Frailty models and social frailty

Frailty is a geriatric syndrome characterized by a reduced ability to maintain homeostasis due to age-related declines in physiological reserves. It increases the risk of adverse health outcomes such as falls, hospitalization, disability, and mortality, especially in older adults. Key risk factors for frailty include cancer, chronic obstructive pulmonary disease, and cerebrovascular disease. Several models of frailty exist, including the physical frailty phenotype, the deficit accumulation model, and mixed physical-psychosocial models. Numerous tools are available for assessment. Cognitive dysfunction is closely related to frailty, sharing underlying mechanisms such as oxidative stress, inflammation, and vascular pathologies. Additionally, social frailty, which can be exacerbated by isolation and limited social support, further complicates the challenges faced by frail individuals. It is recommended that frailty screening, particularly through gait speed assessment, can be conducted in primary healthcare settings. Despite existing guidelines, there is still no consensus on the definition, screening, and diagnosis of frailty. This emphasizes the necessity for additional research to conduct a conceptual diagnosis and screen the older population. Artificial intelligence approaches show promise in identifying frail patients and managing their care.

Environmental pollution and diabetes mellitus

Diabetes mellitus (DM) is a chromic metabolic disease that affects a large segment of the population worldwide. Physical inactivity, poor nutrition, and genetic predisposition are main risk factors for disease development. In the last decade, it was clear to the scientific community that DM development is linked to a novel disease inducer that was later defined as diabetogenic factors of pollution and endocrine disrupting agents. Environmental pollution is exponentially increasing in uncontrolled manner in several countries. Environmental pollutants are of diverse nature and toxicities, including polyaromatic hydrocarbons (PAHs), pesticides, and heavy metals. In the current review, we shed light on the impact of each class of these pollutants and the underlined molecular mechanism of diabetes induction and biological toxicities. Finally, a brief overview about the connection between coronavirus disease 2019 and diabetes pandemics is presented.

What is the purpose of launching World Journal of Meta-Analysis?

The exponential growth of scientific evidence (i.e., primary research) and the ongoing development of methods to summarize such evidence, such as meta-analyses and mixed treatment comparisons (i.e., secondary research), make the worldwide dissemination of high-quality meta-analyses and pertinent articles a key scientific priority. The World Journal of Meta-Analysis will apply an electronic open access publishing approach combined with a timely and thorough peer-review of submitted manuscripts, weighing more on quality than priority, in order to improve the dissemination of systematic reviews and meta-analyses, as well as novelties and advancements in methods related to them, focusing on clinical medicine, but spanning all biomedical, epidemiological, and psychological research fields.

Meta-analyses in the wonderland of neurology

Meta-analyses are often misused and underused in neurology. This editorial provides some comments on the role of meta-analyses in neurological research. Recently, a huge increase in the number of meta-analyses and systematic reviews has been observed in neurological journals. The major strengths of meta-analyses are the increase of statistical power. However, as for any other investigative tool, meta-analytic research is a research method itself which can produce severe shortcomings. Specifically, the issues of search terms, time periods of published studies, databases used for searching, the definitions of inclusion and exclusion criteria for papers (which greatly affect clinical heterogeneity), publication bias; and the statistical methods used, dramatically influence the results of meta-analyses. The main problem of meta-analyses is that they cannot be expected to overcome the limitations of the studies they include (the so-called “garbage in, garbage out” phenomenon). Furthermore, most systematic reviews in the neurological literature lead to the unsatisfying and clinically frustrating statement “further studies are needed”. However it is much more frustrating to see how the gaps in scientific knowledge identified by meta-analyses have not been translated into serious efforts to fill them. Besides their role in evaluating efficacy and tolerability of drugs, meta-analyses may be used to assess diagnostic values of debatable clinical findings, as they represent powerful tools to try to answer questions not posed by individual studies and to settle controversies arising from conflicting claims.

Responses to disrupted operative care during the coronavirus pandemic at a Caribbean hospital

The coronavirus pandemic was thrust upon all nations in the year 2020 and required swift public health responses. Resource-poor health care facilities, such as those in the Caribbean, were poorly prepared but had to respond to the threat. In this experience report we examined the response by the surgical specialty to evaluate the lessons learned and to identify positive changes that may continue post-pandemic.

Outcomes of microwave versus radiofrequency ablation for hepatocellular carcinoma: A systematic review and meta-analysis

BACKGROUND

Studies to date comparing outcomes of microwave ablation (MWA) with radiofrequency ablation (RFA) on patients with hepatocellular carcinoma have yielded conflicting results, with no clear superiority of one technique over the other. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of MWA with RFA.

AIM

To perform a systematic review and meta-analysis comparing the efficacy and safety of MWA with RFA.

METHODS

A systematic literature search was performed using Ovid Medline, Embase, PubMed, Reference Citation Analysis, Cochrane Central and Cochrane Systematic Review databases, and Web of Science. Abstracts and full manuscripts were screened for inclusion utilising predefined inclusion and exclusion criteria comparing outcomes of MWA and RFA. A random-effects model was used for each outcome. Meta-regression analysis was performed to adjust for the difference in follow-up period between the studies. Primary outcome measures included complete ablation (CA) rate, local recurrence rate (LRR), survival [local recurrence-free survival (LRFS), overall survival (OS)] and adverse events.

RESULTS

A total of 42 published studies [34 cohort and 8 randomised controlled trials (RCT)] with 6719 patients fulfilled the selection criteria. There was no significant difference in tumour size between the treatment groups. CA rates between MWA and RFA groups were similar in prospective cohort studies [odds ratio (OR) 0.95, 95% confidence interval (CI) 0.28–3.23] and RCTs (OR 1.18, 95%CI 0.64–2.18). However, retrospective studies reported higher rates with MWA (OR 1.29, 95%CI 1.06–1.57). Retrospective cohort studies reported higher OS (OR 1.54, 95%CI 1.15–2.05 and lower LRR (OR 0.67, 95%CI 0.51–0.87). No difference in terms of LRFS or 30-d mortality was observed between both arms. MWA had an increased rate of adverse respiratory events when compared to RFA (OR 1.99, 95%CI 1.07–3.71, P = 0.03).

CONCLUSION

MWA achieves similar CA rates and as good or better longer-term outcomes in relation to LRR and OS compared to RFA. Apart from an increased rate of respiratory events post procedure, MWA is as safe as RFA.

Cancer risk stratification system and classification of gastritis: Perspectives

Kyoto global consensus reports that the current ICD-10 classification for gastritis is obsolete. The Kyoto classification of gastritis states that severe mucosal atrophy has a high risk of gastric cancer, while mild to moderate atrophy has a low risk. The updated Kimura-Takemoto classification of atrophic gastritis considers five histological types of multifocal corpus atrophic gastritis according to stages C2 to O3. This method of morphological diagnosis of atrophic gastritis increases sensitivity by 2.4 times for severe atrophy compared to the updated Sydney system. This advantage should be considered when stratifying the high risk of gastric cancer. The updated Kimura-Takemoto classification of atrophic gastritis should be used as a reference standard (gold standard) in studies of morpho-functional relationships to identify serological markers of atrophic gastritis with evidence-based effectiveness. The use of artificial intelligence in the serological screening of atrophic gastritis makes it possible to screen a large number of the population. During serological screening of atrophic gastritis and risk stratification of gastric cancer, it is advisable to use the Kyoto classification of gastritis with updated Kimura-Takemoto classification of atrophic gastritis.

Comparison of functional outcomes after retropubic, laparoscopic and robot-assisted radical prostatectomy: A meta-analysis

AIM: To assess the 6-mo and 12-mo functional outcomes after retropubic, laparoscopic and robot-assisted laparoscopic radical prostatectomy retropubic radical prostatectomy (RRP) laparoscopic radical prostatectomy (LRP); robot-assisted laparoscopic prostatectomy (RARP).

METHODS: A literature search was conducted using the PubMed, EMBASE, The Cochrane Library and the Web of Knowledge databases updated to March, 2014 for relevant published studies. After data extraction and quality assessment via the Newcastle-Ottawa Scale or the Cochrane collaboration’s tool for assessing risk of bias, meta-analysis was performed using RevMan 5.1. Either a random-effects model or a fixed-effects model was used. Potential publication bias was assessed using visual inspection of the funnel plots, and verified by the Egger linear regression test.

RESULTS: Thirty-seven studies were identified in total: 14 articles comparing LRP with RRP, 12 articles comparing RARP with RRP, and 11 articles comparing RARP with LRP. For urinary continence, a statistically significant advantage was observed in RARP compared with LRP or RRP both at 6 mo [odds ratio (OR) = 1.93; P < 0.01, OR = 2.23; P < 0.05, respectively] and 12 mo (OR = 1.47; P < 0.01, OR = 2.93; P < 0.01, respectively) postoperatively. The continence recovery rates after LRP and RRP, with obvious heterogeneity (6-mo: I² = 74%; 12-mo: I² = 75%), were equivalent (6-mo: P = 0.52; 12-mo: P = 0.75). In terms of potency recovery, for the first time, we ranked the three surgical approaches into a superiority level: RARP > LRP > RRP, with a statistically significant difference at 12 mo [RARP vs LRP (OR = 1.99; P < 0.01); RARP vs RRP (OR = 2.66; P < 0.01); LRP vs RRP (OR = 1.34; P < 0.05)], respectively. Meta-regression and subgroup analyses according to adjustment of the age, body mass index, prostate volume, Gleason score or prostate-specific antigen did not vary significantly.

CONCLUSION: Current evidence suggests that minimally invasive approaches (RARP or LRP) are effective procedures for functional recovery. However, more high-quality randomized control trials investigating the long-term functional outcomes are needed.

Relationship between perioperative anaemia and outcomes in older people with hip fractures: A systematic review and meta-analysis protocol

BACKGROUND

Hip fractures are common with increasing age and is associated with decline in mobility. Both the fracture and the surgery can lead to blood loss, resulting in anaemia. However, it is uncertain at which time point haemoglobin is most strongly associated with different clinical outcomes after hip fracture. Our hypothesis is perioperative anaemia (admission, postoperative and discharge) during hip fracture surgery is associated with poor clinical outcomes.

AIM

To determine the effects of perioperative anaemia during hip fracture surgery on mortality, functional status and other clinical outcomes.

METHODS

Electronic databases will be searched to identify studies evaluating perioperative anaemia and outcomes of hip fracture surgery. Reference lists of included studies will also be searched to identify additional published studies. Eligibility criteria are as follows: Population: People who underwent hip fracture surgery; Exposure: Perioperative anaemia; Comparison: No anaemia before or after hip fracture surgery; Outcome: Mortality, hospital length of stay, postoperative complications, hospital readmission, change of discharge destination, quality of life and functional status. Risk of bias assessment will be assessed using the Cochrane Collaboration’s tool for randomized controlled trials and the modified version of the Epidemiological Appraisal Instrument for observational studies. Data will be pooled for meta-analysis if deemed appropriate.

CONCLUSION

This review seeks to clarify outcomes associated with perioperative anaemia at various time-points around hip fracture surgery. These findings will potentially inform evidence-based clinical practice on interventions in those with anaemia.

Effect of resistance exercise on insulin sensitivity of skeletal muscle

Insulin resistance (IR) is the common pathophysiological basis of many metabolic diseases. IR is characterized by decreased glucose uptake in skeletal muscle and adipose tissue, especially in skeletal muscle. Skeletal muscle is the main target tissue of glucose uptake under insulin stimulation. Glucose uptake by skeletal muscle is complex, and it is controlled by many pathways. The PI3K/AKt/GSK-1 signaling pathway is not only the main pathway for insulin signal transduction but also an important mechanism for regulating blood glucose. From the binding of insulin to its receptors on the surface of target cells to the transportation of glucose from extracellular fluid to skeletal muscle, a series of signal transduction processes is completed, any of which potentially affects the physiological effects of insulin and leads to IR. Resistance exercise (RT) can reduce skeletal muscle IR and effectively improve blood glucose control and glycosylated hemoglobin level in patients with type 2 diabetes mellitus (T2DM). However, the exact mechanism by which RT improves skeletal muscle IR remains unclear. Therefore, this paper discusses the above problems by tracking the progress of the literature to deepen the correlation between RT and skeletal muscle insulin sensitivity and provide further evidence for the application of exercise therapy in IR. In conclusion, RT mainly improves insulin sensitivity of skeletal muscle by increasing muscle mass, microvascular blood flow, and glucose transporter-4 expression in skeletal muscle, as well as by reducing lipid accumulation and inflammation in skeletal muscle. Thus, it is potentially useful in the prevention and treatment of T2DM.

COVID-19 and psychiatry training: A cross-national trainee perspective

The coronavirus disease 2019 pandemic has significantly altered many aspects of our professional lives, including how psychiatry as a medical discipline is taught and learnt. Training in psychiatry relies on developing competencies through observing and interacting with patients, developing empathic consultation skills and seeking feedback from colleagues derived from cognitive and constructivist theories of learning, in a time-bound manner. The pandemic has drawn attention to the dual role of psychiatry residents as both trainees and physicians, with a pressing identity crisis at an inopportune time. This paper aims to illustrate some of the emerging themes in psychiatry training during the pandemic and some solutions for the same.

Risk factors associated with the development of chronic pouchitis following ileal-pouch anal anastomosis surgery for ulcerative colitis

BACKGROUND

Chronic pouchitis remains a significant and prevalent complication following ileal pouch-anal anastomosis in patients with ulcerative colitis.

AIM

To identify potential risk factors for the development of chronic pouchitis.

METHODS

Predictors of chronic pouchitis were investigated through a systematic review and meta-analysis. A comprehensive search of the Medline, EMBASE, and PubMed databases was undertaken to identify relevant studies published up to October 2023. Meta-analytic procedures employed random-effects models for the combination of estimates, with the I² statistic used to assess between-study heterogeneity.

RESULTS

Eleven studies with a total of 3722 patients, comprising 513 with chronic pouchitis and 3209 patients without, were included in the final analysis. Extraintestinal manifestation [odds ratio (OR) = 2.11, 95% confidence intervals (CI): 1.53-2.91, P < 0.001, I² = 0%], specifically primary sclerosing cholangitis (PSC) (OR = 3.69, 95%CI: 1.40-9.21, P = 0.01, I² = 48%), and extensive colitis (OR = 1.96, 95%CI: 1.23-3.11, P = 0.00, I² = 31%) were associated with an increased risk of chronic pouchitis. Other factors, including gender, smoking status, family history of inflammatory bowel disease and ileal pouch anal anastomosis surgical indication were not significantly associated with chronic pouchitis.

CONCLUSION

Extraintestinal manifestations, PSC and extensive colitis are associated with the development of chronic pouchitis. These findings underscore the importance of comprehensive pre-operative assessment and tailored post operative management strategies.

Observed communication between oncologists and patients: A causal model of communication competence

AIM: To investigate and test a causal model derived from previous meta-analytic data of health provider behaviors and patient satisfaction.

METHODS: A literature search was conducted for relevant manuscripts that met the following criteria: Reported an analysis of provider-patient interaction in the context of an oncology interview; the study had to measure at least two of the variables of interest to the model (provider activity, provider patient-centered communication, provider facilitative communication, patient activity, patient involvement, and patient satisfaction or reduced anxiety); and the information had to be reported in a manner that permitted the calculation of a zero-order correlation between at least two of the variables under consideration. Data were transformed into correlation coefficients and compiled to produce the correlation matrix used for data analysis. The test of the causal model is a comparison of the expected correlation matrix generated using an Ordinary Least Squares method of estimation. The expected matrix is compared to the actual matrix of zero order correlation coefficients. A model is considered a possible fit if the level of deviation is less than expected due to random sampling error as measured by a chi-square statistic. The significance of the path coefficients was tested using a z test. Lastly, the Sobel test provides a test of the level of mediation provided by a variable and provides an estimate of the level of mediation for each connection. Such a test is warranted in models with multiple paths.

RESULTS: A test of the original model indicated a lack of fit with the summary data. The largest discrepancy in the model was between the patient satisfaction and the provider patient-centered utterances. The observed correlation was far larger than expected given a mediated relationship. The test of a modified model was undertaken to determine possible fit. The corrected model provides a fit to within tolerance as evaluated by the test statistic, χ² (8, average n = 342) = 10.22. Each of the path coefficients for the model reveals that each one can be considered significant, P < 0.05. The Sobel test examining the impact of the mediating variables demonstrated that patient involvement is a significant mediator in the model, Sobel statistic = 3.56, P < 0.05. Patient active was also demonstrated to be a significant mediator in the model, Sobel statistic = 4.21, P < 0.05. The statistics indicate that patient behavior mediates the relationship between provider behavior and patient satisfaction with the interaction.

CONCLUSION: The results demonstrate empirical support for the importance of patient-centered care and satisfy the need for empirical casual support of provider-patient behaviors on health outcomes.

Is dose modification or discontinuation of nilotinib necessary in nilotinib-induced hyperbilirubinemia?

Nilotinib is a specific breakpoint cluster region-Abelson leukemia virus-tyrosine kinase inhibitor that is used as an effective first- or second-line treatment in imatinib-resistant chronic myelogenous leukemia (CML) patients. Hepatotoxicity due to nilotinib is a commonly reported side effect; however, abnormal liver function test (LFT) results have been reported in asymptomatic cases. When alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels are more than five-fold the upper limit of the normal (ULN) or when the serum total bilirubin level is more than three-fold the ULN, dose modification or discontinuation of nilotinib is recommended, resulting in decreased levels of hematological indicators in certain patients with CML. Nilotinib-induced hyperbilirubinemia typically manifests as indirect bilirubinemia without elevated ALT or AST levels. Such abnormal liver functioning is thus not attributed to the presence of a true histologic lesion of the liver. The underlying mechanism may be related to the inhibition of uridine diphosphate glucuronosyltransferase activity. Therefore, nilotinib dose adjustment is not recommended for this type of hyperbilirubinemia, and in the absence of elevated liver enzyme levels or presence of abnormal LFT findings, physicians should consider maintaining nilotinib dose intensity without modifications.

Hydroxychloroquine alone or in combination with azithromycin and corrected QT prolongation in COVID-19 patients: A systematic review

BACKGROUND

Despite the controversies about the effectiveness of the current drug regimens for coronavirus disease 2019 (COVID-19), these drugs are still the only options available. Moreover, the safety of these drugs is yet to be confirmed. A serious concern is the occurrence of various cardiac arrhythmias, particularly QT prolongation.

AIM

To summarize the incidence and estimate the risk of QT interval prolongation in patients scheduling for conventional treatment (hydroxychloroquine alone or in combination with azithromycin) for COVID-19.

METHODS

We comprehensively searched Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane Central Register of Controlled Trials databases until October 31, 2020 for all eligible studies under the considered keywords COVID-19, arrhythmia, QT interval, therapy, azithromycin, and hydroxychloroquine until. The study protocols were established in compliance with PRISMA-P guidelines (Preferred Reporting Items for Systematic Review and Meta-Analysis – Protocols), and a nine-star Newcastle-Ottawa Scale scoring system was used to assess the methodological quality of all eligible studies. Outcome measures were corrected QT (QTc) prolongation, cardiac arrhythmias, or sudden cardiac death.

RESULTS

Fifteen studies enrolling 8298 patients with targeted COVID-19 therapeutic regimes were included. The eligible studies found a significant increase in the mean QTc interval following treatment with the described medications compared to baseline QTc with weighted standard differences in means of 0.766. The pooled prevalence rate of QTc prolongation was estimated to be 9.2% (95% confidence interval: 4.5% to 18.1%).

CONCLUSION

Hydroxychloroquine ± azithromycin regimen can significantly increase the risk of developing QTc prolongation.

Impact of socioeconomic factors on pediatric atopic dermatitis population

BACKGROUND

Atopic dermatitis (AD), or eczema, is a chronic, pruritic inflammatory skin disease affecting children and adults. Socioeconomic status (SES) plays a significant role in developing AD. However, mixed evidence from a previous study by Bajwa et al makes it difficult to determine the directionality of the association. There is a literature gap in understanding the causal association between AD and socioeconomic factors.

AIM

To evaluate the impact of disparities in SES on pediatric AD populations.

METHODS

Based on the eligibility criteria, the literature review identified eight articles since July 2021, and a descriptive analysis was conducted using an Excel spreadsheet on key components collected from the identified studies.

RESULTS

Eight observational studies assessed SES in pediatric AD. Five observational studies showed mixed associations between AD and SES. Sub-analysis revealed that urban areas had a higher prevalence of AD, and four studies identified a positive association between parental education and AD in the pediatric population. Socioeconomic variables, such as residential areas and household income, significantly influence disease outcomes.

CONCLUSION

There is mixed association between pediatric AD and SES, with AD positively associated with parental education. There is critical need to evaluate global impact of SES variables on pediatric AD.

Opinion on double strategy to fight against COVID-19: Vaccination and home treatment with non-steroidal anti-inflammatory drugs

The goals of global vaccination are to control, eliminate, or eradicate infectious diseases in a sustainable way that strengthens public health systems. Although the use of vaccines is essential for the control of epidemics, the vaccines against coronavirus disease 2019 (COVID-19) proved to be inadequate to end the pandemic and thus are considered incomplete. These vaccines failed to prevent infection, so their primary purpose has been shifted to prevent severe disease and reduce hospitalizations and deaths. Therefore, we believe that all the strategies available to reduce transmission, hospitalizations and deaths due to COVID-19 will be put in place. It is reported that uncontrolled inflammation and thrombosis are the principal mechanisms for aggravation and death in patients with COVID-19. Unlike corticosteroids that should not be administered at the beginning of the symptoms for their immunosuppressive action, which could worsen the evolution of the disease, the usefulness of non-steroidal anti-inflammatory drugs in the early at-home treatment of the disease is becoming evident.

Expression of epithelial cellular adhesion molecule in gastric cancer: A meta-analysis

AIM: To obtain an accurate evaluation of the association between high expression of epithelial cellular adhesion molecule (EpCAM) and gastric cancer (GC) risk.

METHODS: Studies that had examined the association between high expression of EpCAM and GC risk were identified by searching electronic databases PubMed, EMBASE, Cochrane library and Chinese Biomedical Literature database. Risk ratios (RRs) together with their 95%CIs were used to assess the association between high expression of EpCAM and GC risk. We selected eligible studies based on inclusion criteria. RevMan 5.3 software was used to calculate the pooled values.

RESULTS: A total of 14 studies were included in this meta-analysis. EpCAM-positive cases were significantly associated with tumor size (RR: 1.68, 95%CI: 1.47-1.91, P < 0.00001 fixed-effect), depth of invasion (RR: 1.37, 95%CI: 1.11-1.68, P = 0.003 random-effect), TNM stage (RR: 2.02, 95%CI: 1.35-3.02, P = 0.0007 random-effect), tumor location (RR: 0.80, 95%CI: 0.71-0.91, P = 0.0007 fixed-effect), histologic differentiation (RR: 1.23, 95%CI: 1.13-1.33, P < 0.00001 fixed-effect) and lymph node metastasis (RR: 1.89, 95%CI: 1.28-2.80, P = 0.001 random-effect). However, we did not observe any significant association between the presence of EpCAM with age, gender, distant metastasis, Borrmann type or Lauren classification. Additionally, EpCAM expression was not associated with the overall survival rate. The pooled HR of the overall effect was 1.39 (95%CI: 0.30-6.48, P = 0.67 random-effect).

CONCLUSION: Our meta-analysis indicates that EpCAM contributes to GC risk, which acts as a prognostic factor and a marker of poor outcome.

Using fluorodeoxy-D-glucose-positron emission tomography to monitor neoadjuvant chemotherapy response in sarcoma: A meta-analysis

AIM: To systematically evaluate the accuracy of 18-fluorodeoxy-D-glucose-positron emission tomography (18-FDG PET) to assess response to neoadjuvant chemotherapy in bone and soft tissue sarcomas.

METHODS: Studies published in English language regarding the accuracy of F-18 FDG PET for the indication were retrieved from MEDLINE. The QUADAS tool was utilized for methodological quality appraisal. Relevant data were extracted, and quantitative data synthesis included pooled estimation and subgroup analysis.

RESULTS: A total of fifteen studies involving 420 patients with pathologically confirmed sarcoma were collected. Methodological quality was relatively high. The pooled sensitivity and specificity of PET to predict histopathological response were 87% (95%CI: 81%-91%) and 83% (95%CI: 77%-87%), respectively. Ten studies employed a lower standardized uptake value (SUV) after chemotherapies (mostly 2.5) and/or a higher SUV reduction rate (mostly around 50%) as PET criteria of good response. Subgroup analysis showed that PET exhibited a significantly better specificity in osteosarcoma (OS) and Ewing sarcoma (ES) than in soft-tissue sarcoma (STS) (91% vs 75%, P < 0.05), and a higher specificity in pediatric patients than in adults (90% vs 74%, P < 0.01). PET yielded a lower specificity in ifosfamide-contained chemotherapies than in the alternative regimen (70% vs 97%, P < 0.01).

CONCLUSION: F-18 FDG PET is promising to predict neoadjuvant therapy response in sarcoma, especially in pediatric patients with OS or ES. Certain chemotherapeutic agents could potentially cause false positives of PET.

Meta-analysis of anti-ribosomal P antibodies in lupus psychosis

AIM: To perform a meta-analysis of the prevalence of anti-ribosomal P (aRP) antibodies in lupus psychosis, and the odds of psychosis in aRP-positive subjects.

METHODS: We identified articles by searching PubMed, PsychInfo, and ISI, and the reference lists of identified studies.

RESULTS: Twenty-four studies met the inclusion criteria. Positive aRP antibodies were found in 51% (91 of 179 total cases) of cases of lupus psychosis. There was an almost 3.5-fold increased odds of psychosis in aRP-positive patients (OR = 3.46, 95%CI: 1.97-6.09, P < 0.001). The population attributable risk percentage was 36% for aRP antibodies.

CONCLUSION: aRP antibodies are common in lupus psychosis, although the potential mechanism(s) underlying this association remain unclear. Given the overlap between the clinical presentation and risk factors for lupus psychosis and schizophrenia, further investigation of aRP antibodies in schizophrenia is warranted.