How to Undertake a Clinically Relevant Systematic Review in a Rapidly Evolving Field: Magnetic Resonance Angiography

Objectives: The aim was to determine which generations of the evolving technology of magnetic resonance angiography (MRA) are currently of clinical relevance in two clinical applications. Our purpose was to plan a systematic review that would be valuable both to purchasers driven by cost-effectiveness and to practicing clinicians. Methods: Information was gathered from a search of major bibliographic databases, from a short questionnaire sent to 500 U.K. vascular radiologists and vascular surgeons, and from local clinical The authors thank A. Jackson and all those who completed a questionnaire. This work was carried out with the financial support of the Secretary of State for Health under the NHS Health Technology Assessment Programme, project 97/13/04. The views and opinions expressed do not necessarily reflect those of the Secretary of State for Health. In part, this work was undertaken by the Leeds Teaching Hospitals NHS Trust, which received funding from the NHS Executive. The views expressed in this publication are those of the authors and not necessarily those of the NHS Executive.experts. We asked which of the MRA techniques were currently used and, assuming availability, what would be their technique of choice. Results: There were 206 published articles that satisfied preliminary inclusion criteria: 69 discussed 2D time of flight (TOF); 47, 3D TOF; and 38, contrast-enhanced techniques. There were 162 questionnaires returned (60 radiologists, 102 surgeons). Of the total respondents, 77/162 (48%) used MRA in the assessment of carotid artery stenosis; 47/77 (61%) used 2D TOF; 32/77 (42%), 3D TOF; and 26/77 (34%), contrast-enhanced techniques. Thirty-five of 162 (22%) respondents used MRA in the assessment of peripheral vascular disease (PVD); 15/35 (43%) used 2D TOF, 4/35 (11%) used 3D TOF, and 22/35 (63%) used contrast-enhanced techniques. For those wishing to use MRA, contrast-enhanced techniques were the method of choice. Conclusions: The TOF methods that represent earlier generations of the technology remain clinically relevant, and will therefore be included in our systematic review. To ensure complete and relevant coverage in reviews of other evolving technologies, it would be advisable to obtain data for guidance in a similar way

Use of magnetic resonance angiography to select candidates with recently symptomatic carotid stenosis for surgery: systematic review

Objective To determine if sufficient evidence exists to support the use of magnetic resonance angiography as a means of selecting patients with recently symptomatic high grade carotid stenosis for surgery. Design Systematic review of published research on the diagnostic performance of magnetic resonance angiography, 1990-9. Main outcome measures Performance characteristics of diagnostic test. Results 126 potentially relevant articles were identified, but many articles failed to examine die performance of magnetic resonance angiography as a diagnostic test at the surgical decision thresholds used in major clinical trials on endarterectomy. 26 articles were included in a meta-analysis that showed a maximal joint sensitivity and specificity of 99% (95% confidence interval 98% to 100%) for identifying 70-99% stenosis and 90% (81% to 99%) for identifying 50-99% stenosis. Only four articles evaluated contrast enhanced magnetic resonance angiography. Conclusions Magnetic resonance angiography is accurate for selecting patients for carotid endarterectomy at the surgical decision thresholds established in the major endarterectomy trials, but the evidence is not very robust because of the heterogeneity of the studies included. Research is to determine the diagnostic performance of the most recent developments in magnetic resonance angiography, including contrast enhanced techniques, as well as to assess the impact of magnetic resonance angiography on surgical decision making and outcomes

A human tau seeded neuronal cell model recapitulates molecular responses associated with Alzheimer's disease

Cellular models recapitulating features of tauopathies are useful tools to investigate the causes and consequences of tau aggregation and the identification of novel treatments. We seeded rat primary cortical neurons with tau isolated from Alzheimer's disease brains to induce a time-dependent increase in endogenous tau inclusions. Transcriptomics of seeded and control cells identified 1075 differentially expressed genes (including 26 altered at two time points). These were enriched for lipid/steroid metabolism and neuronal/glial cell development genes. 50 genes were correlated with tau inclusion formation at both transcriptomic and proteomic levels, including several microtubule and cytoskeleton-related proteins such as Tubb2a, Tubb4a, Nefl and Snca. Several genes (such as Fyn kinase and PTBP1, a tau exon 10 repressor) interact directly with or regulate tau. We conclude that this neuronal model may be a suitable platform for high-throughput screens for target or hit compound identification and validation

Moisture susceptibility of high and low compaction dry process crumb rubber modified asphalt mixtures

The field performance of dry process crumb rubber-modified (CRM) asphalt mixtures has been reported to be inconsistent with stripping and premature cracking on the surfacing. One of the concerns is that, because achieving field compaction of CRM material is difficult due to the inherent resilient nature of the rubber particle, nonuniform field compaction may lead to a deficient bond between rubber and bitumen. To assess the influence of compaction, a series of CRM and control mixtures was produced and compacted at two levels: 4% (low, optimum laboratory compaction) and 8% (high, field experience) air void content. The long-term durability, in regard to moisture susceptibility of the mixtures, was assessed by conducting repeated moisture conditioning cycles. Mechanical properties (stiffness, fatigue, and resistance to permanent deformation) were determined in the Nottingham Asphalt Tester. Results indicated that compared with conventional mixtures, the CRM mixtures, regardless of compaction effort, are more susceptible to moisture with the degree of susceptibility primarily depending on the amount of rubber in the mixture, rather than the difference in compaction. This behavior is different from that of conventional mixtures in which, as expected, poorly compacted mixtures were found to be more susceptible to moisture than were well-compacted mixtures

Linear viscoelastic properties of high reclaimed asphalt content mixes with biobinders

The use of high Reclaimed Asphalt (RA) content mixtures together with binders produced from renewable resources (biobinders) is one of the current challenges in pavement engineering research. On one hand, RA has been used for decades but there are still some concerns about its performance, especially when high contents are used (>30%). On the other hand, biobinders are relatively new materials which have to be deeply characterised and studied in order to develop good-practices for their use. In this paper, linear viscoelastic properties of biobinders and bio-mixtures manufactured with high-RA content and biobinders are analysed and discussed. High-modulus mixtures with 50% RA were selected for the mix design. Binders and mixtures were tested over a wide range of asphalt service temperatures and frequencies by means of DSR and two-point bending tests respectively. Results show that biobinders have an important effect on mixtures behaviour. However, no direct links between their linear viscoelastic properties were found. Bio-asphalt mixtures still need further development for commercial exploitation; however the take-away fact of this investigation is that it is possible to manufacture asphalt-like mixtures with acceptable viscoelastic properties while being composed only of RA and non-petroleum based binders

Sedimentology, structure and age estimate of five continental slope submarine landslides, eastern Australia

Sedimentological and accelerator mass spectrometry (AMS) ¹⁴C data provide estimates of the structure and age of five submarine landslides (∼0.4–3 km³) present on eastern Australia's continental slope between Noosa Heads and Yamba. Dating of the post-slide conformably deposited sediment indicates sediment accumulation rates between 0.017 m ka^–1 and 0.2 m ka^–1, which is consistent with previous estimates reported for this area. Boundary surfaces were identified in five continental slope cores at depths of 0.8 to 2.2 m below the present-day seafloor. Boundary surfaces present as a sharp colour-change across the surface, discernible but small increases in sediment stiffness, a slight increase in sediment bulk density of 0.1 g cm^–3, and distinct gaps in AMS ¹⁴C ages of at least 25 ka. Boundary surfaces are interpreted to represent a slide plane detachment surface but are not necessarily the only ones or even the major ones. Sub-bottom profiler records indicate that: (1) the youngest identifiable sediment reflectors upslope from three submarine landslides terminate on and are truncated by slide rupture surfaces; (2) there is no obvious evidence for a post-slide sediment layer draped over, or burying, slide ruptures or exposed slide detachment surfaces; and (3) the boundary surfaces identified within the cores are unlikely to be near-surface slide surfaces within an overall larger en masse dislocation. These findings suggest that these submarine landslides are geologically recent (<25 ka), and that the boundary surfaces are either: (a) an erosional features that developed after the landslide, in which case the boundary surface age provides a minimum age for the landslide; or (b) detachment surfaces from which slabs of near-surface sediment were removed during landsliding, in which case the age of the sediment above the boundary surface indicates the approximate age of landsliding. While an earthquake-triggering mechanism is favoured for the initiation of submarine landslides on the eastern Australian margin, further evidence is required to confirm this interpretation

Geometric morphometrics defines shape differences in the cortical area map of C57BL/6J and DBA/2J inbred mice

BACKGROUND: We previously described planar areal differences in adult mouse visual, somatosensory, and neocortex that collectively discriminated C57BL/6J and DBA/2J inbred strain identity. Here we use a novel application of established methods of two-dimensional geometric morphometrics to examine shape differences in the cortical area maps of these inbred strains. RESULTS: We used Procrustes superimposition to align a reliable set of landmarks in the plane of the cortical sheet from tangential sections stained for the cytochrome oxidase enzyme. Procrustes superimposition translates landmark configurations to a common origin, scales them to a common size, and rotates them to minimize an estimate of error. Remaining variation represents shape differences. We compared the variation in shape between C57BL/6J and DBA/2J relative to that within each strain using a permutation test of Goodall's F statistic. Significant differences in shape in the posterior medial barrel subfield (PMBSF), as well as differences in shape across primary sensory areas, characterize the cortical area maps of these common inbred, isogenic strains. CONCLUSION: C57BL/6J and DBA/2J have markedly different cortical area maps, in both size and shape. These differences suggest polymorphism in genetic factors underlying cortical specification, even between common isogenic strains. Comparing cortical phenotypes between normally varying inbred mice or between genetically modified mice can identify genetic contributions to cortical specification. Geometric morphometric analysis of shape represents an additional quantitative tool for the study of cortical development, regardless of whether it is studied from phenotype to gene or gene to phenotype

Disability in young adults following major trauma: 5 year follow up of survivors

BACKGROUND: Injuries are a major cause of mortality and morbidity in young people. Despite this, the long-term consequences for young survivors of severe injury are relatively unexplored. METHODS: Population based cohort study involving 5 year post injury structured interview of all cases of major trauma (Injury Severity Score > 15) identified retrospectively for 12 month period (1988 to 1989) within former Yorkshire Health Authority area of the United Kingdom. RESULTS: 125 individuals aged 11–24 years at time of injury were identified. Of these, 109 (87%) were interviewed. Only 20% (95% CI 14–29%) of those interviewed reported no disability. Mean Office of Population Census and Surveys (OPCS) disability score of the remainder was 7.5 (median 5.8, range 0.5 to 19.4). The most commonly encountered areas of disability were behaviour (54%, 95% CI 45–63%), intellectual functioning (39%, 95% CI 31–49%) and locomotion (29%, 95% CI 22–39%). Many respondents reported that their daily lives were adversely affected by their health problems for example, causing problems with work, 54% (95% CI 45–63%), or looking after the home, 28% (95% CI 21–38%). Higher OPCS scores were usually but not always associated with greater impact on daily activities. The burden of caring responsibilities fell largely on informal carers. 51% (95% CI 42–61%) of those interviewed would have liked additional help to cope with their injury and disability. CONCLUSION: The study has revealed significant disability amongst a cohort of young people 5 years post severe injury. Whilst many of these young people were coping well with the consequences of their injuries, others reported continuing problems with the activities of daily life. The factors underpinning the young people's differing experiences and social outcome should be explored

Evaluation of bio-materials’ rejuvenating effect on binders for high-reclaimed asphalt content mixtures

The interest in using bio-materials in pavement engineering has grown significantly over the last decades due to environmental concerns about the use of non-recoverable natural resources. In this paper, bio-materials are used together with Reclaimed Asphalt (RA) to restore some of the properties of the aged bitumen present in mixtures with high RA content. For this purpose, two bio-materials are studied and compared to conventional and polymer modified bitumens. Blends of these materials with RA bitumen were produced and studied to simulate a 50% RA mixture. The rejuvenating effect of the two bio-materials on RA has been assessed and compared with the effect of the conventional binders. Apparent Molecular Weight Distribution of the samples (obtained by the ?-method) and different rheological parameters were used for this purpose. Results revealed the power of bio-materials to rejuvenate RA bitumen, showing their capability to be used as fresh binders in high-RA content mixtures

A Rapid New Assay to Detect RNA Editing Reveals Antipsychotic-Induced Changes in Serotonin-2C Transcripts

ABSTRACT We report the development of a new assay as an alternative to direct DNA sequencing to measure RNA-edited variation in tissue. The new assay has been validated and is accurate, cheaper, more rapid, and less labor-intensive than DNA sequencing. We also outline the statistical modeling required for analyses of the hierarchical, clustered RNA-editing data generated in these studies. Using the new technique, we analyzed the effects of long-term antipsychotic medication on serotonin-2C receptor (5-HT 2C R) RNA editing in rat brain. Our hypothesis that a drug with high affinity for 5-HT 2C R, such as clozapine, would alter its RNA-editing profile was not confirmed. Whereas haloperidol, a typical antipsychotic drug that is primarily a dopamine receptor antagonist, reduced 5-HT 2C VNV isoform frequency and the level of RNA editing at the D site, risperidone and not the prototype atypical antipsychotic drug clozapine increased the frequency of 5-HT 2C VNV and D-site editing. Our data emphasize that caution is required in the interpretation of RNA-editing data in studies of psychiatric disorders, because these studies usually include subjects who received long-term exposure to medication. This newly established method will facilitate high-throughput investigations of RNA editing in disease pathology and in the pharmacological activity of drugs. The revelation that the human genome comprises between 30,000 and 40,000 protein-coding genes was unexpected, because such few genes are unlikely to explain the functional diversity between humans and less complex organisms. These interspecies differences could arise from post-transcriptional processes such as RNA editing and alternative splicing, which allow a single gene to generate several protein variants. The current study focuses on RNA editing. The recent detection of 1637 potential new substrates for RNA editing Because of their relatively recent discovery, substrates of RNA editing have not been extensively characterized. Adenine-to-inosine RNA editing in mammalian brain has been identified in ionotropic receptors (such as the GluR2 subunit of the ␣-amino-3-hydroxy-5-methylisoxazole-4-propionate receptor) and in the serotonin (5-HT)-2C receptor (R), which is coupled to GTP-binding protein. Discrepancies between genomic DNA and cDNA sequences led to the discovery of nucleotide changes caused by the activity of ADAR enzymes. In the fully edited 5-HT 2C R, three amino acid codons in the pre-mRNA are changed so that the sequence coding for IRNPI becomes VRGP