Meta-epidemiological study of publication integrity, and quality of conduct and reporting of randomized trials included in a systematic review of low back pain.

OBJECTIVE: To comprehensively describe the quality of conduct, reporting, and publication integrity characteristics for all trials included in a large Cochrane review, comparing those published by presumed predatory publishers with those published by nonpredatory publishers. DESIGN: Cross-sectional meta-epidemiological study. STUDY SELECTION: Two hundred seventy-nine studies (25,704 participants) eligible for the recent update of the "Exercise therapy for chronic low back pain" Cochrane review were included. DATA EXTRACTION: Study and manuscript characteristics, including predatory publication status and other quality and integrity characteristics were extracted along with treatment effect. RESULTS: Nine percent of trials included were in presumed predatory publications; 12% in the period since 2010. We found frequency of other concerning characteristics to range from low (eg, plagiarism, 5%) to common (eg, lack of evidence of trial registration or protocol publication [75%]; insufficient sample size [84%]) in included studies. Studies published by presumed predatory publishers consistently had inferior conduct, reporting and publication integrity characteristics. Presumed predatory publication was associated with missing conflict of interest statement (OR 7.6, 95% CI 3.0-19.1), inadequate follow-up duration (OR 11.2, 95% CI 3.7-33.7), incomplete study methods (OR 12.1, 95% CI 2.8-52.2) and baseline reporting (OR 4.3, 95% CI 1.6-11.7), and high risk of bias (OR 2.7, 95% CI 1.2-6.3). All (100%) presumed predatory publications were missing trial registrations (vs. 72%) and had inadequate sample sizes (vs. 82%). Trials published in presumed predatory journals did not appear to have inflated effect sizes. CONCLUSIONS: Predatory publishers pose a distinct challenge to the consumption and synthesis of randomized controlled trials. More work is needed in other clinical areas to understand the potential impact of randomized controlled trials published in predatory publications, and as a result, the potential impact on evidence from systematic reviews that include these studies.

Mu opioid receptors in the medial habenula contribute to naloxone aversion.

The medial habenula (MHb) is considered a brain center regulating aversive states. The mu opioid receptor (MOR) has been traditionally studied at the level of nociceptive and mesolimbic circuits, for key roles in pain relief and reward processing. MOR is also densely expressed in MHb, however, MOR function at this brain site is virtually unknown. Here we tested the hypothesis that MOR in the MHb (MHb-MOR) also regulates aversion processing. We used chnrb4-Cre driver mice to delete the Oprm1 gene in chnrb4-neurons, predominantly expressed in the MHb. Conditional mutant (B4MOR) mice showed habenula-specific reduction of MOR expression, restricted to chnrb4-neurons (50% MHb-MORs). We tested B4MOR mice in behavioral assays to evaluate effects of MOR activation by morphine, and MOR blockade by naloxone. Locomotor, analgesic, rewarding, and motivational effects of morphine were preserved in conditional mutants. In contrast, conditioned place aversion (CPA) elicited by naloxone was reduced in both naïve (high dose) and morphine-dependent (low dose) B4MOR mice. Further, physical signs of withdrawal precipitated by either MOR (naloxone) or nicotinic receptor (mecamylamine) blockade were attenuated. These data suggest that MORs expressed in MHb B4-neurons contribute to aversive effects of naloxone, including negative effect and aversive effects of opioid withdrawal. MORs are inhibitory receptors, therefore we propose that endogenous MOR signaling normally inhibits chnrb4-neurons of the MHb and moderates their known aversive activity, which is unmasked upon receptor blockade. Thus, in addition to facilitating reward at several brain sites, tonic MOR activity may also limit aversion within the MHb circuitry.

Understanding the reasons for decline of HIV prevalence in Haiti.

OBJECTIVES: HIV sero-surveillance rounds and projection estimates suggest a decline of HIV prevalence among pregnant women and the general population in Haiti. This study aimed to evaluate the decline of HIV prevalence and understand the reasons for the decline. METHODS: Following an epidemiological analysis, three mathematical models were used to re-create the national epidemic, calculate HIV incidence, and confirm the decline of HIV prevalence. Declining trends in prevalence data were compared with observed trends in behavioural data. RESULTS: HIV progressed rapidly from initial infection to AIDS and death, with people dying twice as fast as in developed countries. With the rapid progression of the disease and the early intervention efforts in securing the blood supply, prevalence among commercial sex workers and blood donors peaked in the late 1980s followed by a decline in the mid-1990s in the general population. The observed decline among pregnant women and in the general population was confirmed after controlling for confounding variables. The Haitians are well informed: there is an increase in condom use with occasional partners at last contact and in abstinence and fidelity, and a decrease in the number of occasional partners. However, the age of sexual debut is lower and the proportion of sexually active youth has increased. CONCLUSIONS: There is evidence of decline in HIV prevalence among pregnant women, specifically among pregnant women living in urban areas and pregnant women 25 years and older, but not among pregnant women living in rural areas and pregnant women 24 years and younger. Although many factors have acted in synergy to halt the AIDS epidemic in Haiti, the main reasons for decline seem to point to mortality and blood safety intervention efforts in the early stages of the epidemic.

Declines in HIV prevalence can be associated with changing sexual behaviour in Uganda, urban Kenya, Zimbabwe, and urban Haiti.

OBJECTIVE: To determine whether observed changes in HIV prevalence in countries with generalised HIV epidemics are associated with changes in sexual risk behaviour. METHODS: A mathematical model was developed to explore the relation between prevalence recorded at antenatal clinics (ANCs) and the pattern of incidence of infection throughout the population. To create a null model a range of assumptions about sexual behaviour, natural history of infection, and sampling biases in ANC populations were explored to determine which factors maximised declines in prevalence in the absence of behaviour change. Modelled prevalence, where possible based on locally collected behavioural data, was compared with the observed prevalence data in urban Haiti, urban Kenya, urban Cote d'Ivoire, Malawi, Zimbabwe, Rwanda, Uganda, and urban Ethiopia. RESULTS: Recent downturns in prevalence observed in urban Kenya, Zimbabwe, and urban Haiti, like Uganda before them, could only be replicated in the model through reductions in risk associated with changes in behaviour. In contrast, prevalence trends in urban Cote d'Ivoire, Malawi, urban Ethiopia, and Rwanda show no signs of changed sexual behaviour. CONCLUSIONS: Changes in patterns of HIV prevalence in urban Kenya, Zimbabwe, and urban Haiti are quite recent and caution is required because of doubts over the accuracy and representativeness of these estimates. Nonetheless, the observed changes are consistent with behaviour change and not the natural course of the HIV epidemic.

Detection of coproantigen in early trichinellosis.

Trichinellosis has become undoubtedly worldwide in distribution. Its diagnosis relies largely on the serodiagnostic procedures which are of great value but unfortunately miss the enteric phase. This could be a serious diagnostic problem in the absence of corresponding epidemiological data and typical symptoms and signs of the disease. In this study the possibility of coproantigen detection, as an early diagnostic aid in trichinellosis, was investigated in mice experimentally infected with Trichinella spiralis. A modified double sandwich ELISA was developed using polyclonal antibodies raised in rabbits and guinea pigs against larval somatic antigens. The first detection of coproantigen was as early as the first day post infection, gradually increasing to reach its peak on the seventh day and then decreasing to disappear completely on the third week post infection. Another test, the coagglutination test (Co-A) was used, and this test confirmed the previous results. The finding of this study suggest that the coproantigen detection could be exploited to confirm ongoing early Trichinella spiralis infection. This fast and easy to use diagnostic method should improve the early infection in human.

Feasibility of the membrane bioreactor process for water reclamation.

The feasibility of the membrane bioreactor (MBR) process for water reclamation was studied. Process evaluation was based on the following: literature review of MBRs, worldwide survey of MBRs, and preliminary costs estimates. The literature review and the survey have shown that the MBR process offers several benefits over the conventional activated sludge process, including: smaller space and reactor requirements, better effluent water quality, disinfection, increased volumetric loading, and less sludge production. The MBR process can exist in two different configurations, one with the low-pressure membrane modules replacing the clarifier downstream the bioreactor (in series), and the second with the membranes submerged within the bioreactor. Four major companies are currently marketing MBRs while many other companies are also in the process of developing new MBRs. The MBR process operates in a considerably different range of parameters than the conventional activated sludge process. The preliminary cost evaluation has shown that the MBR process is cost competitive with other conventional wastewater treatment processes.

Imaging of atypical hemangiomas of the liver with pathologic correlation.

Compared with the imaging features of typical hepatic hemangiomas, the imaging features of atypical hepatic hemangiomas have not been well studied or well described. Knowledge of the entire spectrum of atypical hepatic hemangiomas is important and can help one avoid most diagnostic errors. A frequent type of atypical hepatic hemangioma is a lesion with an echoic border at ultrasonography. Less frequent types are large, heterogeneous hemangiomas; rapidly filling hemangiomas; calcified hemangiomas; hyalinized hemangiomas; cystic or multilocular hemangiomas; hemangiomas with fluid-fluid levels; and pedunculated hemangiomas. Adjacent abnormalities consist of arterial-portal venous shunt, capsular retraction, and surrounding nodular hyperplasia; hemangiomas can also develop in cases of fatty liver infiltration. Associated lesions include multiple hemangiomas, hemangiomatosis, focal nodular hyperplasia, and angiosarcoma. Types of atypical evolution are hemangiomas enlarging over time and hemangiomas appearing during pregnancy. Complications consist of inflammation, Kasabach-Merritt syndrome, intratumoral hemorrhage, hemoperitoneum, volvulus, and compression of adjacent structures. In some cases, such as large heterogeneous hemangiomas, calcified hemangiomas, pedunculated hemangiomas, or hemangiomas developing in diffuse fatty liver, a specific diagnosis can be established with imaging, especially magnetic resonance imaging. However, in other atypical cases, the diagnosis will remain uncertain at imaging, and these cases will require histopathologic examination.

LIVE/DEAD BacLight : application of a new rapid staining method for direct enumeration of viable and total bacteria in drinking water.

A rapid epifluorescence staining method using the LIVE/DEAD Bacterial Viability Kit (BacLight) was applied to estimate both viable and total counts of bacteria in drinking water. BacLight is composed of two nucleic acid-binding stains: SYTO 9 and propidium iodide. SYTO 9 penetrates all bacterial membranes and stains the cells green, while propidium iodide only penetrates cells with damaged membranes, and the combination of the two stains produces red fluorescing cells. Optimal incubation conditions were found to be 15 to 20 min, at room temperature in the dark. Total (red + green) and viable (green) cells can hence be counted simultaneously. Factors affecting the staining procedure were tested (addition of glutaraldehyde, staining time, chlorine impact). In the absence of stress, BacLight viable counts were comparable and to 5-cyano-2,3-ditolyl tetrazolium (CTC) counts. BacLight total counts were comparable to acridine orange counts (differing by <0.1 log/ml). However, the increase in environmental stresses (chlorine, growth rate or temperature) induced a decrease in viability that was more pronounced for CTC and plate counts than for BacLight viable counts.

Effects of caregiver specialty on cost and clinical outcomes following hospitalization for heart failure.

In 614 consecutive hospitalizations with the primary discharge diagnosis of diagnosis-related group (DRG) 127 (heart failure and shock), we sought to assess the effect of caregiver specialty (generalist, n = 217; cardiologist, n = 397) on hospital costs, length of stay, and in-hospital mortality. Patients treated by cardiologists were younger (68 vs 71 years) and less likely to have hypertension (52% vs 61%), but were more likely to be men (61% vs 44%), require an intensive care stay (13% vs 5%), have coronary artery disease (49% vs 23%), have a left ventricular ejection fraction <40% (74% vs 49%), and have lower systolic (132 vs 146 mm Hg) and diastolic (76 vs 81 mm Hg) blood pressures on admission. Predictors of acute disease severity were similarly distributed between the 2 groups. No difference was found between patients treated by cardiologists versus those treated by generalists with respect to crude or adjusted hospital cost, length of stay, and in-hospital mortality. However, in subsets of patients who required intensive care during hospitalization (n = 64), as well as those who did not (n = 550), care by cardiologists was associated with a lower adjusted hospital cost. Any potential cost savings that could have accrued from care by cardiologists was, however, negated by the higher proportion of patients treated by cardiologists who required intensive care during hospitalization. We conclude that when differences in clinical variables are adjusted, care by cardiologists versus generalists is associated with similar or lower hospital cost for patients with DRG 127. Our findings challenge the notion that in-patient care provided by specialists is more expensive than that provided by generalists.

Role of anti-Trichinella spiralis antibodies and interferon-gamma in the protection against the enteral phase of experimental trichinosis.

Expulsion of adult Trichinella spiralis is the result of a complex immunologically mediated response. Experiments in mice demonstrated that IFN-gamma, released by mesenteric lymph nodes (MLN) during infection play a major role. However, the role of mucosal and serum antibody responses is thought to be limited. Working on the intestinal phase, this study investigated, the role played by antibodies, transferred from vaccinated infected animals, in the immune response in comparison to that obtained by IFN-gamma administration. Transfer of antibodies gave 82.7% protection, while IFN-gamma in a dose of 1 x 10(4) U gave 98.4% protection. The use of half the previous dose induced a protection of 58.3%. These data indicate that vaccination followed by infection could generate antibodies capable of producing a protective immune response against the intestinal phase of T. spiralis. This reached a level near to that obtained by IFN-gamma administration.

Clinical variables affecting recovery of left atrial mechanical function after cardioversion from atrial fibrillation.

OBJECTIVES: We sought to evaluate the effect of clinical factors on recovery of atrial function after cardioversion for atrial fibrillation. BACKGROUND: Lack of effective mechanical atrial function (EMAF) after cardioversion of atrial fibrillation predisposes to thromboembolic complications and delays improvement in functional capacity. METHODS: Fifty-two patients underwent cardioversion (group I, electrical cardioversion, n = 40; group II, pharmacologic or spontaneous cardioversion, n = 12) for atrial fibrillation. Serial transmitral inflow Doppler variables were recorded after cardioversion until EMAF (atrial filling velocity > 0.50 m/s) was seen. Clinical variables (age, duration of atrial fibrillation, left ventricular ejection fraction, left atrial diameter, underlying cardiovascular disease, antiarrhythmic drug therapy and mode of cardioversion) were tested for an association with the outcomes of recovery of atrial function by day 3 and day 7. RESULTS: Effective mechanical atrial function recovered in 68% of patients by day 3 and in 76% by day 7 after cardioversion. The mode of cardioversion was significantly associated with recovery of atrial function by day 3 in bivariate and multivariate analyses (odds ratio 0.12, 95% confidence interval 0.01 to 1.0, for electrical cardioversion). None of the variables had an association with recovery of atrial function by day 7. Group I patients took a longer time to recover atrial function than group II patients (p = 0.012). In addition, group I patients had a significantly lower peak atrial filling velocity (mean [+/-SD] 0.39 +/- 0.19 m/s vs. 0.56 +/- 0.16 m/s) and a higher early filling to atrial filling velocity ratio (2.5 +/- 1.2 vs. 1.5 +/- 0.5) after cardioversion. CONCLUSIONS: A high proportion of patients recover EMAF within 1 week after cardioversion. Patients who undergo electrical cardioversion display a greater degree and a longer duration of mechanical atrial dysfunction than those who convert pharmacologically or spontaneously.

[Post-traumatic hematoma of the duodenum. A case in a young child]. / Hématome post-traumatique du duodénum. Un cas chez un jeune enfant.

We report a case of traumatic duodenal hematoma. The patient's age (2.5 y.) and the absence of evidence of trauma when the symptoms began led to perform plain films of the abdomen, upper GI series, US, CT, and MR. This excess of imaging modalities emphasize the diagnostic value of plain X Rays of the abdomen and opacification of the duodenum.

Detection of Trichinella pseudospiralis antigen in the parenteral phase in experimentally infected mice.

Antigen distribution of T. pseudospiralis in muscles was studied at 10 days, 2,3 and 5 weeks post infection. Immunocytolocalization of antigen in the muscle was performed by peroxidase antiperoxidase (PAP) and immunogold silver staining techniques. Weak positive reaction of the stichosome and the cuticle was observed at 10 days post-infection which increased to attain its highest level in the fully infective stage larvae 3 and 5 weeks post infection. The intensity of staining reaction in the cytoplasm and nucleoplasm of infected host cell and surrounding tissue was highest at 5 weeks p.i. The small nuclei of the host cells and the inflammatory cells were unstained.

Detection of circulating Trichinella pseudospiralis antigen by enzyme linked immunosorbant assay (ELISA).

A modified double antibody sandwich ELISA was used as a sensitive technique for demonstrating the appearance of circulating antigen of T. pseudospiralis in the sera of infected mice. The sera were tested at 5 days, 2, 4, 6, 7, 8, 10 and 12 weeks P.I. The antigen was first detected on the 5th day P.I., its level increased to reach the 1st peak at 4 weeks, then declined at 6 weeks. A second peak was observed at 8th weeks followed by a sharp decline to give negative OD reading at 10th week and increased to a moderate level at 12 weeks P.I.

Detection of Trichinella pseudospiralis antigen in the enteral phase in experimentally infected mice.

The distribution of T. pseudospiralis antigen in tissue sections of the intestine of infected mice was studied at different intervals (10, 21, 35 hours and 10 days post-infection (P.I.). Immunocytolocalization of antigen in the intestine was done by peroxidase antiperoxidase staining technique. Positive staining reaction of the enterocytes was noted in all durations examined. The mononuclear cells of the lamina propria were positively stained at 10 hrs P.I. while patchy staining of muscularis mucosa was observed at 10 days P.I. The present study revealed intense staining reaction in the stichosome and the cuticle of 10 hrs-old larvae L1, the intensity of the reaction decreased throughout the worm development, until it almost disappeared at 10 days P.I. The gut lining and its occupying substance were positive throughout the enteral phase. Intense staining reaction of the hypodermal cells was observed in L2, L3 and adult stage worm. The genital primordium was weakly stained in the larval stages while the male and female reproductive systems were moderately stained at the adult stage.

Scanning electron microscopic study of Trichinella pseudospiralis muscle phase after modulation of host response using an immunostimulant drug.

In a previous study, evident collagen deposition around T. pseudospiralis larvae was noticed after administration of Levamisole to infected mice. The present investigation was undertaken to confirm these findings. Scanning electron microscopic examination revealed multiple clear cystic formations on the surface of the diaphragm muscle. The present investigation was undertaken to confirm these findings. Scanning electron microscopic examination revealed multiple clear cystic formations on the surface of the diaphragm muscle. The presence of such structures was seen to be more frequent when the drug was given as early as the 6th day post infection. Membrane like structure was observed around T. pseudospiralis larvae, an interesting finding which was by far not reported before.

Modulation of host response during infection with Trichinella pseudospiralis using immuno-stimulant drug.

Infection of the mouse with Trichinella pseudospiralis is accompanied by pronounced suppression of host inflammatory response. This study examines the effect of infection with this parasite on one major component of cell mediated immunity: delayed type hypersensitivity (DTH) reaction and the effect of administration of immunostimulant drug (Levamisole) on host response to T. pseudospiralis infection. Serum cortisol levels and the response of skin test to phytohaemagglutinin were used to construct the time table of drug regimen. Three groups were studied; group I (infected mice), group II (received levamisole on day 6 p.i.) and group II (received Levamisole on day 14 p.i.) Early administration of Levamisole restored DTH response to normal and histopathological examination of infected muscles revealed evident collagen deposition around the muscle larvae.

Studies on T. spiralis and T pseudospiralis larvae recovered from mice immunized with heterologous Trichinella antigen.

In this study, S3 antigen of T. spiralis and T. pseudospiralis was given to the heterologous infection in albino mice. The recovered larvae were studied as regards: their number, length and steroscan examination. It was found that vaccination of mice with T. spiralis (S3) antigen induced reduction in T. pseudospiralis larval count by 66.43% and significant reduction in length. Using T. pseudospiralis (S3) antigen reduction of 74.77% in T. spiralis larval count was detected as well as significant reduction in length. Scanning electron microscopic (SEM) examination revealed more or less similar finding in both species: loss of integrity of the cuticle, some of the larvae were attacked by granulocytes mainly eosinophils and few larvae appeared completely destructed with loss of normal architecture. A peculiar finding was noticed in case of T. pseudospiralis larvae in form of fine electron dense deposits giving the cuticular surface a motling appearance.

Determining the prevalence of neurosyphilis in a cohort co-infected with HIV.

A retrospective study of 767 HIV positive patients from a large urban public hospital, 238 of whom were co-infected with syphilis, was performed to determine the prevalence of neurosyphilis. A prevalence of 3% of neurosyphilis in the co-infected cohort was demonstrated. The 7 cases of neurosyphilis ascertained were of the early stage variety, with cranial nerve involvement the predominant focal deficit. Of the 5 cases presenting after initial diagnosis and treatment of syphilis, 4 were felt to be inadequately treated. An overall prevalence of 1% (7/767) was determined for the entire HIV(+) cohort. The majority of the cases of syphilis (90%) were characterized as latent syphilis. Based on these findings, the authors recommend routine CSF examination in all patients who are HIV positive and who present with latent syphilis. Treatment regimens should be maximized in an effort to reduce the prevalence of neurosyphilis in such a co-infected cohort.

Cyclosporin A in experimental trichinosis scanning electron microscopic study.

The surface morphology of adult and larvae of Trichinella spiralis after cyclosporin A treatment was studied by scanning electron microscopy (SEM) of fixed, dried and metal coated specimens. The earliest topographic changes revealed in adults after the drug treatment were in form of disorganization of the cuticle especially between the hypodermal pores which appeared somewhat thickened and irregular. Other changes were in form of bullae formation covering the whole width of the adult surface. Other specimens showed wrinkling of the outer layer that was seen later to peel off. In few worms layer outer was damaged releasing some of the internal organs. Smoothing of the cuticle with obliteration of the grooves between the cuticular ridges were observed as the earliest surface larval changes, ulcer formation which was deeply seated was seen in patchy areas in some specimens. The interaction between the parasite surface and the drug is of significant importance as this can throw light on the possibilities of its mode of action.