Incidence of tuberculous meningitis in France, 2000: a capture-recapture analysis.

OBJECTIVE: To estimate the incidence of culture-positive and culture-negative tuberculous meningitis (TBM) in France in 2000. METHODS: Capture-recapture method using two unrelated sources of data: the tuberculosis (TB) mandatory notification system (MNTB), recording patients treated by anti-tuberculosis drugs, and a survey by the National Reference Centre (NRC) for mycobacterial drug resistance, recording culture-positive TBM. RESULTS: Of 112 cases of TBM reported to the MNTB, 28 culture-positive and 34 culture-negative meningitis cases were validated (17 duplicates, 3 cases from outside France, 21 false notifications, and 9 lost records were excluded). The NRC recorded 31 culture-positive cases, including 21 known by the MNTB. When the capture-recapture method was applied to the reported culture-positive meningitis cases, the estimated number of meningitis cases was 41 and the incidence was 0.7 cases per million. Sensitivity was 75.6% for the NRC, 68.3% for the MNTB, and 92.7% for both systems together. When sensitivity of the MNTB for culture-positive cases was applied to culture-negative meningitis, the total estimated number of culture-negative meningitis cases was 50 and the incidence was 0.85 cases per million. CONCLUSION: TBM is underestimated in France. Capture-recapture analysis using different sources to better estimate its incidence is of great interest.     

Clinicopathological and prognostic significance of Nestin expression in patients with non-small cell lung cancer: a systematic review and meta-analysis

Latest evidence indicates that Nestin expression may be associated with the high malignancy and poor prognosis of non-small cell lung cancer (NSCLC), but a relevant consensus has not been reached until now. Therefore, we conducted this meta-analysis to evaluate the clinicopathological and prognostic significance of Nestin expression in patients with NSCLC. We searched PubMed, EMBASE and the Web of Science for eligible full-text articles. Odds ratio (OR) and hazard ratio (HR) with 95 % confidence interval (95 % CI) severed as the summarized statistics. Q-test and I ²-statistic were applied to evaluate the heterogeneity, and sensitivity analysis was conducted for adjustments. Publication bias was detected by Begg’s test and Egger’s test. Finally, eight eligible articles with 834 NSCLC cases were included. Nestin expression was found to be significantly associated with the unfavorable outcomes of differentiation degree (OR: 2.47; 95 % CI 1.61–3.79; P < 0.001), lymphatic metastasis (OR: 2.45; 95 % CI 1.41–4.25; P = 0.001), TNM stage (OR: 1.73; 95 % CI 1.07–2.79; P = 0.025) and tumor size (OR: 2.68; 95 % CI 1.20–5.98; P = 0.016), but not associated with gender, age, smoking status and NSCLC subtypes. Nestin expression could significantly predict the lower overall survival of NSCLC (HR: 2.41; 95 % CI 1.72–3.38; P < 0.001). The prognostic value of Nestin remained statistically reliable in the subgroups stratified by statistical analysis, patients’ origins and follow-up periods, but not significant in patients with squamous cell carcinoma. In conclusion, Nestin expression may be an independent predictor for the poor prognosis and clinicopathological characteristics of NSCLC. Further studies are necessary to validate our discoveries.     

经皮微创与开放手术治疗胸腰椎骨折的疗效对比观察

目的:对比研究经皮微创手术和传统开放手术治疗胸腰椎骨折的临床疗效。方法:自2011年9月~2013年9月治疗38例新鲜胸腰椎骨折患者,其中18例行经皮微创手术,20例行传统开放手术,比较围手术期参数、影像学指标、术后半年腰背部疼痛评分(VAS评分)及腰背残障功能指数(ODI)。结果:两组比较围手术期参数、VAS评分及ODI均有统计学意义(P<0.05),经皮微创组明显低于开放手术组;两组分别比较术前、术后影像学指标如椎体前缘高度、后凸Cobb’s角、椎间隙高度及椎管堵塞指数,差异有统计学意义(P<0.05);但两组之间术后影像学指标及骨折愈合时间对比,差异无统计学意义(P>0.05)。结论:经皮椎弓根微创手术治疗胸腰椎骨折具有手术时间短、创伤小,对椎旁肌损伤小,恢复快,术后疼痛轻等优点,同时达到了传统开放手术的效果,值得临床推广应用。     

Predictors of Underestimation of Malignancy after Image‐Guided Core Needle Biopsy Diagnosis of Flat Epithelial Atypia or Atypical Ductal Hyperplasia

Flat epithelial atypia (FEA) and atypical ductal hyperplasia (ADH) are precursors of breast malignancy. Management of FEA or ADH after image‐guided core needle biopsy (CNB) remains controversial. The aim of this study was to evaluate malignancy underestimation rates after FEA or ADH diagnosis using image‐guided CNB and to identify clinical characteristics and imaging features associated with malignancy as well as identify cases with low underestimation rates that may be treatable by observation only. We retrospectively reviewed 2,875 consecutive image‐guided CNBs recorded in an electronic data base from January 2010 to December 2011 and identified 128 (4.5%) FEA and 83 (2.9%) ADH diagnoses (211 total cases). Of these, 64 (30.3%) were echo‐guided CNB procedures and 147 (69.7%) mammography‐guided CNBs. Twenty patients (9.5%) were upgraded to malignancy. Multivariate analysis indicated that age (OR = 1.123, p = 0.002, increase of 1 year), mass‐type lesion with calcifications (OR = 8.213, p = 0.006), and ADH in CNB specimens (OR = 8.071, p = 0.003) were independent predictors of underestimation. In univariate analysis of echo‐guided CNB (n = 64), mass with calcifications had the highest underestimation rate (p < 0.001). Multivariate analysis of 147 mammography‐guided CNBs revealed that age (OR = 1.122, p = 0.040, increase of 1 year) and calcification distribution were significant independent predictors of underestimation. No FEA case in which, complete calcification retrieval was recorded after CNB was upgraded to malignancy. Older age at diagnosis on image‐guided CNB was a predictor of malignancy underestimation. Mass with calcifications was more likely to be associated with malignancy, and in cases presenting as calcifications only, segmental distribution or linear shapes were significantly associated with upgrading. Excision after FEA or ADH diagnosis by image‐guided CNB is warranted except for FEA diagnosed using mammography‐guided CNB with complete calcification retrieval.