Abstract 114: The Predictive Ability of the CTA Spot Sign for Hematoma Expansion is Dependent on Time Since ICH Onset: A Systematic Review and Patient-level Meta-analysis.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Dar Dowlatshahi ◽  
Bart Brouwers ◽  
Andrew Demchuk ◽  
Michael D Hill ◽  
Richard Aviv ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Predictive Ability ◽  
Cochrane Library ◽  
Hematoma Expansion ◽  
Cochrane Central Register ◽  
Contrast Extravasation ◽  
Spot Sign ◽  
Predictive Values ◽  
Patient Level ◽  
Chi Square Analysis

Background: Hematoma expansion (HE) occurs in up to 40% of patients with intracerebral hemorrhage (ICH), and predicts poor clinical outcome. Contrast extravasation following CT-angiography (CTA), termed “spot sign”, identifies patients at highest risk of HE. However, the prevalence and predictive values of the spot sign varies across studies, possibly due to differences in onset-to-CTA time. We therefore performed a patient-level meta-analysis to define the relationship between onset-to-CTA time and the prevalence & predictive value of spot sign, and the size of HE. Methods: We searched the Cochrane Central Register of Controlled Trials, the Cochrane Library Database of Systematic Reviews, MEDLINE and EMBASE for studies of CTA spot sign prevalence and HE. We pooled data on the prevalence and predictive values for significant HE (defined as either 6mL or 33% growth of ICH) for patients with ICH stratified by onset-to-CTA time: <3hours, 3-6 hours, >6hours. We used chi-square analysis to assess the spot sign in each time strata, and two-way ANOVA to compare across time strata. Results: We identified ICH spot sign databases derived from 7 countries and 14 centers (n=705). Prevalence of spot sign decreased with increasing onset-to-CTA time (Table; p<0.001). The subset with follow-up scans used for HE analysis (n=582) revealed spot sign sensitivity and PPV were highest in the earliest time strata, whereas specificity and NPV were highest in the latest time strata (Table). Spot positive patients had greatest absolute HE in the earlier CTA time strata (median spot positive growth 6.8mL, 5.6mL, 5.2mL for 6hr respectively; p<0.001; means in Table). Conclusion: Prevalence, predictive values and magnitude of effect of the spot sign are dependent on onset-to-CTA timing; these results are relevant to both ICH trial design and acute management.

Abstract 77: Ongoing Leakage Revealed by Second Phase Spot Sign Volume Expansion in Multi-Phase Computed Tomography Angiography Strongly Predicts Intracranial Hemorrhage Growth

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Abdulaziz Al Sultan ◽  
Ericka Teleg ◽  
MacKenzie Horn ◽  
Piyush Ojha ◽  
Linda Kasickova ◽  
...  
Keyword(s):  
Volume Expansion ◽  
Single Phase ◽  
Meta Analysis ◽  
Hematoma Expansion ◽  
Second Phase ◽  
Hematoma Volume ◽  
Spot Sign ◽  
Time Resolved ◽  
Multi Phase

Background: CTA spot sign is a predictor of intracerebral hemorrhage (ICH) expansion. This sign can fluctuate in appearance, volume, and timing. Multiphase CTA (mCTA) can identify spot sign through 3 time-resolved images. We sought to identify a novel predictor of follow up total hematoma expansion using mCTA. Methods: This cohort study included patients with ICH between 2012-2019. Quantomo software was used to measure total hematoma volume (ml) from baseline CT & follow-up CT/MRI blinded to spot sign in 3 mCTA phases. Spot sign expansion was calculated by subtracting 1 st phase spot sign volume from 2 nd phase spot sign volume measured in microliters. Results: 199 patients [63% male, mean age 69 years, median NIHSS 11, IQR 6-20] were included. Median baseline ICH volume was 16.1 ml (IQR 5-29.9 ml). Amongst all three mCTA phases, spot sign was best detected on the 2nd phase (23% vs 17.5% 1 st phase vs 22% 3 rd phase). In multivariable regression, spot sign expansion was significantly associated with follow up total hematoma expansion (OR: 1.03 per microliter of spot sign expansion, p=0.01). Figure 1 shows the predicted total hematoma expansion by spot sign expansion. mCTA spot sign had a higher sensitivity for predicting total hematoma volume expansion than single-phase CTA (reported in meta-analysis of 14 studies), 86% vs 53%, respectively, while both having similar specificity, 87% vs 88%, respectively. Conclusion: Spot sign expansion on mCTA is a novel predictor of total hematoma expansion and could be used to select patients for immediate therapeutic intervention in future clinical trials. Using mCTA improves sensitivity while preserving specificity over single-phase CTA.

scholarly journals Guided or self-guided internet-based cognitive–behavioural therapy (iCBT) for depression? Study protocol of an individual participant data network meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026820 ◽  
Author(s):  
Eirini Karyotaki ◽  
Toshi A Furukawa ◽  
Orestis Efthimiou ◽  
Heleen Riper ◽  
Pim Cuijpers
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Meta Analysis ◽  
Substantial Reduction ◽  
Behavioural Therapy ◽  
Cochrane Library ◽  
Individual Participant Data ◽  
Relative Efficacy ◽  
Patient Level ◽  
Cognitive Behavioural ◽  
Individual Participant

IntroductionAlthough guided forms of internet-based cognitive–behavioural therapy (iCBT) result in a substantial reduction in depression, it seems that the most scalable way to deliver iCBT is without guidance. However, direct evidence on the comparison between guided and self-guided iCBT is scarce. Moreover, it is unclear which types of patients may benefit more from each of these two forms of iCBT. Network meta-analysis (NMA) using individual participant data (IPD) offers a way to assess the relative efficacy of multiple (>2) interventions. Moreover, it maximises our power to detect patient-level characteristics (covariates) that have an important effect on the efficacy of interventions. This protocol describes the procedures of an IPD-NMA, which aims at examining the relative efficacy of guided compared with self-guided iCBT and at identifying predictors and moderators of treatment outcome.Methods and analysisWe will use an existing database on psychotherapies for adult depression to identify eligible studies. This database has been updated up to 1 January 2018, through literature searches in PubMed, Embase, PsycINFO and Cochrane Library. The outcome of this IPD-NMA is reduction in depressive symptoms severity. We will fit the model in a Bayesian setting. After fitting the model, we will report the relative treatment effects for different types of patients, and we will discuss the clinical implications of our findings. Based on the results from the IPD-NMA model, we will develop and validate a personalised prediction model, aiming to provide patient-level predictions about the effects of the interventions.Ethics and disseminationAn ethical approval is not required for this study. The results will be published in a peer-review journal. These results will guide clinical decisions about the most efficient way to allocate iCBT resources, thereby increasing the scalability of this innovative therapeutic approach.

scholarly journals Diagnostic accuracy of MRA and MRI for the bursal-sided partial-thickness rotator cuff tears: a meta-analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Tao Huang ◽  
Jian Liu ◽  
Yupeng Ma ◽  
Dongsheng Zhou ◽  
Liang Chen ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Mr Arthrography ◽  
Diagnostic Value ◽  
Rotator Cuff Tears ◽  
Cochrane Library ◽  
Predictive Values ◽  
Partial Thickness ◽  
Sensitivity Specificity

Abstract Background Numerous quantitatively studies have focused on the diagnosis of bursal-sided partial-thickness rotator cuff tears (RCTs); however, the accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) remains inconclusive. This study was performed systematically to compare the diagnostic value of MRA and MRI for the bursal-sided partial-thickness RCTs. Methods Three electronic databases, PubMed, Embase, and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting bursal-sided partial-thickness RCTs. After screening and diluting out the articles that met the inclusion criteria to be used for statistical analysis, the pooled evaluation indexes include sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curve (AUC). Results Twelve studies involving 1740 patients and 1741 shoulders were identified. The pooled sensitivity, specificity, DOR, and AUC of MRA to diagnose bursal-sided partial-thickness RCTs were 0.77 (95% CI, 0.67–0.85), 0.98 (95% CI, 0.95–0.99), 73.01 (95% CI, 35.01–152.26), and 0.88 (95% CI, 0.85–0.91), respectively. The pooled sensitivity, specificity, DOR, and AUC of MRI were 0.77 (95% CI, 0.66–0.86) and 0.96 (95% CI, 0.81–0.99), and 37.12 (95% CI, 8.08–170.64) and 0.82 (95% CI, 0.78–0.85), respectively. Conclusions This meta-analysis reveals that MRA and MRI have similar diagnostic value for the diagnosis of bursal-sided partial-thickness rotator cuff tears.

scholarly journals Accuracy of multiparametric magnetic resonance imaging for detecting extracapsular extension in prostate cancer: a systematic review and meta-analysis

2019 ◽  
Vol 92 (1104) ◽  
pp. 20190480 ◽  
Author(s):  
Fan Zhang ◽  
Chen-Lu Liu ◽  
Qian Chen ◽  
Sheng-Chao Shao ◽  
Shuang-Qing Chen
Keyword(s):  
Prostate Cancer ◽  
Confidence Interval ◽  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
High Specificity ◽  
Cochrane Library ◽  
Extracapsular Extension ◽  
Predictive Values ◽  
Enhanced Mri

Objective: To evaluate the diagnostic accuracy of multiparametric MRI (mpMRI) for detecting extracapsular extension (ECE) in patients with prostate cancer (PCa). Methods and materials: We searched MEDLINE, PubMed, Embase and the Cochrane library up to December 2018. We included studies that used mpMRI to differentiate ECE from organ-confined PCa with a combination of T2 weighted imaging (T2WI), diffusion-weighted imaging, and dynamic contrast-enhanced MRI. All studies included had pathological diagnosis with radical prostatectomy. Two reviewers independently assessed the methodological quality of included studies by using Quality Assessment of Diagnostic Accuracy Studies 2 tool. We calculated pooled sensitivity, specificity, positive and negative predictive values, diagnostic odds ratios and receiver operating characteristic curve for mpMRI from 2 × 2 tables. Results: A total of 17 studies that comprised 3374 participants were included. The pooled data showed a sensitivity of 0.55 (95% confidence interval 0.43, 0.66]) and specificity of 0.87 (95% confidence interval 0.82, 0.91) for extracapsular extension detection in PCa. Conclusion: First, our meta-analysis shows moderate sensitivity and high specificity for mpMRI to differentiate ECE from organ-confined prostate cancer before surgery. Second, our meta-analysis shows that mpMRI had no significant differences in performance compared with the former meta-analysis with use of T2WI alone or with additional functional MRI. Advances in knowledge: It is the first meta-analysis to evaluate the accuracy of mpMRI in combination of TWI, diffusion-weightedimaging and dynamiccontrast-enhanced-MRI for extracapsular extension detection.

A Systematic Review and Meta-Analysis of Radioimmunotherapy Consolidation for Untreated Patients with Follicular Lymphoma (FL)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 101-101
Author(s):  
Adam C. Rose ◽  
Gia Garrett ◽  
Miray Seward ◽  
Pareen J Shenoy ◽  
Roy A Kucuk ◽  
...  
Keyword(s):  
Systematic Review ◽  
Maintenance Therapy ◽  
Follicular Lymphoma ◽  
Annual Meeting ◽  
Research Funding ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Cochrane Central Register ◽  
Inclusion Criteria ◽  
American Society

Abstract Abstract 101 Background: The disease course of FL is characterized by multiple relapses and progressively shorter response durations with subsequent therapies. As a result, numerous treatment strategies have been developed to reduce the risk of progression including consolidation with transplantation, radio-immunotherapy (RIT), or maintenance therapy with rituximab (R). At present, the optimal therapeutic strategy for FL patients (pts) remains undefined. R maintenance and RIT with an anti-CD20 antibody linked to iodine-131 (I131 Tositumomab) or to yttrium-90 (Y90-ibritumomab tiuxetan) have emerged as well tolerated treatments following induction. To quantify the benefits of consolidative RIT, we conducted a systematic review of the literature and a meta-analysis of selected studies. Methods: As part of a broader review, we searched the Cochrane Central Register of Controlled Trials (Cochrane Library Issue, 2011), MEDLINE (1/1966-6/2011), American Society of Hematology Annual Meeting abstracts (2004–2010), and American Society of Clinical Oncology Annual Meeting abstracts (2007–2010). Each database was searched using combinations of the term ‘follicular lymphoma' and the terms for treatment regimens. Inclusion criteria for studies were as follows: 1) reports on phase 2/3 studies; 2) n≥30; 3) previously untreated patients 4) treatment with RIT targeted at the CD20 antigen following an induction regimen; 5) original reporting in English of the following treatment outcome measures for pts with FL: CR/CR-unconfirmed, OR, and at least one form of survival data. Extracted data included pre-treatment disease status, pt characteristics, treatment regimen, progression free survival (PFS), overall survival (OS), complete response (CR) and overall response (OR). Pooled estimates of the CR rate, OR rate, 2-year PFS and 5-year PFS for pts treated with consolidative RIT were computed using DerSimonian and Laird random effects models. Results: Over 1136 records were reviewed with 8 studies meeting inclusion criteria with 556 patients. Between 1998 and 2007, pts were accrued at multiple sites in all but one study. Median ages ranged from 49–57 years with 41–61% male subjects, among the studies reporting gender. A weighted average of 97.2% of patients had stage III/IV disease with 73–98% pts having grade 1/2 disease, among those studies reporting histology. Among studies reporting this information, 19–44% of patients had abnormal LDH values, and 25–100% had bulky lymph nodes. CR rates ranged from 51% to 97%, 2-year PFS ranged from 65% to 86%, and 5-year PFS ranged from 38% to 67%. The pooled estimates of the CR rate and OR rate following consolidative RIT were 78% (95% CI 66%–87%) and 98% (95% CI 92.9%–99.5%), respectively (Figure A). The pooled estimates for the 2-year and 5-year PFS were 77.0% (95% CI 70.5–82.4%) and 56.0% (95% CI 41.9–69.2%), respectively (Figure B). Conclusions: This analysis suggests that consolidative RIT is beneficial to patients with previously untreated FL with meaningful CR rates and 5-year PFS. In addition, consolidative RIT compares favorably to maintenance therapy with R given after chemotherapy (ECOG 1496) in both 2-year PFS (77.0% vs. 73.5%) and 5-year PFS (56.0% vs. 46.4%), and needs to be compared to maintenance R following R-chemotherapy induction. Disclosures: Flowers: Genentech/Roche (unpaid): Consultancy; Celgene: Consultancy, Research Funding; Millennium/Takeda: Consultancy, Research Funding; Seattle Genetics: Consultancy; Novartis: Research Funding; Spectrum: Consultancy, Research Funding.

scholarly journals Associations and prognostic accuracy of electrolyte imbalances in predicting poor COVID-19 outcome: a systematic review and meta-analysis of 28 observational studies

2021 ◽  
Author(s):  
Harris Jun Jie Muhammad Danial Song ◽  
Alys Zhi Qin Chia ◽  
Benjamin Kye Jyn Tan ◽  
Chong Boon Teo ◽  
Horng Ruey Chua ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Observational Studies ◽  
Inflammatory Marker ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Cochrane Library ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Poor Outcome ◽  
Prognostic Accuracy

BACKGROUND: Serum electrolyte imbalances are highly prevalent in COVID-19 patients. However, their associations with COVID-19 outcomes are inconsistent, and of unknown prognostic value. OBJECTIVES: To systematically clarify the associations and prognostic accuracy of electrolyte imbalances (sodium, calcium, potassium, magnesium, chloride and phosphate) in predicting poor COVID-19 clinical outcome. METHODS: PubMed, Embase and Cochrane Library were searched. Odds of poor clinical outcome (a composite of mortality, intensive-care unit (ICU) admission, need for respiratory support and acute respiratory distress syndrome) were pooled using mixed-effects models. The associated prognostic sensitivity, positive and negative likelihood ratios (LR+, LR-) and predictive values (PPV, NPV; assuming 25% pre-test probability), and area under the curve (AUC) were computed. RESULTS: We included 28 observational studies from 953 records with low to moderate risk-of-bias. Hyponatremia (OR=2.08, 95%CI=1.48-2.94, I2=93%, N=8), hypernatremia (OR=4.32, 95%CI=3.17-5.88, I2=45%, N=7) and hypocalcemia (OR=3.31, 95%CI=2.24-4.88, I2=25%, N=6) were associated with poor COVID-19 outcome. These associations remained significant on adjustment for covariates such as demographics and comorbidities. Hypernatremia was 97% specific in predicting poor outcome (LR+ 4.0, PPV=55%, AUC=0.80) despite no differences in CRP and IL-6 levels between hypernatremic and normonatremic patients. Hypocalcemia was 76% sensitive in predicting poor outcome (LR- 0.44, NPV=87%, AUC=0.71). Overall quality of evidence ranged from very low to moderate. CONCLUSION: Hyponatremia, hypernatremia and hypocalcemia are associated with poor COVID-19 clinical outcome. Hypernatremia is 97% specific for a poor outcome and the association is independent of inflammatory marker levels. Further studies should evaluate if correcting these imbalances help improve clinical outcome.

scholarly journals Medical Cannabinoids for Cancer Cachexia: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Jing Wang ◽  
Yanling Wang ◽  
Mengting Tong ◽  
Hongming Pan ◽  
Da Li
Keyword(s):  
Quality Of Life ◽  
Cancer Patients ◽  
Cancer Cachexia ◽  
Meta Analysis ◽  
Life Quality ◽  
Cochrane Library ◽  
Cochrane Central Register ◽  
Negative Effects ◽  
Central Register

Objectives. Cancer cachexia (CCA) is an intractable and ineffective metabolic syndrome that attacks 50–80% of cancer patients. It reduces patient’s life quality, affects the efficacy of treatment, and then increases their mortality; however, there are no established therapeutic strategies for CCA in the world. In this study, we assess the positive and negative effects of cannabinoid in the treatment of CCA. Methods. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Web of Science, and PubMed up to December 2017. Results. Of the 256 screened studies, three studies with a total of 592 participants were included. Compared with placebo, cannabinoid increased the appetite (MD 0.27, 95% CI -0.51 to 1.04; n= 3) but failed to improve the overall quality of life (QOL; MD -12.39, 95% CI [-24.21 to -0.57; n = 2), and a total of 441 patients had 607 adverse events (AEs; 496 in the cannabinoid group and 111 in the placebo group). Conclusions. Our analysis showed cannabinoid is effective in increasing appetite in cancer patients. However, it declines the quality of life, which may be due to the side effects of cannabinoid.

Abstract TP338: The Dynamic CT Angiography Spot Sign: Prevalence, Predictive Value, and Rate of Contrast Extravasation

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Dar Dowlatshahi ◽  
Hee Sahng Chung ◽  
Franco Momoli ◽  
Grant Stotts ◽  
Richard I Aviv ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Predictive Performance ◽  
Primary Objective ◽  
Hematoma Expansion ◽  
Contrast Extravasation ◽  
Spot Sign ◽  
Maximal Volume ◽  
Time Curve ◽  
Secondary Objective ◽  
The Relationship

Introduction: Hematoma expansion is a predictor of poor clinical outcome in intracerebral hemorrhage (ICH). The CT angiography (CTA) spot sign is a validated predictor of hematoma expansion, but its predictive performance is modest. This is in part because traditional “static” CTA can miss delayed spot signs, depending on the timing of image acquisition. Dynamic CTA (dCTA) can detect delayed spot sign formation and allows calculation of contrast extravasation rate. However, the predictive performance of a delayed “dynamic spot” and the relationship between rate of extravasation and hematoma expansion are not known. Our primary objective was to calculate the prevalence and predictive performance of the dynamic spot sign with dCTA. Our secondary objective was to determine whether the rate of contrast extravasation predicts significant hematoma expansion. Methods: We prospectively enrolled 79 patients who presented with primary ICH and underwent dCTA within 6 hours from onset. Primary outcomes were the prevalence of dCTA spot sign and its predictive performance for significant hematoma expansion (increase in hematoma by 6mL or 33% from baseline). For the secondary objective, we calculated the rate of contrast extravasation as the slope of the time curve from the first appearance of contrast at a spot sign to the maximal volume of contrast in 19 acquisitions over 60 seconds. We assessed the relationship between rate of extravasation and hematoma expansion using Mann-Whitney U test and logistic regression. Results: The prevalence of the dCTA spot sign was 45.6% (95% CI, 34.5-56.6%). Significant HE was seen in 58.1% (18/31) of spot-positive patients versus 29.0% (9/31) of spot-negative patients (P=0.04). The sensitivity and specificity of the dCTA spot sign in predicting significant HE was 67% and 63%, respectively. Median rate of extravasation was 0.0022 mL/min in patients with hematoma expansion vs 0.0013 mL/min in those without (p=0.05). Conclusion: Dynamic CTA had a higher spot sign prevalence than conventional CTA. While the sensitivity in predicting expansion was higher with dCTA, the specificity was lower, possibly due to a lower risk of expansion with delayed spot signs. The rate of extravasation was roughly double in patients with hematoma expansion.

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