The objective of this study was to assess whether vitamin D (VD) treatment alters the overall all-cause and cardiovascular mortalities in a chronic kidney disease (CKD) population. We systematically searched PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials without language restriction, until the publication date of 22 February 2016. All related literatures that compared VD treatment with non-VD treatment and reported the mortality of patients with CKD (including those undergoing dialysis) were identified. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated by using the random- and fixed-effects models. Randomised controlled trials (RCTs) that used the intention-to-treat principle and observational studies (OSs) were analysed separately. For this study, 38 studies involving 223 429 patients (17 RCTs, n=1819 and 21 OSs, n=221610) were included. In the OSs, VD treatment was significantly associated with reductions in both all-cause and cardiovascular mortalities; however, such significant association was not found in the RCTs. The existing RCTs do not provide sufficient or precise evidence that VD supplementation affects the mortality of patients with CKD, although subsets of patients that could potentially benefit from VD treatment can be identified by using the existing data from the RCTs. Nevertheless, large-size RCTs are needed in the future to assess any potential differences in survival prospectively.
Background: To investigate the repeatability and accuracy of quantitative CT (QCT) measurement of bone mineral density (BMD) by low-mAs using iterative model reconstruction (IMR) technique based on phantom model. Methods:European spine phantom (ESP) was selected and measured on the Philips Brilliance iCT Elite FHD machine for 10 times. Data were transmitted to the QCT PRO workstation to measure BMD (mg/cm 3 ) of the ESP (L1, L2, L3). Scanning method: the voltage of X-ray tube is 120 kV, the electric current of X-ray tube output in five respective groups A-E were: 20, 30, 40, 50 and 60 mAs. Reconstruction: all data were reconstructed using filtered back projection (FBP), IR levels of hybrid iterative reconstruction (iDose 4 , levels 1, 2, 3, 4, 5, 6 were used) and IMR (levels 1, 2, 3 were used). ROIs were placed in the middle of L1, L2 and L3 spine phantom in each group. CT values, noise and contrast-to-noise ratio (CNR) were measured and calculated. One-way analysis of variance (ANOVA) was used to compare BMD values of different mAs and different IMR. Methods Research subjectsThis study measured and analyzed the same ESP (No.145, Germany ORM company). The ESP adopted for QCT examination is a phantom that simulates spine of the human body and was used to standardize and calibrate BMD measuring instruments, applied both for dual X-ray absorptiometry (DXA) and QCT. It could be used for routine quality control (4). ESP is composed of plastic made of epoxy resin plus a variety of other ingredients which is equivalent to water and bone solid material composition, including three trabecular of unequal BMD.The hydroxyapatite density of three trabecular were L1 (50 mg/cm 3 ), L2 (100 mg/cm 3 ) and L3 (200 mg/cm 3 ) (3). BMD of the ESP was measured on a Philips Brilliance iCTElite FHD machine. CT was performed according to the set conventional spine scanning conditions: scanning method:tube voltages were all set as 120 kV and the tube currents were respectively set as A-E (20, 30, 40, 50, 60 mAs).Reconstruction: both filtered back projection (FBP), iDose 4 (levels 1, 2, 3, 4, 5, 6) and iterative model reconstruction (IMR) (levels 1, 2, 3) data reconstruction were conducted. When using traditional filtered-back projection (FBP) Objective assessment of ESP phantom imagesThe following indicators were jointly measured by two radiologists. The middle of L1, L2 and L3 was marked on the coronal images and correlated to the corresponding axial images. The ROIs were set at L1, L2 and L3. The circular area was about 2/3 of the entire lumbar axial image.CT value was recorded as CT1; At the same time, ROI was placed at a position 2/3 from anterior margin of lumbar spine to ventral front of corresponding lumbar vertebra (water as material). CT value was measured and recorded as CT2. The standard deviation (SD) was set as image background noise. Contrast-to-noise ratio (CNR) was
Objectives To develop and test a new multifeature‐based computer‐aided diagnosis (CADx) scheme of lung cancer by fusing quantitative imaging (QI) features and serum biomarkers to improve CADx performance in classifying between malignant and benign pulmonary nodules. Methods First, a dataset involving 173 patients was retrospectively assembled, which includes computed tomography (CT) images and five serum biomarkers extracted from blood samples. Second, a CADx scheme using a four‐step–based semiautomatic segmentation method was applied to segment the targeted lung nodules, and compute 78 QI features from each segmented nodule from CT images. Third, two support vector machine (SVM) classifiers were built using QI features and serum biomarkers, respectively. SVM classifiers were trained and tested using the overall dataset with a Relief feature selection method, a synthetic minority oversampling technique and a leave‐one‐case‐out validation method. Finally, to further improve CADx performance, an information‐fusion method was used to combine the prediction scores generated by two SVM classifiers. Results Areas under receiver operating characteristic curves (AUC) generated by QI feature and serum biomarker‐based SVMs were 0.81 ± 0.03 and 0.69 ± 0.05, respectively. Using an optimal weighted fusion method to combine prediction scores generated by two SVMs, AUC value significantly increased to 0.85 ± 0.03 (P < 0.05). Conclusions This study demonstrates (a) higher CADx performance by using QI features than using the serum biomarkers and (b) feasibility of further improving CADx performance by fusion of QI features and serum biomarkers, which indicates that QI features and serum biomarkers contain the complementary classification information.
Paricalcitol reduces the risk of cardiovascular events in CKD patients but increases the risk of hypercalcemia and cannot improve cardiac structure. Meanwhile, it cannot significantly reduce proteinuria level or protect renal function.
BackgroundDrug‐eluting stents (DESs) and bare metal stents (BMSs) are both recommended to improve coronary revascularization and to treat coronary artery disease in patients with chronic kidney disease (CKD). However, the potential superiority of DESs over BMSs for reducing the incidence of long‐term major adverse cardiovascular events and mortality in CKD patients has not been established, and the results remain controversial. We aimed to systematically assess and quantify the total weight of evidence regarding the use of DESs versus BMSs in CKD patients.Methods and ResultsIn this systematic review and conventional meta‐analysis, electronic studies published in any language until May 20, 2016, were systematically searched through PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials and observational studies comparing outcomes in CKD patients with DESs versus BMSs and extracted data in a standard form. Pooled odd ratios and 95% CIs were calculated using random‐ and fixed‐effects models. Finally, 38 studies involving 123 396 patients were included. The use of DESs versus BMSs was associated with significant reductions in major adverse cardiovascular events (pooled odds ratio 0.75; 95% CI, 0.64–0.88; P<0.001), all‐cause mortality (odds ratio 0.81; 95% CI, 0.73–0.90; P<0.001), myocardial infarction, target‐lesion revascularization, and target‐vessel revascularization. The superiority of DESs over BMSs for improving clinical outcomes was attenuated in randomized controlled trials.ConclusionsThe use of DESs significantly improves the above outcomes in CKD patients. Nevertheless, large‐sized randomized controlled trials are necessary to determine the real effect on CKD patients and whether efficacy differs by type of DES.
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