A systematic review of cost-effectiveness analyses of complex wound interventions reveals optimal treatments for specific wound types.

BackgroundComplex wounds present a substantial economic burden on healthcare systems, costing billions of dollars annually in North America alone. The prevalence of complex wounds is a significant patient and societal healthcare concern and cost-effective wound care management remains unclear. This article summarizes the cost-effectiveness of interventions for complex wound care through a systematic review of the evidence base.MethodsWe searched multiple databases (MEDLINE, EMBASE, Cochrane Library) for cost-effectiveness studies that examined adults treated for complex wounds. Two reviewers independently screened the literature, abstracted data from full-text articles, and assessed methodological quality using the Drummond 10-item methodological quality tool. Incremental cost-effectiveness ratios were reported, or, if not reported, calculated and converted to United States Dollars for the year 2013.ResultsOverall, 59 cost-effectiveness analyses were included; 71% (42 out of 59) of the included studies scored 8 or more points on the Drummond 10-item checklist tool. Based on these, 22 interventions were found to be more effective and less costly (i.e., dominant) compared to the study comparators: 9 for diabetic ulcers, 8 for venous ulcers, 3 for pressure ulcers, 1 for mixed venous and venous/arterial ulcers, and 1 for mixed complex wound types.ConclusionsOur results can be used by decision-makers in maximizing the deployment of clinically effective and resource efficient wound care interventions. Our analysis also highlights specific treatments that are not cost-effective, thereby indicating areas of resource savings. Please see related article: http://dx.doi.org/10.1186/s12916-015-0288-5

MISIM: A Novel Code Similarity System

Code similarity systems are integral to a range of applications from code recommendation to automated software defect correction. We argue that code similarity is now a first-order problem that must be solved. To begin to address this, we present machine Inferred Code Similarity (MISIM), a novel end-to-end code similarity system that consists of two core components. First, MISIM uses a novel context-aware semantic structure, which is designed to aid in lifting semantic meaning from code syntax. Second, MISIM provides a neural-based code similarity scoring algorithm, which can be implemented with various neural network architectures with learned parameters. We compare MISIM to three state-of-the-art code similarity systems: (i) code2vec, (ii) Neural Code Comprehension, and (iii) Aroma. In our experimental evaluation across 328,155 programs (over 18 million lines of code), MISIM has 1.5x to 43.4x better accuracy than all three systems

The final transformation of Étaín

Abstract Background Although serotonin (5-HT3) receptor antagonists are effective in reducing nausea and vomiting, they may be associated with increased cardiac risk. Our objective was to examine the comparative safety and effectiveness of 5-HT3 receptor antagonists (e.g., dolasetron, granisetron, ondansetron, palonosetron, tropisetron) alone or combined with steroids for patients undergoing chemotherapy. Methods We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception until December 2015 for studies comparing 5-HT3 receptor antagonists with each other or placebo in chemotherapy patients. The search results were screened, data were abstracted, and risk of bias was appraised by pairs of reviewers, independently. Random-effects meta-analyses and network meta-analyses (NMAs) were conducted. Results After screening 9226 citations and 970 full-text articles, we included 299 studies (n = 58,412 patients). None of the included studies reported harms for active treatment versus placebo. For NMAs on the risk of arrhythmia (primary outcome; three randomized controlled trials [RCTs], 627 adults) and mortality (secondary outcome; eight RCTs, 4823 adults), no statistically significant differences were observed between agents. A NMA on the risk of QTc prolongation showed a significantly greater risk for dolasetron + dexamethasone versus ondansetron + dexamethasone (four RCTs, 3358 children and adults, odds ratio 2.94, 95% confidence interval 2.13–4.17). For NMAs on the number of patients without nausea (44 RCTs, 11,664 adults, 12 treatments), number of patients without vomiting (63 RCTs, 15,460 adults, 12 treatments), and number of patients without chemotherapy-induced nausea or vomiting (27 RCTs, 10,924 adults, nine treatments), all agents were significantly superior to placebo. For a NMA on severe vomiting (10 RCTs, 917 adults), all treatments decreased the risk, but only ondansetron and ramosetron were significantly superior to placebo. According to a rank-heat plot with the surface under the cumulative ranking curve results, palonosetron + steroid was ranked the safest and most effective agent overall. Conclusions Most 5-HT3 receptor antagonists were relatively safe when compared with each other, yet none of the studies compared active treatment with placebo for harms. However, dolasetron + dexamethasone may prolong the QTc compared to ondansetron + dexamethasone. All agents were effective for reducing risk of nausea, vomiting, and chemotherapy-induced nausea or vomiting. Trial registration This study was registered at PROSPERO: ( CRD42013003564 )

Delineation of VEGF-regulated genes and functions in the cervix of pregnant rodents by DNA microarray analysis

<p>Abstract</p> <p>Background</p> <p>VEGF-regulated genes in the cervices of pregnant and non-pregnant rodents (rats and mice) were delineated by DNA microarray and Real Time PCR, after locally altering levels of or action of VEGF using VEGF agents, namely siRNA, VEGF receptor antagonist and mouse VEGF recombinant protein.</p> <p>Methods</p> <p>Tissues were analyzed by genome-wide DNA microarray analysis, Real-time and gel-based PCR, and SEM, to decipher VEGF function during cervical remodeling. Data were analyzed by EASE score (microarray) and ANOVA (Real Time PCR) followed by Scheffe's <it>F</it>-test for multiple comparisons.</p> <p>Results</p> <p>Of the 30,000 genes analyzed, about 4,200 genes were altered in expression by VEGF, i.e., expression of about 2,400 and 1,700 genes were down- and up-regulated, respectively. Based on EASE score, i.e., grouping of genes according to their biological process, cell component and molecular functions, a number of vascular- and non-vascular-related processes were found to be regulated by VEGF in the cervix, including immune response (including inflammatory), cell proliferation, protein kinase activity, and cell adhesion molecule activity. Of interest, mRNA levels of a select group of genes, known to or with potential to influence cervical remodeling were altered. For example, real time PCR analysis showed that levels of VCAM-1, a key molecule in leukocyte recruitment, endothelial adhesion, and subsequent trans-endothelial migration, were elevated about 10 folds by VEGF. Further, VEGF agents also altered mRNA levels of decorin, which is involved in cervical collagen fibrillogenesis, and expression of eNO, PLC and PKC mRNA, critical downstream mediators of VEGF. Of note, we show that VEGF may regulate cervical epithelial proliferation, as revealed by SEM.</p> <p>Conclusion</p> <p>These data are important in that they shed new insights in VEGF's possible roles and mechanisms in cervical events near-term, including cervical remodeling.</p

Characteristics and knowledge synthesis approach for 456 network meta-analyses: a scoping review.

BACKGROUND Network meta-analysis (NMA) has become a popular method to compare more than two treatments. This scoping review aimed to explore the characteristics and methodological quality of knowledge synthesis approaches underlying the NMA process. We also aimed to assess the statistical methods applied using the Analysis subdomain of the ISPOR checklist. METHODS Comprehensive literature searches were conducted in MEDLINE, PubMed, EMBASE, and Cochrane Database of Systematic Reviews from inception until April 14, 2015. References of relevant reviews were scanned. Eligible studies compared at least four different interventions from randomised controlled trials with an appropriate NMA approach. Two reviewers independently performed study selection and data abstraction of included articles. All discrepancies between reviewers were resolved by a third reviewer. Data analysis involved quantitative (frequencies) and qualitative (content analysis) methods. Quality was evaluated using the AMSTAR tool for the conduct of knowledge synthesis and the ISPOR tool for statistical analysis. RESULTS After screening 3538 citations and 877 full-text papers, 456 NMAs were included. These were published between 1997 and 2015, with 95% published after 2006. Most were conducted in Europe (51%) or North America (31%), and approximately one-third reported public sources of funding. Overall, 84% searched two or more electronic databases, 62% searched for grey literature, 58% performed duplicate study selection and data abstraction (independently), and 62% assessed risk of bias. Seventy-eight (17%) NMAs relied on previously conducted systematic reviews to obtain studies for inclusion in their NMA. Based on the AMSTAR tool, almost half of the NMAs incorporated quality appraisal results to formulate conclusions, 36% assessed publication bias, and 16% reported the source of funding. Based on the ISPOR tool, half of the NMAs did not report if an assessment for consistency was conducted or whether they accounted for inconsistency when present. Only 13% reported heterogeneity assumptions for the random-effects model. CONCLUSIONS The knowledge synthesis methods and analytical process for NMAs are poorly reported and need improvement

Влијание на кинеската традиционална медицина за лекување на болки во грбот

Болките во грбот претставуваат еден од почестите проблеми со кој се соочуваат луѓето во нивниот секојдневен живот и се најчеста причина за значајни загуби на работните денови. Хроничните болки во грбот станаа една од најчестите причини за боледување кај вработените на возраст под 45 години. Кога луѓето остануваат дома заради повреда во грбот, само 65% се враќаат на работа по една недела и речиси 14% се сеуште отсутни по еден месец. И ако некој е на боледување подолго од шест месеци, има само 50% шанси да се врати на работа. Поголемиот дел од болките во грбот се должат на иритација на зглобовите, или притисок врз лигаментите и мускулите од заболени дискови или шилци. Притисокот врз нервните завршетоци исто така може, да доведе до болки во грбот и нозете. Многу фактори можат да ги влошат болките во грбот. Доживеаниот стрес, преголемата тежина, неправилното држење на телото и лошата кондиција можат да ги влошат или продолжат болките во грбот. Постојат огромен број причини за појава на болки во грбот, но најчесто се работи за една од следниве: механички проблеми, повреди, стекнати болести, инфекции и тумори и емоционален стрес. Кинеската традиционална медицина се развивала во денешна Кина, потоа била пренесена во Јапонија, Кореа, Монголија, Виетнам, Филипините и др. Од физиолошка гледна точка, древните лекари го разгледувале човечкиот организам како сложен систем, во кој елементите се функционално поврзани. Тие си го претставиле телото како “монада“, поделено на два еднакви дела Jин и Јан. Јан го претставува машкиот дел или татковото потекло, кој се изразува во секое светло, активно, суво, топло, творечко, постојано. Jин е од мајчинско потекло кое се изразува како влажно, ладно, темно, сокриено, пасивно. Здравото тело олицетворение на хармонијата помеѓу Јан и Jин. Дисбалансот помеѓу нив доведува до болест. Друга претстава од страна на старата источна медицина е взаемното дејство помеѓу петте елементи – симболи на физичката состојба на природата: дрвото – црн дроб, оган – срце, земја – панкреас, метал – бели дробови, вода – бубрези. Древните научници откриле точки кои ги нарекле космички точки. Боцкањето со игли, загревањето со мокса, притисокот и масажата во тие точки доведува до подобрување на состојбата. Исто така била откриена и т.н. космичка енергија или Чи која што се движи по невидливите канали - меридијаните. Меридијаните се 12 парни кои се расположени по двете страни на телото и два непарни, кои на краевите се поврзани со внатрешните клонови еден со друг и така енергијата Чи циркулира низ телото во еден затворен систем. Секој меридијан има најголема активност по 2 часа дневно. Кај болков синдром меридијаните со нивните билошко – активни точки (БАТ) се место на надворешна симптоматика и перку нив може да се дијагностицира. Точките стануваат болни, со покачена температура и тврди. Треба да се знае дека точките не се поставени во близина на болниот орган, туку тие се наоѓаат по меридијаните. Акупресурата како метода има предност затоа што е безболна и безкрвна процедура, не е потребна специјална техника и лесно се применува. Таа се употребува за покачување на заштитните сили на организмот, за тонизирање, за подобрување и одржување на општата состојба, се употребува и како профилактички метод. Може да се употреби и со други терапевтски методи: класична или сегментарна масажа, климато терапија, балнео терапија. Клучни зборови Акупресура – метод на лекување со притискање. Јин – вид на енергија во телото кое го претставува женскиот пол Јан – вид на енергија во телото кое го претставува машкиот по