Influence of eNOS Gene Polymorphisms on Carotid Atherosclerosis

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Understanding systematic reviews : the meta-analysis graph (also called 'forest plot')

Mammographic screening for breast cancer is controversial, as reflected in greatly varying national policies. The objective was to assess the effect of screening for breast cancer with mammography on mortality and morbidity. MEDLINE (16 May 2000), The Cochrane Breast Cancer Group's trial register (24 Jan 2000) and reference lists. Letters, abstracts and unpublished trials. Authors were contacted. Randomised trials comparing mammographic screening with no mammographic screening. Data were extracted by both authors independently. Seven completed and eligible trials involving half a million women were identified. The two best trials provided medium-quality data and, when combined, yield a relative risk for overall mortality of 1.00 (95% CI 0.96-1.05) after 13 years. However, the trials are underpowered for all-cause mortality, and confidence intervals include a possible worthwhile effect as well as a possible detrimental effect. If data from all eligible trials (excluding flawed studies) are considered then the relative risk for overall mortality after 13 years is 1.01 (95% CI 0.99-1.03). The best trials failed to show a significant reduction in breast cancer mortality with a relative risk of 0.97 (95% CI 0.82-1.14). If data from all eligible trials (excluding flawed studies) are considered then the relative risk for breast cancer mortality after 13 years is 0.80 (95% CI 0.71-0.89). However, breast cancer mortality is considered to be an unreliable outcome and biased in favour of screening. Flaws are due to differential exclusion of women with breast cancer from analysis and differential misclassification of cause of death. The currently available reliable evidence does not show a survival benefit of mass screening for breast cancer (and the evidence is inconclusive for breast cancer mortality). Women, clinicians and policy makers should consider these findings carefully when they decide whether or not to attend or support screening programs

Cost-effectiveness analysis of stand-alone or combined non-invasive imaging tests for the diagnosis of stable coronary artery disease: results from the EVINCI study

Aim: This study aimed at evaluating the cost-effectiveness of different non-invasive imaging-guided strategies for the diagnosis of obstructive coronary artery disease (CAD) in a European population of patients from the Evaluation of Integrated Cardiac Imaging in Ischemic Heart Disease (EVINCI) study.Methods and results: Cost-effectiveness analysis was performed in 350 patients (209 males, mean age 59 ± 9 years) with symptoms of suspected stable CAD undergoing computed tomography coronary angiography (CTCA) and at least one cardiac imaging stress-test prior to invasive coronary angiography (ICA) and in whom imaging exams were analysed at dedicated core laboratories. Stand-alone stress-tests or combined non-invasive strategies, when the first exam was uncertain, were compared. The diagnostic end-point was obstructive CAD defined as > 50% stenosis at quantitative ICA in the left main or at least one major coronary vessel. Effectiveness was defined as the percentage of correct diagnosis (cd) and costs were calculated using country-specific reimbursements. Incremental cost-effectiveness ratios (ICERs) were obtained using per-patient data and considering “no-imaging” as reference. The overall prevalence of obstructive CAD was 28%. Strategies combining CTCA followed by stress ECHO, SPECT, PET, or stress CMR followed by CTCA, were all cost-effective. ICERs values indicated cost saving from − 969€/cd for CMR-CTCA to − 1490€/cd for CTCA-PET, − 3,09 €/cd for CTCA-SPECT and − 3776€/cd for CTCA-ECHO. Similarly when considering early revascularization as effectiveness measure.Conclusion: In patients with suspected stable CAD and low prevalence of disease, combined non-invasive strategies with CTCA and stress-imaging are cost-effective as gatekeepers to ICA and to select candidates for early revascularization.</p

Diagnosing acute stroke with magnetic resonance imaging (MRI) calls for caution: computed tomography (CT) is preferable for standard care.

4noneSquizzato A; Moja L; Ricci S; Gensini GF.Squizzato, Alessandro; Moja, L; Ricci, S; Gensini, G. F