, 94/104), 96 (92.3%, 96/104) eyes. CFP showed that the edge of SDD in the macular area was blurred. UWF showed that the dot and the ribbon SDD were light yellow pale discrete deposits and light yellow interlaced network deposits respectively. MC showed the dot SDD had a strong yellow-green circular reflection, while the edge of the ribbon SDD was surrounded by a weak reflection, and the boundary was clear. SD-OCT showed that SDD had strong reflection signal, which was located between the retinal pigment epithelium layer and the photoreceptor cell layer. The dot SDD could break through the ellipsoid zone and caused slight uplift or interruption of the external membrane, showing a cone-like strong reflection signal. While the ribbon SDD showed a continuous "hill-like" protrusion, which hardly broke through ellipsoid zone. The sensitivity and specificity of CFP, MC and UWF for SDD were 73.1%, 90.4%, 92.3% and 61.1%, 94.4% and 83.3%, respectively. ConclusionsMC and UWF show high sensitivity and specificity in diagnosing AMD-SDD, which is superior to CFP. SD-OCT can effectively reveal the location and morphoLogical characteristics of SDD under retina.