Inconsistency Index Research Articles

Meta-analysis of the HTR2A–1354C/T polymorphism in schizophrenia and bipolar disorder

ObjectiveSchizophrenia (SCZ) and bipolar disorder (BD) are common psychotic disorders, which show some overlaps in genetic aetiology. Researchers have conducted a number of studies to investigate the relationship between SCZ and the 1354C/T genetic polymorphism of 5-hydroxytryptamine receptor 2A (HTR2A–1354C/T), as well as the associations between BD and the HTR2A–1354C/T polymorphism. However, the results were conflicting. To provide a more robust estimate about the effects of the HTR2A–1354C/T polymorphism on the risk of these two psychotic disorders, we performed this meta-analysis.MethodsWe used the pooled odds ratios (ORs) with 95% confidence intervals (95% CIs) to investigate the relationships between SCZ and the 1354C/T polymorphism of HTR2A, as well as the associations between BD and HTR2A–1354C/T. Publication bias was tested by Begg's test and inverted funnel plot, and heterogeneity was checked by Cochran's Q statistic and the inconsistency index (I2).ResultsEight studies were concerned with SCZ, analysing a cumulative total of 2953 cases and 3153 controls; six papers studied BD, using a total of 923 cases and 928 controls. There was no significant association found between HTR2A–1354C/T and SCZ in the overall population (T allele vs. C allele, OR = 1.035, 95% CI 0.912–1.175, p = 0.596) or in the subgroups Caucasian population and Asian population. Moreover, there was no significant association between the HTR2A–1354C/T polymorphism and BD in the overall population (T allele vs. C allele, OR = 1.038, 95% CI = 0.607–1.772, p = 0.892).ConclusionOn the basis of these results, the HTR2A–1354C/T polymorphism is unlikely to be a risk factor for SCZ and BD.

Meta‐analysis of vitamin D receptor polymorphisms and psoriasis risk

Vitamin D receptor (VDR) gene polymorphisms have been studied as candidate variants that affect psoriasis risk. However, results have been conflicting. We reviewed studies on VDR polymorphisms and psoriasis risk published to October 1, 2011, and quantitatively summarized associations of the most widely studied variants (FokI, TaqI, ApaI, BsmI) using meta-analysis. Associations were measured using random-effect odds ratios (ORs) combined with 95% confidence intervals (CIs). Eleven eligible studies, encompassing 1106 cases and 1209 controls, were retrieved from electronic databases and included in this review. The results were heterogeneous, which may be partly explained by small sample bias, the phenomenon of winner's curse, and differences among populations. For FokI and ApaI polymorphisms, we did not find any evidence of association. A borderline allelic association was found for the BsmI B variant after exclusion of the earliest significant report (OR = 0.81, 95% CI 0.68-0.98; P = 0.04, inconsistency index [I2] = 12.7%). Among Caucasian subjects, the TaqI t allele was nominally associated with psoriasis risk (OR = 0.77, 95% CI 0.64-0.97; P = 0.012, I (2) = 0), with homozygous carriers (tt vs. TT, OR = 0.59, 95% CI 0.39-0.90; P = 0.01, I2 = 0) and recessive model (tt vs. Tt + TT, OR = 0.66, 95% CI 0.44-0.98; P = 0.04, I2 = 0) as protective factors. None of these associations persisted after adjustment for multiple comparisons. No publication bias was detected in this meta-analysis. No genetic variant examined in the VDR gene showed a robust and reproducible association with risk for psoriasis. Any association that may exist is likely to be weak and potentially restricted to specific populations.

NQO1 C609T polymorphism and esophageal cancer risk: a HuGE review and meta-analysis

BackgroundMany studies have been carried out to test the hypothesis that the NQO1 C609T polymorphism might be associated with the risk of esophageal cancer. However, the results are poorly consistent, partly due to genetic or other sources of heterogeneity. To investigate the association between this polymorphism and the risk of esophageal cancer, a meta-analysis was performed.MethodsWe used odds ratios (ORs) with 95% confidence intervals (CIs) to assess the strength of association. The frequency of the putative risk allele in the controls was estimated by the inverse-variance method. Cochran’s Q statistic and the inconsistency index (I2) were used to check heterogeneity. Egger’s test and an inverted funnel plot were used to assess the publication bias.ResultsOur study included eight published case-control studies about the NQO1 C609T polymorphism and esophageal cancer, including a total of 1,217 esophageal cancer patients and 1,560 controls. Overall, a significant association was found between the NQO1 C609T variant and esophageal cancer under a recessive model (OR = 1.647; 95% CI = 1.233-2.200). Regarding histological type, more significant evidence was found for esophageal squamous cell carcinoma (ESCC) (OR = 2.03; 95% CI = 1.29-3.19) than esophageal adenocarcinoma (EAC) (OR = 1.61; 95% CI = 1.01-2.56) under a recessive model.ConclusionsThe meta-analysis suggests that the NQO1 C609T polymorphism considerably increases the risk of esophageal cancer.

Rebamipide Helps Defend Against Nonsteroidal Anti-Inflammatory Drugs Induced Gastroenteropathy: A Systematic Review and Meta-Analysis

Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs (NSAIDs) has been perplexing most clinicians and users of NSAIDs. Rebamipide is increasingly advocated as a candidate option for the prevention of NSAIDs induced gastrointestinal mucosal injury. To assess the efficacy and the safety of rebamipide for the prevention and treatment of NSAID-induced gastroenteropathy. PubMed, Embase, Web of Science, Google Scholar, the Cochrane Library, Japan Science and Technology Information Aggregator, and China Biology Medicine Disc were searched up to December 2011. Randomized controlled trials (RCTs) recruiting subjects with co-prescriptions of NSAIDs and rebamipide were eligible. Efficacy and safety of rebamipide were reevaluated, and dichotomous data were pooled to obtain relative risk (RR) with a 95 % confidence interval. Heterogeneity and publication bias were assessed by the inconsistency index statistic and funnel plot analysis, respectively. The search identified 338 citations, and 15 RCTs including 965 individuals were eligible. In general, rebamipide acted better than placebo against short-term NSAID-induced gastroduodenal injury. Separate studies showed rebamipide was equal to or not superior to traditional strategies (including PPIs, H2RA and misoprostol treatment). Especially, rebamipide showed a beneficial effect against the small bowel damage (total RR = 2.70, 95 % confidence interval = 1.02-7.16, P = 0.045) when compared with placebo group. The average incidence of adverse events was about 36.1 % (0-70.0 %) but no serious event was recorded. Current evidences show rebamipide is effective and safe for defending against NSAID-induced gastroduodenal and lower-gastrointestinal injuries. However, more well-designed trials should be conducted to fully confirm the practical value of rebamipide.

Prostate Cancer

The purpose of this study was to compare the diagnostic performance of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging for prostate cancer (PCa) detection by performing a meta-analysis of studies evaluating these techniques within the same patient cohort. Evidence-based online databases were searched for studies reporting the performance of DWI and DCE in PCa detection in the same patient cohorts using histopathology as reference standard and providing sufficient data to construct 2 × 2 contingency tables. Pooled estimates of diagnostic performance were computed across included studies. Of 80 initial studies identified, 5 studies (total of 265 patients and 1730 prostatic regions) met criteria for inclusion in the meta-analysis. Pooled sensitivity was 58.4% (95% confidence interval [CI], 53.5%-63.1%) for DWI and 55.3% (95% CI, 50.4%-60.1%) for DCE. Pooled specificity was 89.0% (95% CI, 87.2%-0.7%) for DWI and 87.9% (95% CI, 86.0%-89.6%) for DCE. At summary receiver-operating-characteristic analysis, area-under-the-curve was 0.810 (0.059) for DWI and 0.786 (0.079) for DCE. Heterogeneity across studies was high for sensitivity and specificity [inconsistency index (I), >90%], although heterogeneity of specificity was substantially improved after excluding an outlier study in terms of diagnostic threshold (I = 0.0%-68.8%). Relative performance of DWI and DCE remained similar after this exclusion There was a paucity of studies comparing DWI and DCE in the same patient cohorts, and heterogeneity among these studies was substantial. Nevertheless, performance of DWI and DCE was similar across identified studies, with both techniques showing substantially better specificity than sensitivity. Larger studies with uniform methodology are warranted to further understand relative merits of the 2 techniques.

Meta-analysis of Diffusion-Weighted Magnetic Resonance Imaging in Detecting Prostate Cancer

The objective of this study was to determine the diagnostic performance of quantitative diffusion-weighted magnetic resonance imaging in detection of prostate cancer. A comprehensive search was performed for English articles published before May 2012 that fulfilled the following criteria: patients had histopathologically proved prostate cancer; diffusion-weighted imaging (DWI) was performed for the detection of prostate cancer, and data for calculating sensitivity and specificity were included. Methodological quality was assessed by using the quality assessment of diagnostic studies instrument. Publication bias analysis, homogeneity, inconsistency index, and threshold effect were performed by STATA version 12. Of 119 eligible studies, 12 with 1637 malignant and 4803 benign lesions were included. There was notable heterogeneity beyond threshold effect and publication bias. The sensitivity and specificity with 95% confidence interval (CI) estimates of DWI on a per-lesion basis were 77% (CI, 0.76-0.84) and 84% (CI, 0.78-0.89), respectively, and the area under the curve of summary receiver operating characteristic curve was 0.88 (CI, 0.85-0.90). The overall positive and negative likelihood ratios with 95% CI were 4.93 (3.39-7.17) and 0.278 (0.19-0.39), respectively. Quantitative DWI has a relative sensitivity and specificity to distinguish malignant from benign in prostate lesions. However, large-scale randomized control trials are necessary to assess its clinical value because of nonuniformed diffusion gradient b factor, diagnosis threshold, and small number of studies.

Paper alert

Paper alert

Aplicação de medidas de gravidade e de inconsistência de fala em crianças com transtorno fonológico

OBJETIVO: Descrever os índices PCC-R, IRS, IRO e IRD, PDI e IIF em crianças com transtorno fonológico, com e sem os processos fonológicos de ensurdecimento, e verificar a eficiência desses índices na identificação de diferenças entre as crianças. MÉTODOS: Trata-se de pesquisa retrospectiva e transversal com 20 crianças com transtorno fonológico e idade entre 5 e 8 anos. Foram realizados dois agrupamentos, de acordo com a presença dos processos fonológicos de ensurdecimento de plosivas e de fricativas. Todos foram submetidos ao teste de fonologia ABFW, no qual foi verificada a produtividade dos processos fonológicos, o número de diferentes tipos de processos fonológicos e os índices PDI, PCC-R, IRS, IRO e IRD. A prova de inconsistência de fala foi aplicada para calcular o índice de inconsistência de fala. Os dados foram submetidos à análise estatística inferencial. RESULTADOS: O estudo indicou que crianças com transtorno fonológico e presença de ensurdecimento de fricativas e/ou plosivas têm maior comprometimento de fala e apresentam valores mais altos do índice de inconsistência de fala, PDI, IRS, IRO e IRD. O erro articulatório mais ocorrente em ambos os grupos foi a substituição, sendo que a distorção ocorreu mais no grupo sem os processos fonológicos de ensurdecimento. CONCLUSÃO: Os índices aplicados foram eficientes para diferenciar crianças com e sem a presença dos processos fonológicos de ensurdecimento. Há evidências de que as crianças que apresentam os processos fonológicos de ensurdecimento têm dificuldade na representação fonológica.

Meta‐analysis of diffusion‐weighted MRI in the differential diagnosis of lung lesions

To perform a meta-analysis to evaluate the diagnostic performance of the diffusion-weighted imaging (DWI) technique in differentiating malignant from benign lung lesions. Medical and scientific literature databases were searched for studies that assessed the diagnostic performance of DWI in patients suspected of lung cancer who underwent DWI and biopsy. Only studies in the English or Chinese language and published before September 2011 were considered for inclusion. Methodological quality was assessed by the Quality Assessment of Diagnostic Studies (QUADAS) instrument. Homogeneity was explored by the Chi-square test and inconsistency index. Sensitivities (SEN), specificities, predictive values, diagnostic odds ratio (dOR), and areas under the receiver operator characteristic (ROC) curve were calculated. Potential threshold effect was investigated by using Spearman's correlation coefficient. Publication bias analysis was evaluated by Deeks' asymmetry test. Of 33 eligible studies, 11 were included in the meta-analysis, comprising 755 malignant and 294 benign lesions. Heterogeneity was found to have arisen primarily from threshold effect. The data points from the Deeks' funnel plot indicated the presence of publication bias. Methodological quality was moderate. The pooled weighted SEN with corresponding 95% confidence interval (CI) was 0.80 (95% CI: 0.76, 0.83), SPE was 0.93 (95% CI: 0.91, 0.95), positive likelihood ratio was 9.24 (95% CI: 3.58, 23.83), negative likelihood ratio was 0.24 (95% CI: 0.19, 0.29), and dOR was 46.14 (95% CI: 27.56, 77.26). The area under the ROC curve was 0.91 (95% CI: 0.89, 0.93). DWI is a noninvasive, nonradiative, and accurate technique for distinguishing between malignant and benign lung lesions. However, large-scale randomized control trials are necessary to assess its clinical value and to establish standards of DWI for measurement, analysis, and cutoff values of diagnosis.

Diagnostic yield of small-bowel capsule endoscopy in patients with iron-deficiency anemia: a systematic review

Iron-deficiency anemia (IDA) is the most common cause of anemia worldwide. Current guidelines recommend the use of small-bowel capsule endoscopy (SBCE) in IDA. Evidence of the validity of SBCE in patients with IDA alone is still limited. To assess the diagnostic yield (DY) of SBCE in IDA by pooling data from relevant studies. Systematic review and meta-analysis. Fixed-effects or random-effects models were used as appropriate. Studies that estimated the DY of SCBE in IDA were identified. Two investigators independently conducted the search and data extraction. A total of 24 studies enrolling 1960 patients with IDA who underwent SBCE were included. Per-patient DY, with 95% confidence intervals. Subgroup analysis was also performed. The pooled DY of SBCE in IDA, evaluated by a random-effects model, was 47% (95% CI, 42%-52%), but there was statistically significant heterogeneity among the included studies (inconsistency index [I(2)] = 78.8%, P < .0001). The pooled DY of SBCE in studies focused solely on patients with IDA (subset 1, 4 studies) was 66.6% (95% CI, 61.0%-72.3%; I(2) = 44.3%); conversely, that of studies not focusing only on IDA patients (subset 2, 20 studies) was 44% (95% CI, 39%-48%; I(2) = 64.9%). In particular, more vascular (31% vs 22.6%, P = .007), inflammatory (17.8% vs 11.3%, P = .009), and mass/tumor (7.95% vs 2.25%, P < .0001) lesions were detected with SBCE in patients participating in the studies in subset 1. Heterogeneity of studies, retrospective design, and selection bias. This analysis demonstrates the validity of SBCE in the investigation of patients with IDA and negative findings on a previous diagnostic workup, although certain factors such as heterogeneity and quality of the included studies should be taken into account.

Association Between TNF-δ 238G/A Polymorphisms and the Risk of Ischemic Stroke

ABSTRACTBackground: Stroke is the second highest cause of morbidity and functional disability around the world. In addition, it is the second most common cause of death worldwide []. However, the genetic pathology of stroke is still unclear. Published data on the association between TNF-a 238G/A polymorphisms and ischemic stroke risk are inconsistent and controversial. To provide a more robust estimate about TNF-a 238G/A polymorphisms on the risk of ischemic stroke, we conducted this meta-analysis. Methods: We used the pooled odds ratios (ORs) with 95% confidence intervals (95%CIs) to investigate the relationship between TNF-α238G/A polymorphisms and ischemic stroke. Publication bias was tested by Begg's test and inverted funnel plot, and Heterogeneity was checked by Cochran's Q statistic and the inconsistency index (I2). Results: There are 7 studies that include 1,766 cases and 1,560 controls in this meta-analysis. The results indicated a significant association between TNF-α238G/A polymorphisms and ischemic stroke in overall analysis, Caucasian and Adult. However, statistical association was not observed in Juvenile and Asian. Conclusions: This meta-analysis suggests that TNF-α238G/A polymorphisms increases the risk of ischemic stroke in Adult, Caucasian, and overall analysis. However, in Juvenile and Asian analysis, significant associations between TNF-α238G/A and ischemic stroke were not found.

Racial Differences in the Effect of Alcohol and Tobacco on the Risk of Esophageal Squamous Cell Carcinoma

Purpose: Within the U.S., African and Asian Americans have higher incidences of esophageal squamous cell carcinoma (ESCC) than whites. Alcohol and tobacco use are well-established risk factors for ESCC. We hypothesized that the effects of these exposures are stronger among individuals of Asian or African descent than among those of European descent. Methods: We performed a systematic literature review in electronic databases regardless of language. Eligible studies were population-based assessments of the effect of tobacco and/or alcohol on the risk of ESCC, and allowed for stratification by race. Quality of studies was assessed by the Newcastle-Ottawa Scale. Meta-analyses were performed to identify summary estimates using random effect models. Heterogeneity was defined by Cochrane's Q p<0.20 and the inconsistency index (I2, < 25% low, > 75% high). Results: Systematic review identified 4,951 unique citations, of which 39 were eligible. 30 were case-control and 9 were cohort studies; the majority was high quality. 16 studies provided data on individuals of European, 16 of Asian, 6 of South American, and 2 of African descent. In analyses pooling all races, there were dose-response relationships with alcohol and tobacco use, but with substantial heterogeneity (Table). The effect of current smoking vs. never was weaker among Asians than Europeans (European: OR 4.59, 95% CI 3.46-6.10; Asian: OR 2.59, 95% CI 1.99-3.37), with the 95% CI of the estimates not crossing each other's boundaries, indicating statistical significance. Asians also trended toward having weaker effects of long duration cigarette use (>20 years vs never, European: OR 5.00, 95% CI 3.51-7.12; Asian: OR 3.39, 95% CI 1.66-6.94), and of heavy daily cigarette use (>20 per day vs. none, European: OR 4.65, 95% CI 3.12-6.92; Asian: OR 2.70, 95% CI 1.69-4.30). There was no difference of the effect of alcohol on the risk of ESCC by race.Table: Maximally adjusted summary odds ratios: all studiesConclusion: The estimated effects of alcohol and tobacco use on the risk of ESCC from population-based studies are heterogeneous. Contrary to our hypothesis, a weaker effect of tobacco for ESCC was observed among Asians than among Europeans. Differences in the effects of other factors or in the prevalence of tobacco and alcohol use must explain the higher incidence of ESCC among Asians. The study was limited by the small number of studies among individuals of African descent. More studies are needed to understand the cause of the higher incidence of ESCC among African and Asian Americans.

Potential value of dual-time-point 18F-FDG PET compared with initial single-time-point imaging in differentiating malignant from benign pulmonary nodules

We performed a meta-analysis to assess the potential value of dual-time-point (DTP) imaging as compared with initial single-time-point (STP) scanning with 18F-fluorodeoxyglucose (18F-FDG) PET in differentiating malignant from benign single pulmonary nodules. Data on the performance of DTP 18F-FDG PET imaging in assessing lung nodules were extracted from articles of prospective or retrospective original research published between January 2001 and April 2010. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used to assess the quality of study methodology. Heterogeneity in the results of the studies was assessed, and summary receiver operating characteristic (SROC) curves were constructed. Eleven studies comprising a total of 788 patients who underwent initial scanning, 778 of whom also underwent DTP imaging, were included in the final analysis. The quality of study methodology was judged to be moderate. Substantial heterogeneity in the results of the studies, with inconsistency (I2) index values above 85%, reflected important differences in study methods and populations, including varying lesion sizes, 18F-FDG avidity, uptake interval for delayed imaging, and threshold for positive result on DTP imaging. SROC curve analysis revealed a statistically nonsignificant trend toward higher sensitivity with DTP imaging, at moderate levels of specificity, when compared with initial STP scanning. The area under the curve (SE) values for DTP and initial STP imaging were 0.839 (0.079) and 0.757 (0.074), respectively. Although the results of our analysis do not support the routine use of DTP imaging with 18F-FDG PET in the differential diagnosis of pulmonary nodules, this technique may provide additional information in selected cases with equivocal results from initial scanning. Further prospective research is required to better define the potential benefits of DTP 18F-FDG PET imaging.

An interval-valued intuitionistic fuzzy multiattribute group decision making framework with incomplete preference over alternatives

This article proposes a framework to handle multiattribute group decision making problems with incomplete pairwise comparison preference over decision alternatives where qualitative and quantitative attribute values are furnished as linguistic variables and crisp numbers, respectively. Attribute assessments are then converted to interval-valued intuitionistic fuzzy numbers (IVIFNs) to characterize fuzziness and uncertainty in the evaluation process. Group consistency and inconsistency indices are introduced for incomplete pairwise comparison preference relations on alternatives provided by the decision-makers (DMs). By minimizing the group inconsistency index under certain constraints, an auxiliary linear programming model is developed to obtain unified attribute weights and an interval-valued intuitionistic fuzzy positive ideal solution (IVIFPIS). Attribute weights are subsequently employed to calculate distances between alternatives and the IVIFPIS for ranking alternatives. An illustrative example is provided to demonstrate the applicability and effectiveness of this method.

The rs11833579 and rs12425791 polymorphisms and risk of ischemic stroke in an Asian population: A meta-analysis

BackgroundIn 2009, a GWAS has confirmed that rs11833579 and rs12425791 near the NINJ2 gene could increase the stroke and ischemic stroke (IS) risk. Recently, several studies have been implemented to assess the relationship between the two SNPs and ischemic stroke risk in Asian. However, the results were poorly consistent. To study the association between the both polymorphisms and the risk of ischemic stroke, we performed a meta-analysis. MethodsWe used odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the strength of association. The heterogeneity was checked by Q test and the inconsistency index (I2). Begg's test and Egger's test were used to assess the possible publication bias. ResultsOur study included 6 articles, contained 9 independent case–control studies, involved a total of 9,142 cases and 10,652 controls about rs11833579, 10,165 cases and 11,592 controls about rs12425791. There was a significant association between rs12425791 and IS risk with dominant genetic model (OR=1.087, 95%CI=1.021–1.158, I2=34.6%, P=0.152), but not with recessive genetic model and allele A vs. allele G. For rs11833579, we failed to verify it relate with IS risk under allele A vs. allele G, dominant and recessive genetic model. ConclusionsThis meta-analysis suggest that rs12425791 is relative to ischemic stroke risk under dominant model in Asian population, but not for rs11833579.

Medidas fonológicas em crianças com transtorno fonológico

OBJETIVO: Comparar o desempenho de crianças com e sem transtorno fonológico (TF) quanto às habilidades de consciência fonológica (CF), índice de Porcentagem de Consoantes Corretas - Revisada (PCC-R) e Índice de Inconsistência de Fala (IIF), além de correlacionar estes resultados entre si. MÉTODOS: Participaram 36 sujeitos, entre 5 anos e 7 anos de idade, divididos em: Grupo Pesquisa (GP): 18 crianças com TF; e Grupo Controle (GC): 18 crianças em desenvolvimento típico de linguagem. Foi calculado o PCC-R, aplicado o IIF e o Teste de Sensibilidade Fonológica-Visual (TSF-V): aliteração igual (AI), diferente (AD) e total (AT), rima igual (RI), diferente (RD) e total (RT). Os resultados foram analisados estatisticamente. RESULTADOS: Foram encontradas diferenças na comparação dos grupos em todos os índices, com melhores desempenhos no GC. Neste, houve correlação negativa do IIF com todas as habilidades de CF e com o PCC-R, exceto com RI. Em todos os subtestes do TSF-V houve correlações positivas entre si. No GP, foram encontradas correlações positivas entre o PCC-R e as provas de aliteração; não foram encontradas correlações entre IFF e PCC-R, nem com as provas de CF. Houve correlações no TSF-V: AI com AT; AD com AT; AD com RD; RI com RT e RD com RT. CONCLUSÃO: Crianças com TF apresentam pior desempenho; as do GC, na medida em que estabilizam a produção de fala, desenvolvem as habilidades de rima e aliteração. As crianças do GP são mais inconsistentes e parecem desenvolver as habilidades de CF de forma desorganizada.

Gestational diabetes and pregnancy outcomes--a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria.

BackgroundTwo criteria based on a 2 h 75 g OGTT are being used for the diagnosis of gestational diabetes (GDM), those recommended over the years by the World Health Organization (WHO), and those recently recommended by the International Association for Diabetes in Pregnancy Study Group (IADPSG), the latter generated in the HAPO study and based on pregnancy outcomes. Our aim is to systematically review the evidence for the associations between GDM (according to these criteria) and adverse outcomes.MethodsWe searched relevant studies in MEDLINE, EMBASE, LILACS, the Cochrane Library, CINHAL, WHO-Afro library, IMSEAR, EMCAT, IMEMR and WPRIM. We included cohort studies permitting the evaluation of GDM diagnosed by WHO and or IADPSG criteria against adverse maternal and perinatal outcomes in untreated women. Only studies with universal application of a 75 g OGTT were included. Relative risks (RRs) and their 95% confidence intervals (CI) were obtained for each study. We combined study results using a random-effects model. Inconsistency across studies was defined by an inconsistency index (I2) > 50%.ResultsData were extracted from eight studies, totaling 44,829 women. Greater risk of adverse outcomes was observed for both diagnostic criteria. When using the WHO criteria, consistent associations were seen for macrosomia (RR = 1.81; 95%CI 1.47-2.22; p < 0.001); large for gestational age (RR = 1.53; 95%CI 1.39-1.69; p < 0.001); perinatal mortality (RR = 1.55; 95% CI 0.88-2.73; p = 0.13); preeclampsia (RR = 1.69; 95%CI 1.31-2.18; p < 0.001); and cesarean delivery (RR = 1.37;95%CI 1.24-1.51; p < 0.001). Less data were available for the IADPSG criteria, and associations were inconsistent across studies (I2 ≥ 73%). Magnitudes of RRs and their 95%CIs were 1.73 (1.28-2.35; p = 0.001) for large for gestational age; 1.71 (1.38-2.13; p < 0.001) for preeclampsia; and 1.23 (1.01-1.51; p = 0.04) for cesarean delivery. Excluding either the HAPO or the EBDG studies minimally altered these associations, but the RRs seen for the IADPSG criteria were reduced after excluding HAPO.ConclusionsThe WHO and the IADPSG criteria for GDM identified women at a small increased risk for adverse pregnancy outcomes. Associations were of similar magnitude for both criteria. However, high inconsistency was seen for those with the IADPSG criteria. Full evaluation of the latter in settings other than HAPO requires additional studies.

The TNF-α-308G/A polymorphism is associated with migraine risk: A meta-analysis

Migraine is a neurasthenia and the genetic etiology has not been determined. Several studies concerning the correlation between the tumor necrosis factor (TNF)-α-308G/A polymorphism and migraine have been published, but their results remain controversial and the small samples in each study do not allow sufficient statistical power. In the present study, odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of the association between the polymorphism and migraine. An inverse-variance method was applied to estimate the frequency of the putative risk allele in the controls. Heterogeneity was determined using Cochran's Q test and the inconsistency index (I(2)). Begg's test and the inverted funnel plot were used to assess the publication bias. Five studies on Asian populations, comprising 985 cases and 958 controls, were included in the meta-analysis. The overall results revealed that the TNF-α-308G/A polymorphism was associated with migraine risk in Asians. The ORs were 1.735 (95% CI, 1.129-2.666) for A vs. G; 1.781 (95% CI, 1.166-2.718) for GA vs. GG; 1.821 (95% CI, 1.153-2.874) for AA+GA vs. GG. The subgroup analysis was based on migraine with aura (MA) and migraine without aura (MO) and there was a statistically significant result for MA [the OR was 1.728 (95% CI, 1.095-2.726) for GA vs. GG and 1.651 (95% CI, 1.049-2.598) for AA+GA vs. GG] but not for MO. In conclusion, the TNF-α -308G/A polymorphism was associated with migraine risk.

Accuracy of quantitative ultrasound elastography for differentiation of malignant and benign breast abnormalities: a meta-analysis

The purpose of this study was to systematically review recent literature on diagnostic performance of strain ratio and length ratio, two different strain measurements in ultrasound elastography, for differentiating benign and malignant breast masses. A literature search of PubMed and other medical and general purpose databases from inception through January 2012 was conducted. Published studies that evaluated the diagnostic performance of ultrasound elastography alone reporting either strain ratio or length ratio for characterization of focal breast lesions and using cytology (fine needle aspiration) or histology (core biopsy) as a reference standard were included. Summary diagnostic performance measures were assessed using bivariate generalized linear mixed modeling. Nine studies reported strain ratio for 2,087 breast masses (667 cancers, 1,420 benign lesions). Summary sensitivity and specificity were 88 % (95 % Credible Interval (CrI), 84-91 %), and 83 % (95 % CrI, 78-88 %), respectively. The positive and negative likelihood ratios (LR) were 5.57 (95 % CrI, 3.85-8.01) and 0.14 (95 % CrI, 0.09-0.20), respectively. The inconsistency index for heterogeneity was 6 % (95 % CrI, 1-22 %) for sensitivity and 8 % (95 % CrI, 3-24 %) for specificity. Analysis of three studies reporting length ratio for 450 breast masses demonstrated sensitivity and specificity of 98 % (95 % CrI, 93-99 %) and 72 % (95 % CrI, 31-96 %), respectively. Strain ratio and length ratio have good diagnostic performance for distinguishing benign from malignant breast masses. Although, this performance may not be incrementally superior to that of breast imaging reporting and data system (BIRADS) in B-mode ultrasound, the application of USE using strain ratio or length ratio in combination with USB may have the potential to benefit the patients, and this requires further comparative effectiveness and cost-effectiveness analyses.

Diagnostic Performance of Dual-time 18F-FDG PET in the Diagnosis of Pulmonary Nodules: A Meta-analysis

Perform a comprehensive meta-analysis evaluating the diagnostic performance of dual time point deoxy-2-[(18)F]fluoro-D-glucose positron emission tomography (FDG-PET) in the diagnosis of pulmonary nodules. MEDLINE, EMBASE, and PUBMED were queried between January 2000 and January 2011. Studies were included if they: 1) used dual time point FDG-PET as a diagnostic test for pulmonary nodules, 2) used pathology or clinical follow-up as the reference standard, and 3) reported absolute number of true-positive (TP), true-negative (TN), false-positive (FP), and false-negative (FN) results or stated sufficient data to derive these values. Summary sensitivity (SN), summary specificity (SP), positive and negative likelihood ratios (LR+) and (LR-), and diagnostic odds ratio were calculated. Heterogeneity of the results was assessed using Forest plots and the value of inconsistency index (I(2)). Inclusion criteria were fulfilled by 10 articles with a total of 816 patients and 890 pulmonary nodules. The summary sensitivity was 85% (82%-89% at 95% confidence interval [CI]) and summary specificity was 77% (CI: 72%-81%), with a LR+ of 2.7 (CI: 1.4-5.2) and a LR- of 0.26 (CI: 0.14-0.49). Diagnostic odds ratio was 11 (CI: 3.8-32.2). Significant heterogeneity was found in the sensitivity (I(2) = 77%) and specificity (90.3%). Dual time point FDG-PET demonstrates similar sensitivity and specificity to single time point FDG-PET in the diagnosis of pulmonary nodules. The additive value of the dual time point FDG-PET is questionable, primarily because of the significant overlap of benign and malignant nodule FDG-PET characteristics and lack of consensus criteria for quantitative thresholds to define nodules as malignant.