Improvement of quality of reporting in randomised controlled trials to prevent hypotension after spinal anaesthesia for caesarean section

Hypotension is a frequent complication of spinal anaesthesia for caesarean section and can threaten the well-being of the unborn child. Numerous randomised controlled trials (RCTs) dealt with measures to prevent hypotension. The aim of this study was to determine the reporting quality of RCTs using the Consolidated Standards of Reporting Trials (CONSORT) statement since low quality can lend false credibility to a study and overestimate the effect of an intervention. We performed a systematic literature search in PubMed to identify relevant RCTs in a pre-CONSORT period (1990–1994) and a post-CONSORT period (2004–2008). A comparative evaluation was done between the two periods, and the trials were assessed for compliance with each of the 22 CONSORT items. A total of 37 RCTs was identified. The CONSORT score increased significantly (p < 0.05) from 66.7% (±12.5%) in the pre-CONSORT period to 87.4% (±6.9%) in the post-CONSORT period. A statistically significant improvement was found for eight items, including randomization, blinding and intention-to-treat analysis. The CONSORT score in the post-CONSORT era was fairly good, also in comparison to other medical fields. In the post-CONSORT era, reporting of important items improved, in particular in the domains that are crucial to avoid bias and to improve internal validity. Use of CONSORT should be encouraged in order to keep or even improve the reporting quality

A combined first and second order variational approach for image reconstruction

In this paper we study a variational problem in the space of functions of bounded Hessian. Our model constitutes a straightforward higher-order extension of the well known ROF functional (total variation minimisation) to which we add a non-smooth second order regulariser. It combines convex functions of the total variation and the total variation of the first derivatives. In what follows, we prove existence and uniqueness of minimisers of the combined model and present the numerical solution of the corresponding discretised problem by employing the split Bregman method. The paper is furnished with applications of our model to image denoising, deblurring as well as image inpainting. The obtained numerical results are compared with results obtained from total generalised variation (TGV), infimal convolution and Euler's elastica, three other state of the art higher-order models. The numerical discussion confirms that the proposed higher-order model competes with models of its kind in avoiding the creation of undesirable artifacts and blocky-like structures in the reconstructed images -- a known disadvantage of the ROF model -- while being simple and efficiently numerically solvable.Comment: 34 pages, 89 figure

Sensitivity to heat in MS patients: a factor strongly influencing symptomology - an explorative survey

<p>Abstract</p> <p>Background</p> <p>Many individuals diagnosed with Multiple Sclerosis (MS) are sensitive to increased body temperature, which has been recognized as correlating with the symptom of fatigue. The need to explore this association has been highlighted. The aim of this study was to investigate the occurrence of heat sensitivity and its relations to disease course, disability, common MS-related symptoms and ongoing immunosuppressive treatments among individuals 65 years of age or younger diagnosed with MS.</p> <p>Methods</p> <p>A cross-sectional designed survey was undertaken. A questionnaire was sent to MS-patients with an Expanded Disability Status Score (EDSS) in the interval of 0-6.5 and who were between 20 and 65 years of age, living in an eastern region of Sweden (n = 334). Besides occurrence of heat sensitivity (Yes/No) and corresponding questions, the Fatigue Severity Scale (FSS), the MS-related symptom checklist and the Perceived Deficit Questionnaire (PDQ) were included. Data were analysed in relation to data level using Chi-square, Mann Whitney U-test, and Student's t-test. Pearson's and Spearman's correlations were calculated. In the logistic regression analyses (enter) dichotomized MS-symptoms were used as dependent variables, and EDSS, disease-course, time since onset, heat-sensitivity, age and sex (female/male) were independent variables. In the linear regression analyses, enter, mean FSS and summarized PDQ were entered as dependent variables and EDSS, disease-course, time since onset, heat sensitivity, age and sex (female/male) were independent variables.</p> <p>Results</p> <p>Of the responding patients (n = 256), 58% reported heat sensitivity. The regression analyses revealed heat sensitivity as a significant factor relating not only to fatigue (p < 0.001), but also to several other common MS symptoms such as pain (p < 0.001), concentration difficulties (p < 0.001), and urination urgency (p = 0.009).</p> <p>Conclusions</p> <p>Heat sensitivity in MS patients is a key symptom that is highly correlated with disabling symptoms such as fatigue, pain, concentration difficulty and urination urgency.</p

Evidence for an association of HLA-DRB1*15 and DRB1*09 with leprosy and the impact of DRB1*09 on disease onset in a Chinese Han population

<p>Abstract</p> <p>Background</p> <p>Human leukocyte antigens (HLAs) have been proposed to modulate the immune response to <it>Mycobacterium leprae</it>. The association of HLA-DRB1 with leprosy has been reported in several populations, but not in a Chinese population.</p> <p>Methods</p> <p>The polymerase chain reaction-sequence-specific oligonucleotide probe with Luminex100 (PCR-SSOP-Luminex) method was used to genotype HLA-DRB1 alleles in 305 leprosy patients and 527 healthy control individuals.</p> <p>Results</p> <p>The HLA-DRB1*15 allele was significantly more prevalent among leprosy patients than healthy controls, whereas the frequency of the HLA-DRB1*09 allele was lower among leprosy patients, especially those with early-onset disease.</p> <p>Conclusion</p> <p>HLA-DRB1 alleles are associated with leprosy susceptibility in a Chinese population. The HLA-DRB1*09 allele was found to be protective exclusively in a subset of early-onset leprosy patients.</p

Nonlinear multigrid methods for total variation image denoising

The liver cell entry of enalaprilat, the polar, pharmacologically active dicarboxylic acid metabolite arising from esterolysis of enalapril, a new angiotensin-converting enzyme inhibitor, was examined in the perfused rat liver by use of the multiple-indicator dilution technique. [Phenylpropyl-2,3-3H]enalaprilat was injected into the portal vein in a bolus of blood containing 51Cr-labeled red blood cells (a vascular reference) and 125I-labeled albumin and [14C]sucrose (interstitial references that do not enter cells), with observation of the time courses of their outflow into the hepatic venous blood. A quantitative evaluation of the data was carried out by use of the barrier-limited, space-distributed variable transit time model (C.A. Goresky, G.G. Bach, and B. E. Nadeau, J. Clin. Invest. 52:991-1009, 1973). For data up to 60 s after injection, the transfer coefficients for influx, efflux, and sequestration were 0.018 +/- 0.004 (means +/- SD), 0.044 +/- 0.017, and 0.033 +/- 0.007 s-1, respectively. The influx permeability surface area product (influx clearance) per gram was 0.0057 +/- 0.0013 ml.min-1.g-1, and the rapidly accessible cellular equilibrium distribution space for enalaprilat was 0.137 +/- 0.022 ml water/g wet wt. At times beyond 60 s, the fitted data deviated systematically from the experimental data, suggesting the presence of an additional intracellular pool. With this addition, the coefficients for transfer between the intracellular pools were 0.0150 +/- 0.0045 s-1 for the direction cytoplasmic pool (pool 1)----additional pool (pool 2) and 0.0234 +/- 0.0069 s-1 for the opposite direction, and the fitted volumes of pools 1 and 2 became 0.126 +/- 0.021 and 0.082 +/- 0.018 ml/g, the total accessible cellular distribution space became 0.208 +/- 0.036 ml/g wet wt, and the sequestration transfer coefficient became 0.027 +/- 0.007 s-1. The data indicate that, as previously postulated (I. A. M. de Lannoy and K. S. Pang, Drug Metab. Dispos. 14: 513-520, 1986), the enalaprilat flux across liver cell membranes is retarded by a diffusional barrier. The results also indicate that enalaprilat is excluded from part of the volume of hepatocytes, as expected for an anionic compound crossing the membrane in charged rather than protonated form, given the negative electrical potential of the cytosol vs. the extracellular space