Prognostic Value of Serum Neutrophil Gelatinase-Associated Lipocalin in Acute Heart Failure: A Meta-Analysis

Background: Neutrophil gelatinase-associated lipocalin (NGAL) is not only a sensitive marker of acute kidney injury but may also be a prognostic marker of acute heart failure (AHF). This study aimed to investigate the relationship between serum NGAL and all-cause death (ACD) and the composite outcome of ACD or AHF readmissions in patients with AHF. Methods: The Embase, Cochrane Library, and PubMed databases were searched for articles focusing on serum NGAL and ACD and the composite outcome of ACD or AHF readmissions in patients with AHF. The hazard ratios (HRs) were pooled with random-effects models. Results: The results from 2428 patients from seven studies were pooled in this article. Higher NGAL was relevant to an increased risk of ACD (HR, 1.89; 95% CI, 1.38 to 2.61) and the composite outcome of ACD or AHF readmissions (HR, 2.92; 95% CI, 1.62 to 5.27) in patients with AHF. Conclusions: Serum NGAL has prognostic value for ACD and the composite outcome of ACD or AHF readmissions in AHF. The PROSPERO registration: CRD42022322057, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022322057

Low serum creatine kinase levels in breast cancer patients: a case-control study.

BACKGROUND: Previous studies provide an ambiguous picture of creatine kinase (CK) expression and activities in malignancy. The aim of this study was to investigate the role of serum CK level in breast cancer patients. PATIENTS AND METHODS: 823 female patients diagnosed with breast cancer were consecutively recruited as cases, and 823 age-match patients with benign breast disease were selected as controls. Serum CK was analyzed by commercially available standardized methods. RESULTS: Serum CK level was significantly associated with breast cancer (P = 0.005) and subtypes of breast cancer, including breast cancer with diameter>2 cm (P = 0.031) and stage IIIbreast cancer (P = 0.025). The mean serum CK level in patients with>2 cm tumor was significantly lower than that in≤2 cm (P = 0.0475), and the mean serum CK level of stage III breast cancer patients was significantly lower than that of stage I and II breast cancer patients (P = 0.0246). Furthermore, a significant difference (P = 0.004) was observed between serum CK level and ERBB2+breast cancer not other molecular subtypes. CONCLUSIONS: Serum CK levels in cases was significantly lower compared with controls. Notably, our results indicated for the first time that there was a negative correlation between serum CK levels and breast cancer stage. Serum CK level, which may reflect the status of host immunity, may be an important factor in determining breast cancer development and progression

Intraoperative Ultrasound Guidance Is Associated with Clear Lumpectomy Margins for Breast Cancer: A Systematic Review and Meta-Analysis

<div><p>Purpose</p><p>Margin status is one of the most important predictors of local recurrence after breast conserving surgery (BCS). Intraoperative ultrasound guidance (IOUS) has the potential to improve surgical accuracy for breast cancer. The purpose of the present meta-analysis was to determine the efficacy of IOUS in breast cancer surgery and to compare the margin status to that of the more traditional Guide wire localization (GWL) or palpation-guidance.</p><p>Methods</p><p>We searched the database of PubMed for prospective and retrospective studies about the impact of IOUS on margin status of breast cancer, and a meta-analysis was conducted.</p><p>Results</p><p>Of the 13 studies included, 8 were eligible for the impact of IOUS on margin status of non-palpable breast cancers, 4 were eligible for palpable breast cancers, and 1 was for both non-palpable and palpable breast cancers. The rate of negative margins of breast cancers in IOUS group was significantly higher than that in control group without IOUS (risk ratio (RR)  = 1.37, 95% confidence interval (CI)  = 1.18–1.59 from 7 prospective studies, odds ratio (OR)  = 2.75, 95% CI  = 1.66–4.55 from 4 retrospective studies). For non-palpable breast cancers, IOUS-guidance enabled a significantly higher rate of negative margins than that of GWL-guidance (RR  = 1.26, 95% CI  = 1.09–1.46 from 6 prospective studies; OR  = 1.45, 95% CI  = 0.86–2.43 from 2 retrospective studies). For palpable breast cancers, relative to control group without IOUS, the RR for IOUS associated negative margins was 2.36 (95% CI  = 1.26–4.43) from 2 prospective studies, the OR was 2.71 (95% CI  = 1.25–5.87) from 2 retrospective studies.</p><p>Conclusion</p><p>This study strongly suggests that IOUS is an accurate method for localization of non-palpable and palpable breast cancers. It is an efficient method of obtaining high proportion of negative margins and optimum resection volumes in patients undergoing BCS.</p></div

Selection of studies for the meta-analysis of IOUS associated negative margins of breast cancer.

<p>Selection of studies for the meta-analysis of IOUS associated negative margins of breast cancer.</p

Characteristics of eligible studies about the efficacy of IOUS on margin status included in the study.

<p>BC, breast cancer; IBC, invasive breast cancer; IDBC, invasive ductal breast cancer; DCIS, ductal carcinoma in situ; IOUS, intraoperative ultrasound guidance; GWL, guide wire localization.</p

Impact of IOUS on rates of negative margins of palpable breast cancers.

<p>Forest plot for meta-analysis: rate of negative margins of palpable breast cancers in IOUS group compared with that in control group without IOUS. The width of the horizontal line represents the 95% CI of the individual study, and the square proportional represents the weight of each study. The diamond represents the pooled RR or OR and 95% CI.</p

Summary ORs or RRs and 95% CI of IOUS associated negative margins.

*<p>ORs or RRs was meta-analyzed with publication bias.</p

Impact of IOUS on rates of negative margins of non-palpable breast cancers (retrospective studies).

<p>Forest plot for meta-analysis of retrospective studies: rate of negative margins of non-palpable breast cancers in IOUS group compared with that in GWL group. The width of the horizontal line represents the 95% CI of the individual study, and the square proportional represents the weight of each study. The diamond represents the pooled OR and 95% CI.</p