AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer. METHODS: Only EUS studies confirmed by surgery were selected. Articles were searched in Medline and Pubmed. Two reviewe...AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer. METHODS: Only EUS studies confirmed by surgery were selected. Articles were searched in Medline and Pubmed. Two reviewers independently searched and extracted data. Meta-analysis of the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights. RESULTS: Forty-nine studies (n = 2558) which met the inclusion criteria were included in this analysis. Pooled sensitivity and specificity of EUS to diagnose T1 was 81.6% (95% CI: 77.8-84.9) and 99.4% (95% CI: 99.0-99.7), respectively. To diagnose T4, EUS had a pooled sensitivity of 92.4% (95% CI: 89.2-95.0) and specificity of 97.4% (95% CI: 96.6-98.0). With Fine Needle Aspiration (FNA), sensitivity of EUS to diagnose N stage improved from 84.7% (95% CI: 82.9-86.4) to 96.7% (95% CI: 92.4-98.9). The P value for the χ2 test of heterogeneity for all pooled estimates was > 0.10. CONCLUSION: EUS has excellent sensitivity and specificity in accurately diagnosing the TN stage of esophageal cancer. EUS performs better with advanced (T4) than early (T1) disease. FNA substantially improves the sensitivity and specificity of EUS in evaluating N stage disease. EUS should be strongly considered for staging esophageal cancer.展开更多
Based on the long-term clinical practice and scientific researches on the three methods for the stage-treatment of Parkinson＇s disease put forward by the author in the early years, this essay further discusses the di...Based on the long-term clinical practice and scientific researches on the three methods for the stage-treatment of Parkinson＇s disease put forward by the author in the early years, this essay further discusses the division of the three stages of Parkinson＇s disease. Early stage： Appearance of the early symptoms and signs of Parkinson＇s disease, but short in duration and mild in severity, which do not affect the social communications, daily life and work of the patient; and their modified Hoehn ＆ Yahr grading is 1,0-1.5. Mid stage： With the symptoms and signs of Parkinson＇s disease getting worse and affecting the social communications, daily life and work of the patient, those who have their modified Hoehn ＆ Yahr grading 2-3 need medical treatment. Late stage： The patients have severe clinical symptoms of Parkinson＇s disease, and Levodopa preparation is insufficient for them to maintain their daily life; and their modified Hoehn ＆ Yahr grading is 4-5. The three treating methods are： TCM medical treatment adopted at the early stage; the combined treatment of Chinese and western medicine at the mid stage; and comprehensive treatment with multi-theraoies at the late stage.展开更多
文摘AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer. METHODS: Only EUS studies confirmed by surgery were selected. Articles were searched in Medline and Pubmed. Two reviewers independently searched and extracted data. Meta-analysis of the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights. RESULTS: Forty-nine studies (n = 2558) which met the inclusion criteria were included in this analysis. Pooled sensitivity and specificity of EUS to diagnose T1 was 81.6% (95% CI: 77.8-84.9) and 99.4% (95% CI: 99.0-99.7), respectively. To diagnose T4, EUS had a pooled sensitivity of 92.4% (95% CI: 89.2-95.0) and specificity of 97.4% (95% CI: 96.6-98.0). With Fine Needle Aspiration (FNA), sensitivity of EUS to diagnose N stage improved from 84.7% (95% CI: 82.9-86.4) to 96.7% (95% CI: 92.4-98.9). The P value for the χ2 test of heterogeneity for all pooled estimates was > 0.10. CONCLUSION: EUS has excellent sensitivity and specificity in accurately diagnosing the TN stage of esophageal cancer. EUS performs better with advanced (T4) than early (T1) disease. FNA substantially improves the sensitivity and specificity of EUS in evaluating N stage disease. EUS should be strongly considered for staging esophageal cancer.
文摘Based on the long-term clinical practice and scientific researches on the three methods for the stage-treatment of Parkinson＇s disease put forward by the author in the early years, this essay further discusses the division of the three stages of Parkinson＇s disease. Early stage： Appearance of the early symptoms and signs of Parkinson＇s disease, but short in duration and mild in severity, which do not affect the social communications, daily life and work of the patient; and their modified Hoehn ＆ Yahr grading is 1,0-1.5. Mid stage： With the symptoms and signs of Parkinson＇s disease getting worse and affecting the social communications, daily life and work of the patient, those who have their modified Hoehn ＆ Yahr grading 2-3 need medical treatment. Late stage： The patients have severe clinical symptoms of Parkinson＇s disease, and Levodopa preparation is insufficient for them to maintain their daily life; and their modified Hoehn ＆ Yahr grading is 4-5. The three treating methods are： TCM medical treatment adopted at the early stage; the combined treatment of Chinese and western medicine at the mid stage; and comprehensive treatment with multi-theraoies at the late stage.
