A checklist for critical appraisal of studies of biological variation

Data on biological variation are used for many purposes in laboratory medicine but concern exists over the validity of the data reported in some studies. A critical appraisal checklist has been produced by a working group established by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) to enable standardised assessment of existing and future publications of biological variation data. The checklist identifies key elements to be reported in studies to enable safe accurate and effective transport of biological variation data sets across healthcare systems. The checklist is mapped to the domains of a minimum data set required to enable this process

Family physician and endocrinologist coordination as the basis for diabetes care in clinical practice

<p>Abstract</p> <p>Background</p> <p>To estimate the proportion of diabetic patients (DPts) with peripheral vascular disease treated at a primary health care site after an endocrinologist-based intervention, who meet ATP III and Steno targets of metabolic control, as well as to compare the outcome with the results of the patients treated by endocrinologists.</p> <p>Methods</p> <p>A controlled, prospective over 30-months period study was conducted in area 7 of Madrid. One hundred twenty six eligible diabetic patients diagnosed as having peripheral vascular disease between January 2003 and June 2004 were included in the study. After a treatment period of three months by the Diabetes team at St Carlos Hospital, 63 patients were randomly assigned to continue their follow up by diabetes team (Group A) and other 63 to be treated by the family physicians (FP) at primary care level with continuous diabetes team coordination (Group B). 57 DPts from Group A and 59 from Group B, completed the 30 months follow-up period. At baseline both groups were similar in age, weight, time from diagnosis and metabolic control. The main outcomes of this study were the proportion of patients meeting ATP III and Steno goals for HbA1c (%), Cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, blood pressure, albumine-to-creatinine excretion ratio (ACR), body mass index (BMI), waist circumference (WC), anti-aggregation treatment and smoking status.</p> <p>Results</p> <p>At the end of the follow up, no differences were found between the groups. More than 37% of diabetic patients assigned to be treated by FP achieved a HbA1c < 6.5%, more than 50% a ACR < 30 mg/g, and more than 80% reached low risk values for cholesterol, LDL cholesterol, triglycerides, diastolic blood pressure and were anti-aggregated, and 12% remained smokers. In contrast, less than 45% achieved a systolic blood pressure < 130 mm Hg, less than 12% had a BMI < 25 Kg.m-2 (versus 23% in group A; p < 0.05) and 49%/30% (men/women) had a waist circumference of low risk.</p> <p>Conclusion</p> <p>Improvements in metabolic control among diabetic patients with peripheral vascular disease treated at a primary health care setting is possible, reaching similar results to the patients treated at a specialized level. Despite such an improvement, body weight control remains more than poor in both levels, mainly at primary care level. General practitioner and endocrinologist coordination care may be important to enhance diabetes management in primary care settings.</p> <p>Trial registration</p> <p>Clinical Trial number ISRCTN75037597</p

The spatial evolution of young massive clusters - I. A new tool to quantitatively trace stellar clustering

Context. There are a number of methods that identify stellar sub-structure in star forming regions, but these do not quantify the degree of association of individual stars – something which is required if we are to better understand the mechanisms and physical processes that dictate structure. Aims. We present the new novel statistical clustering tool “INDICATE” which assesses and quantifies the degree of spatial clustering of each object in a dataset, discuss its applications as a tracer of morphological stellar features in star forming regions, and to look for these features in the Carina Nebula (NGC 3372). Methods. We employ a nearest neighbour approach to quantitatively compare the spatial distribution in the local neighbourhood of an object with that expected in an evenly spaced uniform (i.e. definitively non-clustered) field. Each object is assigned a clustering index (“I”) value, which is a quantitative measure of its clustering tendency. We have calibrated our tool against random distributions to aid interpretation and identification of significant I values. Results. Using INDICATE we successfully recover known stellar structure of the Carina Nebula, including the young Trumpler 14-16, Treasure Chest and Bochum 11 clusters. Four sub-clusters contain no, or very few, stars with a degree of association above random which suggests these sub-clusters may be fluctuations in the field rather than real clusters. In addition we find: (1) Stars in the NW and SE regions have significantly different clustering tendencies, which is reflective of differences in the apparent star formation activity in these regions. Further study is required to ascertain the physical origin of the difference; (2) The different clustering properties between the NW and SE regions are also seen for OB stars and are even more pronounced; (3) There are no signatures of classical mass segregation present in the SE region – massive stars here are not spatially concentrated together above random; (4) Stellar concentrations are more frequent around massive stars than typical for the general population, particularly in the Tr14 cluster; (5) There is a relation between the concentration of OB stars and the concentration of (lower mass) stars around OB stars in the centrally concentrated Tr14 and Tr15, but no such relation exists in Tr16. We conclude this is due to the highly sub-structured nature of Tr16. Conclusions. INDICATE is a powerful new tool employing a novel approach to quantify the clustering tendencies of individual objects in a dataset within a user-defined parameter space. As such it can be used in a wide array of data analysis applications. In this paper we have discussed and demonstrated its application to trace morphological features of young massive clusters

A code to Make Your Own Synthetic ObservaTIonS (MYOSOTIS)

We introduce our new code MYOSOTIS (Make Your Own Synthetic ObservaTIonS) which is designed to produce synthetic observations from simulated clusters. The code can synthesize observations from both ground-and spaced-based observatories, for a range of different filters, observational conditions and angular/spectral resolution. In this paper, we highlight some of the features of MYOSOTIS, creating synthetic observations from young massive star clusters. Our model clusters are simulated using NBODY6 code and have different total masses, halfmass radii, and binary fractions. The synthetic observations are made at the age of 2 Myr with Solar metallicity and under different extinction conditions. For each cluster, we create synthetic images of the Hubble Space Telescope (HST) in the visible (WFPC2/F555W) as well as Very Large Telescopes in the nearIR (SPHERE/IRDIS/Ks). We show how MYOSOTIS can be used to look at mass function (MF) determinations. For this aim we re-estimate stellar masses using a photometric analysis on the synthetic images. The synthetic MF slopes are compared to their actual values. Our photometric analysis demonstrate that depending on the adopted filter, extinction, angular resolution, and pixel sampling of the instruments, the power-law index of the underlying MFs can be shallower than the observed ones by at least ±0.25 dex which is in agreement with the observed discrepancies reported in the literature, specially for young star clusters

S2D2: Small-scale Significant substructure DBSCAN Detection

Context. The spatial and dynamical structure of star-forming regions can offer insights into stellar formation patterns. The amount of data from current and upcoming surveys calls for robust and objective procedures for detecting structures in order to statistically analyse the various regions and compare them. Aims. We aim to provide the community with a tool capable of detecting, above random expectations, the small-scale significant structure in star-forming regions that could serve as an imprint of the stellar formation process. The tool makes use of the one-point correlation function to determine an appropriate length scale for ϵ and uses nearest-neighbour statistics to determine a minimum number of points Nmin for the DBSCAN algorithm in the neighbourhood of ϵ. Methods. We implemented the procedure and applied it to synthetic star-forming regions of different nature and characteristics to obtain its applicability range. We also applied the method to observed star-forming regions to demonstrate its performance in realistic circumstances and to analyse its results. Results. The procedure successfully detects significant small-scale substructures in heterogeneous regions, fulfilling the goals it was designed for and providing very reliable structures. The analysis of regions close to complete spatial randomness (Q ∈ [0.7, 0.87]) shows that even when some structure is present and recovered, it is hardly distinguishable from spurious detection in homogeneous regions due to projection effects. Thus, any interpretation should be done with care. For concentrated regions, we detect a main structure surrounded by smaller ones, corresponding to the core plus some Poisson fluctuations around it. We argue that these structures do not correspond to the small compact regions we are looking for. In some realistic cases, a more complete hierarchical, multi-scale analysis would be needed to capture the complexity of the region. Conclusions. We carried out implementations of our procedure and devised a catalogue of the Nested Elementary STructures (NESTs) detected as a result in four star-forming regions (Taurus, IC 348, Upper Scorpius, and Carina). This catalogue is being made publicly available to the community. Implementations of the 3D versionsof the procedure, as well as up to 6D versions, including proper movements, are in progress and will be provided in a future work

The C-terminal region of Trypanosoma cruzi MASPs is antigenic and secreted via exovesicles.

Trypanosoma cruzi is the etiological agent of Chagas disease, a neglected and emerging tropical disease, endemic to South America and present in non-endemic regions due to human migration. The MASP multigene family is specific to T. cruzi, accounting for 6% of the parasite's genome and plays a key role in immune evasion. A common feature of MASPs is the presence of two conserved regions: an N-terminal region codifying for signal peptide and a C-terminal (C-term) region, which potentially acts as GPI-addition signal peptide. Our aim was the analysis of the presence of an immune response against the MASP C-term region. We found that this region is highly conserved, released via exovesicles (EVs) and has an associated immune response as revealed by epitope affinity mapping, IFA and inhibition of the complement lysis assays. We also demonstrate the presence of a fast IgM response in Balb/c mice infected with T. cruzi. Our results reveal the presence of non-canonical secreted peptides in EVs, which can subsequently be exposed to the immune system with a potential role in evading immune system targets in the parasite

Polymorphisms of Pyrimidine Pathway Enzymes Encoding Genes and HLA-B*40∶01 Carriage in Stavudine-Associated Lipodystrophy in HIV-Infected Patients

Altres ajuts: Fundación para la Investigación y Prevención del SIDA en España (FIPSE 36610, 36572/06); Red de Investigación en SIDA (RIS RD12/0017/0005, RD12/0017/0014).To assess in a cohort of Caucasian patients exposed to stavudine (d4T) the association of polymorphisms in pyrimidine pathway enzymes and HLA-B*40∶01 carriage with HIV/Highly active antiretroviral therapy (HAART)-associated lipodystrophy syndrome (HALS). Three-hundred and thirty-six patients, 187 with HALS and 149 without HALS, and 72 uninfected subjects were recruited. The diagnosis of HALS was performed following the criteria of the Lipodystrophy Severity Grading Scale. Polymorphisms in the thymidylate synthase (TS) and methylene-tetrahydrofolate reductase (MTHFR) genes were determined by direct sequencing, HLA-B genotyping by PCR-SSOr Luminex Technology, and intracellular levels of stavudine triphosphate (d4T-TP) by a LC-MS/MS assay method. HALS was associated with the presence of a low expression TS genotype polymorphism (64.7% vs. 42.9%, OR = 2.43; 95%CI: 1.53-3.88, P<0.0001). MTHFR gene polymorphisms and HLA-B*40∶01 carriage were not associated with HALS or d4T-TP intracellular levels. Low and high expression TS polymorphisms had different d4T-TP intracellular levels (25.60 vs. 13.60 fmol/10 6 cells, P<0.0001). Independent factors associated with HALS were(OR [95%CI]: (a) Combined TS and MTHFR genotypes (p = 0.006, reference category (ref.): 'A+A'; OR for 'A+B' vs. ref.: 1.39 [0.69-2.80]; OR for 'B+A' vs. ref.: 2.16 [1.22-3.83]; OR for 'B+B' vs. ref.: 3.13, 95%CI: 1.54-6.35), (b) maximum viral load ≥5 log10 (OR: 2.55, 95%CI: 1.56-4.14, P = 0.001), (c) use of EFV (1.10 [1.00-1.21], P = 0.008, per year of use). HALS is associated with combined low-expression TS and MTHFR associated with high activity polymorphisms but not with HLA-B*40∶01 carriage in Caucasian patients with long-term exposure to stavudine

Network meta‐analysis of post‐exposure prophylaxis randomized clinical trials

Objectives: We performed a network meta‐analysis of PEP randomized clinical trials to evaluate the best regimen. / Methods: After MEDLINE/Pubmed search, studies were included if: (1) were randomized, (2) comparing at least 2 PEP three‐drug regimens and, (3) reported completion rates or discontinuation at 28 days. Five studies with 1105 PEP initiations were included and compared ritonavir‐boosted lopinavir (LPV/r) vs. atazanavir (ATV) (one study), cobicistat‐boosted elvitegravir (EVG/c) (one study), raltegravir (RAL) (one study) or maraviroc (MVC) (two studies). We estimated the probability of each treatment of being the best based on the evaluation of five outcomes: PEP non‐completion at day 28, PEP discontinuation due to adverse events, PEP switching due to any cause, lost to follow‐up and adverse events. / Results: Participants were mostly men who have sex with men (n = 832, 75%) with non‐occupational exposure to HIV (89.86%). Four‐hundred fifty‐four (41%) participants failed to complete their PEP course for any reason. The Odds Ratio (OR) for PEP non‐completion at day 28 in each antiretroviral compared to LPV/r was: ATV 0.95 (95% CI 0.58–1.56; EVG/c: OR 0.65 95% CI 0.30–1.37; RAL: OR 0.68 95% CI 0.41–1.13; and MVC: OR 0.69 95% CI 0.47–1.01. In addition, the rankogram showed that EVG/c had the highest probability of being the best treatment for the lowest rates in PEP non‐completion at day 28, switching, lost to follow‐up or adverse events and MVC for PEP discontinuations due to adverse events. / Conclusions: Our study shows the advantages of integrase inhibitors when used as PEP, particularly EVG as a Single‐Tablet Regimen

Adipose tissue concentrations of non-persistent environmental phenols and local redox balance in adults from Southern Spain

The aim was to evaluate the associations of environmental phenol and paraben concentrations with the oxidative microenvironment in adipose tissue. This study was conducted in a subsample (n=144) of the GraMo cohort (Southern Spain). Concentrations of 9 phenols and 7 parabens, and levels of oxidative stress biomarkers were quantified in adipose tissue. Associations were estimated using multivariable linear regression analyses adjusted for potential confounders. Benzophenone-3 (BP-3) concentration was borderline associated with enhanced glutathione peroxidase (GPx) activity [exp(β)=1.20, p=0.060] and decreased levels of reduced glutathione (GSH) [exp(β)=0.55, p=0.070]. Concentrations of bisphenol A (BPA) and methylparaben (MeP) were associated to lower glutathione reductase (GRd) activity [exp(β)=0.83, exp(β)=0.72, respectively], and BPA was borderline associated to increased levels of oxidized glutathione (GSSG) [exp(β)=1.73, p-value=0.062]. MeP was inversely associated to both hemeoxygenase-1 (HO-1) and superoxide dismustase (SOD) activity, as well as to the levels of thiobarbituric acid reactive substances (TBARS) [0.75 < exp(β) < 0.79]. Our results suggest that some specific non-persistent pollutants may be associated with a disruption of the activity of relevant antioxidant enzymes, in addition to the depletion of the glutathione stock. They might act as a tissue-specific source of free radicals, contributing to the oxidative microenvironment in the adipose tissue.This research was supported in part by research grants from the European Union Commission (H2020-EJP-HBM4EU and SOE1/P1/F0082), Biomedical Research Networking Center-CIBER de Epidemiología y Salud Pública (CIBERESP), from the Institute of Health Carlos III, supported by European Regional Development Fund/FEDER (FIS-PI13/02406, FISPI14/ 00067, FIS-PI16/01820, FIS-PI16/01812, FIS-PI16/01858 and FIS-PI17/01743), and from the Consejería de Salud, Junta de Andalucía (PS-0506-2016). Funding for the equipment used was provided by Velux Fonden, Augustinus Fonden and Svend Andersen Fonden. The authors thank Kirsten og Freddy Johansens Fond and the International Centre for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC, Rigshospitalet, Copenhagen University) for economic support. Dr. Juan Pedro Arrebola is under contract within Ramón y Cajal Program (Ministerio de Economía, Industria y Competitividad de España, RYC-2016-20155)

A cross-sectional study of different patterns of oral contraceptive use among premenopausal women and circulating IGF-1: implications for disease risk

<p>Abstract</p> <p>Background</p> <p>Insulin-like growth factor-1 (IGF-1) is important in normal growth, development, and homeostasis. Current use of oral contraceptives (OC) decreases IGF-1 concentrations; however, the effect of past use, age/timing of use, and type of OC used on IGF-1 levels is unknown. OC are the most commonly used form of birth control worldwide. Both IGF-1 and OC use have been linked to premenopausal breast and colorectal cancers, osteoporosis and cardiovascular disease (CVD). Understanding the effects of different patterns of OC use on IGF-1 levels may offer insight into its influence on disease risk in young women.</p> <p>Methods</p> <p>In a cross-sectional study of 328 premenopausal women ages 18 to 21 and 31 to 40 we examined the relationship between different patterns of OC use and circulating IGF-1 using adjusted linear regression analysis. Information on OC use was obtained through an interviewer administered questionnaire. Plasma IGF-1 was assessed with enzyme linked immunosorbent assay (ELISA).</p> <p>Results</p> <p>Among women aged 18 to 21, ever OC use was significantly associated with decreased IGF-1 levels compared to never use (β = -57.2 ng/ml, 95% confidence interval (CI): -88.7, -25.8). Among women aged 31 to 40, past users who first used OC at 25 years of age or older (β = 43.8 ng/ml, 95% CI: 8.8, 78.8), in the last 15 years (β = 35.1 ng/ml, 95% CI: 9.3, 61.0) or after 1995 (β = 46.6 ng/ml, 95% CI: 13.4, 79.8) had significantly higher IGF-1 levels compared to never users.</p> <p>Conclusion</p> <p>This is the first study to highlight the long term effects of OC use after cessation on IGF-1 levels among premenopausal women, which previously were thought to be transitory. Future studies of past use and IGF-1 levels are required and must consider age/timing of use and type/generation of OC used. Additional studies are needed to confirm the potential mediation of IGF-1 levels in the links between OC use and health outcomes.</p