Our meta-analysis has some shortcomings of its own. First, the total number of studies in our analyses was small; however, this may be offset by the moderate-to- large number of included patients (n = 1172). Second, we did not try to identify studies not published in peer- reviewed journals. Third, only two studies assessed the use of LUS in non-expert physicians who underwent a short training session, precluding our ability to recom- mend its use in general practitioners. Fourth, all studies were conducted in high-income settings, and none were conducted in resource-poor settings where most of the cases and complications from pneumonia are seen worldwide. Fifth, included studies did not assess all lung regions, as some patients were bedridden and posterior zones were difficult to be assessed.
Background & Purpose: Acute community-acquired pneumonia needs to be identified early to keep away from most complications. The common diagnostic tools had been represented by means of blood exams and chest X- ray with CT test coming as a 2nd-line exploration. The presence of air in the pulmonary parenchyma has long been thought of as no longer explorable by ultrasound. The Aim of this work is to provide cumulative data about the diagnostic efficacy of LungUltrasound (LUS) in diagnosis of Community-acquired pneumonia (CAP) in emergency setting. Methods: A systematic search was performed of PubMed, Cochrane library Ovid, Scopus & Google scholar to identify Emergency medicine RCTs, clinical trials, and comparative studies, which studied the Sensitivity and Specificity of LUS in pneumonia patients. A meta-analysis was done using fixed and random-effect methods. The primary outcome was Sensitivity for diagnostic odds ratio (DOR). Secondary outcome was Specificity for diagnostic odds ratio (DOR). The assessment of DOR was assessed by pooled Area under ROC curve for each
The contributing datasets will be reviewed for sample size, available parameters and data completeness, to inform the selec- tion of a modelling approach. A descriptive analysis will be undertaken to understand similarities and differences between the contributing datasets. Participant characteristics, clinical features, and test results will be summarized for each contrib- uting dataset and compared across datasets using chi-square, t-tests, or non-parametric methods as warranted. Additionally, participant characteristics and clinical features will be further evaluated for heterogeneity via IPD meta-analysis accounting for random effects.
Despite signiﬁcant heterogeneity across studies, LUS performed well for the diagnosis of pneumonia in children. Although the sensitivity and speciﬁcity are best in the hands of expert users, our study provides evidence of good diagnostic accuracy even in the hands of nonexperts. Recommendations to train general pediatricians on LUS for the diagnosis of childhood pneumonia may have an important impact in different clinical settings, especially in resource-poor countries and small primary care clinics where CRs may not be commonly available.
On ultrasound examination, consolidation is defined as tissue-like pattern reminiscent of the liver, some- times called “hepatization,” with boundaries that may be formed from the pleural line or a pleural effusion if pre- sent and the aerated lung, potentially forming an irregu- lar scattered line if the consolidation is limited (shred sign) or a regular line if the whole lobe is involved. The LUS is logically capable in detecting superficial pneumo- nia, but it remains, however, doubtful in detecting deep alveolar lesions . Consolidation is defined as an iso- echoic tissue-like structure, which is caused by the loss of lung aeration. [4, 27] Power Doppler sometimes is used in order to differentiate tissue-like structures (e.g., echoic pleural effusion) from consolidation. The shred sign is specific for consolidation. B-lines are well-defined hyperechoic comet-tail artifacts, arising from pleural line and spreading vertically indefinitely, erasing A-lines and moving with the lung sliding when lung sliding is present. It indicates partial loss of lung aeration. Lungultrasound using Doppler or contrast-enhanced sonog- raphy visualizes regional pulmonary blood flow within lung consolidations, thereby providing critical informa- tion about the etiology of the disease . CXR does not provide any information about regional vascularization. The ultrasound detection of a dynamic air bronchogram is reported to be useful for differentiating obstructive ate- lectasis from pneumonia . Several studies have dem- onstrated the superiority of lungultrasound over CXR for diagnosing lung consolidation, particularly when portable CXR technique is used . Therefore, the use of lungultrasound can significantly reduce the number of chest radiographs and CT scans and decreases patients’ radiation exposure. It is easily repeatable at the bedside and provides more accurate diagnostic information than CXR in critically ill and emergency patients with lung consolidation.
We included randomized controlled trials (RCTs) that evaluated the efficacy and safety of epidural injections of steroids plus local anesthetic versus local anesthetic alone for the treatment of LSS patients. The inclusion criteria for the systematicreview and meta-analysis were as follows: (1) randomized controlled trials in adults with LSS with epidural injection treatment; (2) clinical or radiological diagnosis of LSS; (3) describe neurogenic claudication with back (leg) pain and gait assessment; (4) provide the dosage and route of epidural steroid injection administration; and (5) outcomes measured, such as walking ability, pain intensity, quality of life, and global improvement. Studies
can be located anywhere in lung parenchyma. Lungultrasound examination begins in symptomatic regions where the patient complains of pleuritic pain or a pathological finding is present on physical exam . After focal investigation, a global lung exam can be performed from the superior to the inferior parts of the lung along the anatomical lines of the thorax (parasternal, midclavicular, axillary) as well as horizontal scans along the intercostal spaces . Some recommend lung scans in at least six zones in order to achieve high diagnostic accuracy . Another systematic approach developed by Dr. Lichtenstein in 2008, the BLUE-protocol (Bedside Lung Ultrasonography in Emergency) is a goal-directed approach to lung US examination that scans preset locations and establishes profiles of main diseases (pneumonia, pneumothorax, congestive heart failure, COPD, asthma, pulmonary embolism). If done correctly, this protocol has high accuracy for diagnosing most causes of acute respiratory failure .
Diabetes is a chronic medical condition that requires people with diabetes to engage in a lifelong therapeutic self- management regimen in order to maintain glycaemic control(1, 2). The diagnosis of diabetes and efforts towards self-management especially lifestyle modification, demands of daily treatment regimen and thoughts about risk of developing diabetes complications are behaviourally and psychologically challenging (3). It is estimated that 50% of patients demonstrated decreased psychological states at the time of diabetes diagnosis (4). Therefore, among people with diabetes commonly observed co-morbid mental health conditions include diabetes-related distress, anxiety and depression resulting in poor glycaemic control and reduced quality of life (5-7). Diabetes-related distress affected 13.8%-44.6% of people with diabetes (8). Diabetes doubles the odds of co-morbid depression and 12-27% of people with diabetes experience depression at a rate two to three times that of the general population (9-11). Anxiety also occurs in about 14% of people with diabetes while 40% elevated levels of subsyndromal anxiety (12).The relationship between diabetes and co-occurring psychiatric disorders are complex and bidirectional because they both influence each other and are affected by biological pathways, social and psychological factors (13). This review addresses psychological disorders whose pathogenesis results as a complication of living with diabetes. Given that the barriers to coping with diabetes management are mostly cognitive and behavioural, rather than related to insufficient knowledge or skill, an intervention comprising of cognitive and behavioural components may result in improvement. Therefore this review focuses on cognitive behavioural therapy (CBT) as it is recommended as the primary psychological therapy for effectively challenging dysfunctional thoughts, beliefs and negative behaviours in people with long term conditions and replacing these with cognitions that are more self-helping and realistic (14-16). This reduces the feeling of being overwhelmed and aids effective coping with the demands imposed on them by daily stressors and the treatment regimen.
The good ability of LUS to diagnose pediatric pneumo- nia has been previously reported in literature [16, 20, 35] but none of these studies focused on the setting of chil- dren with acute bronchiolitis. Consolidation has to extend to the pleural surface to be visualized by ultrasound and the supraclavicular region and/or the area covered by the scapula can be difficult to explore by LUS. However, stud- ies on adults shows that pneumonia reach the pleura in 92% of hospitalized patients  and up to 98% in the critically ill . A recent meta-analysis done on pediatric patients with suspected pneumonia  revealed a higher sensitivity (96%, 95% CI 94 – 97%) but lower specificity (93%, 95% CI 90 – 96%) of LUS compared with adults data . The higher sensitivity may depend on the smaller thorax size and the thinner chest wall of children that lead to better visualization of the lung parenchyma by LUS . The lower specificity may be a result of non in- filtrative processes including atelectasis, that are common in pediatric diseases as asthma or bronchiolitis and can be
are rapidly evolving. Ultrasound (US) is applied widely for its convincing and dynamic observation. However, the sensitivity and specificity of ultrasound for lymph node metastasis were unreliable and controversial [5, 6]. Owing to radiation and relative lower diagnostic accur- acy, computer tomography (CT) is limited in clinic . Positron emission tomography (PET) and positron emis- sion tomography/computed tomography (PET/CT) can reflect metabolism of glycolytic activity. Undoubtedly, they have shown the higher diagnostic significance in assessing distant metastases and regional metastatic
or retrospective study involving human participants published in a peer-reviewed journal; (2) Population: subjected to invasive MV for at least 24 hours; (3) Inter- vention: diaphragm thickness and excursion measured by ultrasound during weaning process or around sponta- neous breathing trial (SBT) and (4) Predefined outcomes: The primary outcome was the accuracy of diaphragm ultrasound for predicting weaning outcomes in critically ill adults. Weaning failure was defined broadly as SBT failure or the need for reintubation, or non-invasive MV or death within 48 hours. Weaning success was defined as the absence of criteria for failure. The secondary outcome was the influence of DD on the weaning outcome. Diag- nostic criteria of DD by ultrasound were not unified so far. In Ali’s study, 12 DD was diagnosed when diaphrag-
Introduction Clinical management of asthma remains a public challenge. Despite standard treatment with inhaled corticosteroids (ICS) and long- acting beta- agonists (LABAs), asthma remains uncontrolled in a substantial number of chronic asthma patients who risk reduced lung function and severe exacerbations. Azithromycin could have add- on effects for these patients. This study is proposed to systematically evaluate the efficacy of azithromycin as an add- on treatment for adults with persistent uncontrolled symptomatic asthma. Methods and analysis Two reviewers will perform a comprehensive search of PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and four Chinese electronic databases including China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), WanFang Data and VIP Database from inception to May 2019. Only randomised controlled trials will be included. There is no restriction on language or publication status. Combined oral azithromycin and an ICS or/and a LABA will be compared with standard treatment alone or with a placebo. The primary outcomes are the number or frequency of asthma exacerbations, changes in asthma symptoms and lung function. Secondary outcomes include the number or frequency of inhalations of beta- agonists with or without corticosteroids for rescue use, eosinophil counts in blood or sputum, adverse events and others. A meta- analysis will be attempted to provide an estimate of the pooled treatment effect. Otherwise, qualitative descriptions of individual studies will be given.
QUADAS tool. Overall, the quality of the studies was sat- isfactory with a QUADAS score varying from 8.5 to 13.5, the base value being 14. None of the studies reported the feasibility of US imaging in CPPD; however, US prac- ticality is considered acceptable relative to other imaging techniques. Since these US lesions are of potential diag- nostic utility, de ﬁ ning, standardising and validating US lesions thought to be speci ﬁ c to CPPD are likely to be of clinical bene ﬁ t, similar to the Outcomes Measures in Rheumatology (OMERACT) US de ﬁ nitions for RA. The biggest issues are still related to the reliability of the technique and the number of joints to scan, since the time required for evaluating multiple joints or lesions can be long. The standardisation of the description of what is considered a US-detected CPPD lesion may better facilitate the development of US as an outcome tool for the diagnosis and monitoring of the disease. Nevertheless, ultrasound is only an indirect approach of the synovial ﬂ uid and arthrocentesis should remain the gold standard to rule out septic arthritis and bring out the exact nature of the crystal. 28
The main characteristics of the seven included RCTs are presented in Table 1. These studies were published between 2003 and 2013. Of the seven included studies, three were conducted in USA [4,5,7], one in Israel , one in Germany , one in France , and one in Japan . The sample size of the RCTs ranged from 30 to 152 (a total of 546). Four studies enrolled small children and infants [3,5,7,8], and the remaining three studies included adults [2,4,6]. Six studies used the traditional palpation technique as control [2-6,8], whereas one study used the Doppler-assisted technique . In three studies [2,4,8], the operators had experience of ultrasound-guided central venous catheterization but no experience of ultrasound- guided arterial catheterization; while in another three studies [3,5,7], the operators had varying degrees of ex- perience of ultrasound-guided arterial catheterization; and in only one study , the operators were physicians with
Meta-analysis was performed by pooling the results of reported incidence of overall morbidity, mortality, pro- longed air leak, arrhythmia, and pneumonia. Subgroup analysis was also conducted based on matched and un- matched cohort studies, if possible. Relative risks (RR) and their 95% confidence intervals (CI) were calculated for discontinuous data. Summary RRs were calculated by using fixed-effect models when heterogeneity among studies was considered to be statistically insignificant. Otherwise, random-effect models were used to combine the results. Heterogeneity among the studies was identi- fied by conducting a standard Cochrane’s Q test with a significance level of α = 0.10. The I 2 statistic test was per- formed to further examine heterogeneity. I 2 ≥ 50% was considered to indicate substantial heterogeneity. Besides, visual inspection of the funnel plots was used to identify potential publication bias. All P values were two-tailed, and P < 0.05 was considered to be statistically significant. All analysis was conducted with Review Manager Ver- sion 5.3 (Cochrane Collaboration, Software Update, Ox- ford, United Kingdom, 2014).
Articles were included if they met the following inclu- sion criteria: (1) participants were adults diagnosed with RC calcific tendinopathy confirmed by radiography or ultrasound imaging; (2) the intervention included US-guided lavage (specifically lavage and not only fragmentation) alone or in conjunction with another intervention such as a corticosteroid injection; (3) the intervention was compared with a placebo or any other intervention; (4) at least one outcome measure was related to pain, function, health-related quality of life, return to work, satisfaction, a global rating of change or to calcification size; (5) the study was an RCT and (6) was published either in English or in French. Studies were excluded if participants presented a full-thickness RC tear, a postsurgical condition or any other concomitant shoulder, upper limb or neck disorder.
Prostate cancer (PCa) is the most common cancer in men and has the second highest mortality in the USA . In 2018, approximately 164,690 PCa cases were identified, accounting for almost one in five new cancer diagnoses . Although PCa is common worldwide, the detection method and diagnostic technology has remained contro- versial. Generally, the following two significant problems about PCa diagnosis must be settled urgently: (a) prostate-specific antigen (PSA) has been widely adopted for screening PCa; however, the conventional threshold for biopsy (4.0 ng/ml) has been associated with a positive predictive value of approximately 20–30% [2, 3]. Thus, a great number of patients underwent an unnecessary pros- tate biopsy. Are there better biomarkers to help physicians make biopsy decisions? (b) In 1989, Hodge et al. first reported the systematic sextant prostate biopsy to detect
Results: We identified eight randomized controlled trials and four quasi-randomized trials that met the criteria for the systematicreview. Of these trials, 11 studies were pooled for meta- analysis to compare the effects of topical antibiotics versus placebo and 4 studies were pooled for comparison of effects of topical antibiotics versus topical antiseptics on uncomplicated wounds. Fewer wound infections occurred in the topical antibiotic arms compared to placebo (pooled risk ratio: 0.57 [95% CI: 0.37 to 0.86]; p=0.01 and pooled risk difference: −3.1% [95% CI: −5.8% to −0.34%]; p=0.03). Compared to antiseptics, topical antibiotics demonstrated statistically significant relative risk reduction (pooled risk ratio: 0.56 [95% CI: 0.23 to 0.91]; p=0.02), while there was no significant absolute risk reduction (pooled risk difference: −3.7% [95% CI: −7.9% to +0.6%]; p=0.09).
addition, PFS time was also significantly longer in patients treated with VEGF/VEGFR blockers than that in patients treated with placebo. Interestingly, 4 out of the selected 8 Phase III trials tested bevacizumab and meta-analysis on these 4 studies indicated that there was no significant difference between bevacizumab and placebo with or without combination of other chemotherapeutic reagents. By contrast, 3 out of the selected 8 Phase III trials tested ramucirumab and meta-analysis on these 3 studies revealed that ramucirumab was significantly favored in the treatment of gastric cancer. In addition, patients treated with VEGF/ VEGFR blockers had higher morbidity of hypertension and neutropenia but had less risk side effects of vomiting and anemia. These findings suggest that addition of antiangio- genesis reagents to the first- or second-line chemotherapy,
Methods: An electronic search was carried out based on the databases from MEDLINE, Embase, Science Citation Index (SCI), and the Cochrane Library. We included prospective, randomized, and clinical trials in thrombolysis with heparin alone in adults who had evidence of right ventricular dysfunction and normotension. The main endpoints consist of mortality, recurrent PE, and bleeding risk. The relative risk (RR) and the relevant 95% confidence intervals were determined by the dichotomous variable.