Engaging surgeons among clinician-scientists

Since completion of the Human Genome Project at the turn of the century, there have been significant advances in genomic technologies together with genomics research. At the same time, the gap between biomedical discovery and clinical application has narrowed through translational medicine, so establishing the era of personalised medicine. In bridging these two disciplines, the clinician-scientist has become an integral part of modern practice. Surgeons and surgical diseases have been less represented than physicians and medical conditions among clinician-scientists and research. Here, we explore the possible reasons for this and propose strategies for moving forward. Discovery-driven personalised medicine is both the present and the future of clinical patient care worldwide, and South Africa is uniquely placed to build capacity for biomedical discovery in Africa. Diverse engagement across clinical disciplines, including surgery, is necessary in order to integrate modern medicine into a developing-world contextualised perspective

Ventriculoperitoneal shunt insertion for hydrocephalus in human immunodeficiency virus-infected adults: a systematic review and meta-analysis protocol

Responses to peer reviewer comments. HIV VPS Protocol Reviewers Responses. (DOCX 126 kb

Ventriculoperitoneal shunt insertion in human immunodeficiency virus infected adults:a systematic review and meta-analysis

Abstract Background Hydrocephalus is a common, life threatening complication of human immunodeficiency virus (HIV)-related central nervous system opportunistic infection which can be treated by insertion of a ventriculoperitoneal shunt (VPS). In HIV-infected patients there is concern that VPS might be associated with unacceptably high mortality. To identify prognostic indicators, we aimed to compare survival and clinical outcome following VPS placement between all studied causes of hydrocephalus in HIV infected patients. Methods The following electronic databases were searched: The Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), EMBASE, CINAHL Plus, LILACS, Research Registry, the metaRegister of Controlled Trials, ClinicalTrials.gov, African Journals Online, and the OpenGrey database. We included observational studies of HIV-infected patients treated with VPS which reported of survival or clinical outcome. Data was extracted using standardised proformas. Risk of bias was assessed using validated domain-based tools. Results Seven Hunderd twenty-three unique study records were screened. Nine observational studies were included. Three included a total of 75 patients with tuberculous meningitis (TBM) and six included a total of 49 patients with cryptococcal meningitis (CM). All of the CM and two of the TBM studies were of weak quality. One of the TBM studies was of moderate quality. One-month mortality ranged from 62.5–100% for CM and 33.3–61.9% for TBM. These pooled data were of low to very-low quality and was inadequate to support meta-analysis between aetiologies. Pooling of results from two studies with a total of 77 participants indicated that HIV-infected patients with TBM had higher risk of one-month mortality compared with HIV non-infected controls (odds ratio 3.03; 95% confidence-interval 1.13–8.12; p = 0.03). Conclusions The evidence base is currently inadequate to inform prognostication in VPS insertion in HIV-infected patients. A population-based prospective cohort study is required to address this, in the first instance

A giant invasive prolactinoma complicated by a cerebrospinal fluid leak: A short case report

The symbiosis established between cacao plants and arbuscular mycorrhizal fungi (AMF) adds nutritional and competitive benefits for the plant, especially in conditions with a low availability of nutrients. We evaluated three levels of phosphorus (5, 20 and 40 ppm) and the presence or absence of isoflavone formononetin. A Phosphorus level of 14 ppm, without isoflavone or inoculation was the control. All treatments were inoculated with HFMA with the exception of the control. A completely randomized design was used. The morphological characters of the plant at 70, 110 and 150 days after inoculation were determined. The results showed no difference in the response to the morphological characters of the plant with the varied availability of isoflavone during the three sampling. The root length showed significant differences in the different sampling times (70, 110 and 150 days of inoculation), this response being dependent on the availability of P and plant-mycorrhizal interactions. The number of spores demonstrated differences between the samples of 110 and 150 days of inoculation in the presence and absence of isoflavone, suggesting an early stimulation in the establishment of the symbiotic relationship of formononetin in the process of germination and formation of fungal structures.   La simbiosis entre plantas de cacao y hongos micorrízicos arbusculares (HFMA) confiere beneficios nutricionales y competitivos a la planta, especialmente en condiciones de baja disponibilidad de nutrientes. Se evaluó tres niveles de fósforo (5, 20 y 40 ppm) y la presencia o ausencia de isoflavonoide formononetina. El nivel 14 ppm de P sin el isoflavonoide fue el tratamiento testigo. Todos los tratamientos fueron inoculados con HFMA a excepción del tratamiento control. Se utilizó un diseño completamente al azar y se determinaron caracteres morfológicos de la planta a los 70, 110 y 150 días después de la inoculación. Los resultados no mostraron respuesta diferencial a los caracteres morfológicos de la planta por la disponibilidad del isoflavonoide durante los tres muestreos. La longitud radicular presentó diferencias significativas en los muestreo (70, 110 y 150 días de inoculación), siendo esta respuesta dependiente de la disponibilidad de P y la interacción plantamicorriza. El número de esporas mostró diferencias entre los muestreos de 110 y 150 días de inoculación en presencia y ausencia del isoflavonoide, sugiriendo una rápida estimulación en el establecimiento de la relación simbiótica por la formononetina en el proceso de germinación y formación de estructuras fúngicas.

Additional file 1: of Ventriculoperitoneal shunt insertion for hydrocephalus in human immunodeficiency virus-infected adults: a systematic review and meta-analysis protocol

PRISMA-P Checklist. Standardised reporting guideline for production of systematic review protocol. (PDF 184 kb

A clinical-scale BioArtificial Liver, developed for GMP, improved clinical parameters of liver function in porcine liver failure

Abstract Liver failure, whether arising directly from acute liver failure or from decompensated chronic liver disease is an increasing problem worldwide and results in many deaths. In the UK only 10% of individuals requiring a liver transplant receive one. Thus the need for alternative treatments is paramount. A BioArtificial Liver machine could temporarily replace the functions of the liver, buying time for the patient’s liver to repair and regenerate. We have designed, implemented and tested a clinical-scale BioArtificial Liver machine containing a biomass derived from a hepatoblastoma cell-line cultured as three dimensional organoids, using a fluidised bed bioreactor, together with single-use bioprocessing equipment, with complete control of nutrient provision with feedback BioXpert recipe processes, and yielding good phenotypic liver functions. The methodology has been designed to meet specifications for GMP production, required for manufacture of advanced therapy medicinal products (ATMPs). In a porcine model of severe liver failure, damage was assured in all animals by surgical ischaemia in pigs with human sized livers (1.2–1.6 kg liver weights). The BioArtificial liver (UCLBAL) improved important prognostic clinical liver-related parameters, eg, a significant improvement in coagulation, reduction in vasopressor requirements, improvement in blood pH and in parameters of intracranial pressure (ICP) and oxygenation