Platelet rich plasma injection for acute Achilles tendon rupture: PATH-2 randomised, placebo controlled, superiority trial

Objective To determine whether an injection of platelet rich plasma improves outcomes after acute Achilles tendon rupture. Design Randomised, placebo controlled, two arm, parallel group, participant and assessor masked, superiority trial. Setting Secondary care trauma units across 19 hospitals in the United Kingdom’s health service. Participants Recruitment commenced in July 2015 and follow-up was completed in March 2018. 230 adults aged 18 years and over were included, with acute Achilles tendon rupture presenting within 12 days of injury and managed with non-surgical treatment. Exclusions were injury at the insertion or musculotendinous junction, major leg injury or deformity, diabetes mellitus, platelet or haematological disorder, systemic corticosteroids, anticoagulation treatment, and other contraindicating conditions. Interventions Participants were randomised 1:1 to platelet rich plasma (n=114) or placebo (dry needle; n=116) injection. All participants received standard rehabilitation care (ankle immobilisation followed by physiotherapy). Main outcomes and measures Primary outcome was muscle tendon function at 24 weeks, measured objectively with the limb symmetry index (injured/uninjured×100) in maximal work done during the heel rise endurance test (an instrumented measure of repeated single leg heel rises until fatigue). Secondary outcomes included patient reported function (Achilles tendon rupture score), quality of life (short form 12 version 2®), pain (visual analogue scale), goal attainment (patient specific functional scale), and adverse events. A central laboratory analysed the quality and content of platelet rich plasma. Analyses were by modified intention to treat. Results Participants were 46 years old on average, and 57 (25%) of 230 were female. At 24 weeks, 202 (88%) participants completed the heel rise endurance test and 216 (94%) the patient reported outcomes. The platelet rich plasma was of good quality, with expected growth factor content. No difference was detected in muscle tendon function between participants receiving platelet rich plasma injections and those receiving placebo injections (limb symmetry index, mean 34.7% (standard deviation 17.7%) v 38.5% (22.8%); adjusted mean difference −3.9% (95% confidence interval −10.5% to 2.7%)) or in any secondary outcomes or adverse event rates. Complier average causal effect analyses gave similar findings. Conclusions There is no evidence to indicate that injections of platelet rich plasma can improve objective muscle tendon function, patient reported function, or quality of life after acute Achilles tendon rupture compared with placebo, or that they offer any patient benefit. Trial registration isrctn.com identifier: ISRCTN54992179</p

"If we use the strength of diversity among researchers we can only improve the quality and impact of our research": Issues of equality, diversity, inclusion, and transparency in the process of applying for research funding

This paper sets out the recommendations that have emerged from a six-month-long exploration and discussion of the processes that take place before research is submitted for funding: the ‘pre-award’ environment. Our work concentrated on how this environment is experienced by researchers at all career stages and from a variety of backgrounds, demographics, and disciplines, as well as by research managers and research support professionals. In the later stages of our exploration, representatives from research funders were also involved in the discussions. The primary component of this project was an analysis of pre-award activities and processes at UK universities, using information collated from workshops with researchers and research management and support staff. The findings of this analysis were presented as a workflow diagram, which was then used to surface issues relating to equality, diversity, inclusion, and transparency in context. The workflow diagram and the issues highlighted by it were used to structure discussions at a symposium for a range of research stakeholders, held in Bristol, UK, in January 2023. The recommendations set out in this paper are drawn from discussions that took place at that event. This paper is not an exhaustive landscape analysis, nor a review of existing research and practice in the area of pre-award processes or of recent thinking on the topics of equality, diversity, and inclusion (EDI). Instead, it aims to summarise and encapsulate the suggestions put forward by the stakeholders during the symposium. These recommendations, from experienced professionals working in the field, are based on their encounters with the issues raised in the project. They do not solely relate to those working on pre-award processes, but may also apply to funders, policymakers, university leaders, and professional associations, since many of the challenges flagged in our research are systemic and cultural, and reach far beyond the research office

Television viewing and abdominal obesity in women according to smoking status: results from a large cross-sectional population-based study in Brazil Hábito de assistir televisão e obesidade abdominal entre mulheres fumantes: resultados de um estudo transversal de base populacional no Brasil

OBJECTIVE: To investigate the associations between television viewing and abdominal obesity (AO) in Brazilian women, according to smoking status. METHODS: Data of 13,262 adult women (18-49 years) from the 2006's Demographic Health Survey, a cross-sectional household study with complex probabilistic sample and national representativeness, were analyzed. AO, defined as waist circumference &#8805; 80.0 cm, was the outcome. Television viewing frequency (&#8805; 5 times/week, 1-4 times/week, < 1 time/week) was the main exposure variable, and smoking status (yes or no) the main co-variable. Prevalence ratios were estimated using Poisson regression models separately for smokers and non-smokers. RESULTS: A statistically significant interaction term was observed between smoking status and television viewing (p < 0.05). Prevalence of AO among smokers who reported television viewing &#8805; 5 times/week amounted to 59.0%, higher than the 35.0% for those with < 1 time/week television viewing (p-value = 0.020). The values for non-smokers were 55.2% and 55.7%, respectively. Smokers with television viewing &#8805; 5 times/week were 1.7 times (95% CI: 1.1 - 2.5) more likely to pre-sent AO, compared to those who reported a frequency < 1 time/week. There was no significant association among non-smokers. CONCLUSIONS: Television viewing &#8805; 5 times/week may increase the prevalence of AO among women who smoke. More detailed information on media use, as hours per day, may offer better estimates.<br> OBJETIVO: Investigar a associa&#231;&#227;o entre a frequ&#234;ncia assistindo televis&#227;o e obesidade abdominal (OA) entre mulheres brasileiras, segundo o h&#225;bito de fumar. M&#201;TODOS: Foram analisados os dados de 13.262 mulheres adultas (18-49 anos) estudadas na Pesquisa Nacional de Demografia e Sa&#250;de (PNDS-2006), um estudo transversal, com amostragem probabil&#237;stica complexa, de representatividade nacional. OA, definida como circunfer&#234;ncia da cintura &#8805; 80.0 cm, foi considerada como desfecho. A frequ&#234;ncia assistindo televis&#227;o (&#8805; 5 vezes/semana, 1-4 vezes/semana, < 1 vez/semana) foi a principal vari&#225;vel de exposi&#231;&#227;o e o h&#225;bito de fumar (sim ou n&#227;o) a principal covari&#225;vel. Foram estimadas raz&#245;es de preval&#234;ncia por meio de modelos de regress&#227;o de Poisson, para fumantes e n&#227;o fumantes separadamente. RESULTADOS: Observou-se intera&#231;&#227;o estatisticamente significante entre frequ&#234;ncia assistindo televis&#227;o e h&#225;bito de fumar (p < 0,05). A preval&#234;ncia de OA entre mulheres fumantes que assistiam televis&#227;o &#8805; 5 vezes/semana foi de 59,0%, e maior do que 35,0% entre aquelas que assistiam televis&#227;o < 1 vez/semana (p-valor = 0,02). Os valores de OA para n&#227;o fumantes foram 55,2% e 55,7%, respectivamente. Fumantes que assistiam televis&#227;o &#8805; 5 vezes/semana apresentaram chance 1,7 (1,1 - 2,5) vezes maior de ter OA, comparadas aquelas que relataram assistir televis&#227;o < 1 vez/semana. N&#227;o se observou associa&#231;&#227;o significante para n&#227;o fumantes. CONCLUS&#195;O: Assistir televis&#227;o &#8805; 5 vezes/semana pode aumentar a preval&#234;ncia de OA entre as mulheres fumantes. Informa&#231;&#245;es mais detalhadas sobre a frequ&#234;ncia de assistir televis&#227;o, como o n&#250;mero de horas por dia, podem oferecer melhores estimativas

990 C-reactive protein and later preeclampsia

Background: The association high C-reactive protein (CRP) levels with the occurrence of preeclampsia (PE) is a growing matter of debate. This study aims to determine whether CRP concentration during pregnancy is a predictor of PE and whether nutritional status is a potential modifier of CRP in the context of this association. Design and methods: Twenty-two studies were included in a systematic literature review. A meta-analysis was performed using a subset of 17 publications with available data to calculate the weighted mean difference (WMD) of CRP in PE and control groups. A quality assessment was carried out using a scale specifically developed for this study. Results: The WMD of CRP between 664 women who developed PE and 2,823 controls was 1.73 mg/L (95% CI: 0.99-2.47). The heterogeneity among studies was high (I2 = 81.4; p < 0.001). The WMD was found to be lower in studies comprising PE and control groups with similar BMI (WMD = 0.85 [95% CI: 0.10-1.61]; I2 = 25.3%) compared to studies among which BMI was significantly elevated in the PE group (2.01 [95% CI: 1.23-2.78]; I2 = 0.0%), which may explain the high heterogeneity of pooled data. Only 30% of the articles were classified as high quality. Conclusions: Our findings suggest that women with higher levels of CRP may have an increased risk of developing PE. Some factors should be considered in evaluating this association, such as nutritional status, gestational age at blood collection and specimen type. Further studies of high methodological quality are urgently needed