Network meta-analysis of novel and conventional sentinel lymph node biopsy techniques in breast cancer.

Background: The aim of this network meta-analysis was to compare the performance of blue dye alone or in combination with radioisotope (technetium-99m, Tc) with three novel techniques for sentinel lymph node detection in breast cancer: indocyanine green fluorescence (ICG), superparamagnetic iron oxide (SPIO) nanoparticles and contrast-enhanced ultrasound imaging (CEUS). Methods: PubMed, Embase, the Cochrane Library, China Knowledge Research Integrated Database, ClinicalTrials.gov and OpenGrey databases were searched up to 31 November 2017, without language restriction. Studies that compared the detection performance of at least one of the novel methods (ICG, SPIO and CEUS) with that of traditional methods (blue dye and/or radioisotope) were included in network meta-analysis. Results: Thirty-five studies were included. Pooled risk ratios (RRs) for Tc (1·09, 95 per cent c.i. 1·04 to 1·15), ICG (1·12, 1·07 to 1·16) and SPIO (1·09, 1·01 to 1·18) showed statistically better performance in detecting sentinel lymph nodes than blue dye alone. ICG had the lowest false-negative rate, with a RR of 0·29 (0·16 to 0·54), followed by Tc (RR 0·44, 0·20 to 0·96) and SPIO (RR 0·45, 0·14 to 1·45), with blue dye alone as the reference group. Conclusion: SPIO or ICG alone are superior to blue dye alone and comparable to the standard dual-modality technique of blue dye with Tc.

Inverse association between circulating APRIL levels and serological and clinical disease activity in patients with systemic lupus erythematosus.

OBJECTIVE: To assess longitudinal expression of a proliferation-inducing ligand (APRIL) in patients with systemic lupus erythematosus (SLE) and its correlation with B lymphocyte stimulator (BLyS) expression, serum anti-dsDNA titres, and clinical disease activity. METHODS: Sixty eight patients with SLE were longitudinally followed up for a median of 369 days. At each visit the physician assessed disease activity by SLEDAI, and blood was collected for determination of serum APRIL and BLyS levels and of blood APRIL and BLyS mRNA levels. Fifteen normal control subjects underwent similar laboratory evaluation. RESULTS: Dysregulation of APRIL was not as great as that of BLyS. Changes in serum levels of APRIL and BLyS over time were usually discordant, whereas blood levels of APRIL and BLyS mRNA strongly paralleled each other. Serum APRIL levels modestly, but significantly, inversely correlated with serum anti-dsDNA titres in anti-dsDNA positive patients analysed in aggregate. Moreover, serum APRIL levels modestly, but significantly, inversely correlated with clinical disease activity in all patients analysed in aggregate. CONCLUSION: Serum levels of APRIL and BLyS are differentially regulated. APRIL may serve as a down modulator of serological and/or clinical autoimmunity in patients with SLE. This may have important ramifications for BLyS targeted treatment, and it remains to be determined whether agents which neutralise only BLyS will be preferable to agents which neutralise both BLyS and APRIL.

Differentials or integrals: pluses and minuses in their application to additive dose techniques

Retrospective radiation dosimetry is based on the growth of radiation sensitive defects. In Electron Paramagnetic Resonance (EPR), the peak-to-peak measurement of the differential of the absorption spectrum is used, whereas in luminescence dosimetry, the response of the sample to irradiation is traditionally determined by the height or the integral of the emission spectrum. It has been shown experimentally and can be proved mathematically that, except in special cases, the environmental dose estimate (De) depends on which parameter is used to measure radiation response. Since integral methods are directly related to the number of radiation-produced defects, it is increasingly assumed that they will give the best estimates of De in EPR as well as in luminescence dosimetry. We show that the disparity in De is not due to any inherent superiority of a particular method, but is rather due to the different degree of interference between wide and narrow peaks in the different methods. In spite of their conceptual nicety, integral methods do not necessarily give the best estimate of De. This is demonstrated by computer simulation and guidelines are also given on selecting the best method in any particular case. Differential techniques might be very profitably applied to luminescence dosimetry as well as EPR dosimetry. The differential spectrum not only shows detail which may be obscured in the integral curve, but also provides a very simple graphical means of isolating a preferred spectral component. This leads to the possibility of extending the range of substances which may be reliably used for dosimetry or dating by luminescence techniques.