The diagnostic performance of ADC value for tumor grade, deep myometrial invasion and lymphovascular space invasion in endometrial cancer: a meta-analysis.

BACKGROUND: Disputes exist regarding whether the apparent diffusion coefficient (ADC) can differentiate the tumor grade, deep myometrial invasion and lymphovascular space invasion (LVSI) in endometrial cancer. The aim of this review was to assess the diagnostic performance of the ADC value in endometrial cancer. MATERIAL AND METHODS: The PubMed, Web of Science, Embase and Cochrane Library databases were searched for studies that used the ADC value to assess tumor grade, deep myometrial invasion and LVSI in endometrial cancer. We used forest plots to analyze the heterogeneity and generate the pooled sensitivity (SEN) and specificity (SPE). We used summary receiver operating characteristic (SROC) curves to work out the area under the SROC curve (AUC). Likelihood ratios (LRs) were also obtained. RESULTS: Of the 460 identified studies, 11 studies met our inclusion criteria and were included. Overall, nine studies (491 patients) aimed at differentiating high tumor grade had a pooled SEN, SPE and AUC of 77%, 73% and 81%, respectively; three studies (181 patients) for differentiating deep myometrial invasion had a pooled SEN, SPE and AUC of 71%, 67% and 77%, respectively; and two studies (106 patients) for differentiating LVSI had a pooled SEN and SPE of 66% and 74%, respectively. The positive and negative LRs were 2.77 and 0.35 for the tumor grade, 2.08 and 0.45 for deep myometrial invasion, and 2.48 and 0.45 for LVSI. CONCLUSION: This meta-analysis showed that the ADC value had a moderate diagnostic performance for the tumor grade, deep myometrial invasion and LVSI in endometrial cancer.

Comparison of multislice computed tomography and clinical scores for diagnosing acute appendicitis.

OBJECTIVE: To compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado scores with multislice computed tomography (MSCT) for diagnosing acute appendicitis (AA). METHODS: This retrospective study included patients with abdominal pain who had undergone MSCT, and whose medical notes included RIPASA and Alvarado score parameters. MSCT was compared with RIPASA and Alvarado scores for diagnosing AA. RESULTS: Of 297 patients included, sensitivity, specificity and accuracy for diagnosing AA were 95.2%, 73.6% and 87.2% for RIPASA score (cutoff value 7.5) and 63.1%, 80.9% and 69.7% for Alvarado score (cutoff value 7). Sensitivity, specificity and accuracy of MSCT for diagnosing AA were 98.9%, 96.4% and 98.0%, respectively. In terms of accuracy, statistically significant differences were observed between RIPASA and Alvarado scores, and between MSCT and RIPASA scores. The mean RIPASA score was significantly different in the simple AA group (9.7 ± 2.2) compared with other AA groups (10.5 ± 1.7). No statistically significant difference was observed in RIPASA score between nonperforated and perforated AA. MSCT sensitivity, specificity and accuracy for diagnosing simple AA were 94.1%, 96.4% and 95.8%, respectively; for differentiating perforated and nonperforated AA, scores were 90.2%, 95.2% and 94.1%, respectively. CONCLUSION: MSCT is the optimum diagnostic tool for AA, followed by RIPASA score and Alvarado score, particularly in diagnosing simple and perforated AA.

Recapping laminoplasty for the treatment of severe burst fractures of thoracolumbar vertebra complicated with spinal stenosis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate operation skills, therapeutic effects and indications of racapping laminoplasty for the treatment of severe burst fractures of thoracolumbar vertebra complicated with spinal stenosis.</p><p><b>METHODS</b>In the study, 41 patients with severe burst fractures of thoracolumbar vertebra complicated with spinal stenosis were treated with recapping laminoplasty. After the treatment, the size of vertebral canal, spinal stability, altitude recovery of vertebral body and rehabilitation of nerve function were observed.</p><p><b>RESULTS</b>All the patients were followed up and the duration ranged from 1 to 3 years. The anterior height of compressed vertebral bodies restored from preoperative 58% to postoperative 97%, posterior height was from preoperative 76% to postoperative 98.7%. The Cobb angle was corrected from preoperative 24.6 degrees to postoperative 1.8 degrees, and the size of vertebral canal restored from preoperative 43% to postoperative 93%. According to Frankel classification, 1 patient who were at A grade had no changes and others improved by 1 to 3 degrees.</p><p><b>CONCLUSION</b>This is an ideal operation method for treating burst fractures of thoracolumbar vertebra with spinal stenosis, which is simple, safe and enlarging vertebral canal, at the same time completely decompressing the dura mater and nerve roots. This method eliminated secondary spinal stenosis, reconstructed posterior column and increased spinal stability.</p>