Systematic reviews and quality assessment of patient-reported outcome measures for physical function in comparative effectiveness studies regarding acute postoperative pain after total knee arthroplasty-Do we need to start all over again?

BACKGROUND AND OBJECTIVE: Recently, a consensus process specified a core outcome set (COS) of domains to be assessed in each comparative effectiveness research and clinical practice related to acute postoperative pain. Physical function (PF) was one of these domains. The aim of this review was to investigate which patient-reported outcome measures (PROMs) are used to assess PF after total knee arthroplasty (TKA) in clinical trials and if they fulfil basic requirements for a COS of PROMs based on their psychometric properties. METHODS: A systematic review of randomized controlled trials and observational studies based on a search in MEDLINE, EMBASE and CENTRAL was undertaken. PROMs and performance measures were extracted and investigated, including evaluation of psychometric properties of PROMs based on COSMIN recommendations. RESULTS: From initially 2896 identified records, 479 studies were included in the qualitative synthesis. Only 87 of these trials (18%) assessed PF using PROMs, whereas especially performance outcome measures were used in 470 studies (98%). Application of the 'COSMIN Risk-of-Bias-Box 1' to 13 of the 14 identified PROMs resulted in insufficient content validity of the included PROMs regarding the target population based on the inauguration or development articles. CONCLUSION: Our data indicate that a patient-centred postoperative assessment of PF in pain-related clinical trials early after TKA is not common, even though patient-reported assessment is widely recommended. In addition, none of the applied PROMs shows content validity based on their inauguration or development articles for the assessment of postoperative pain-related PF after TKA. SIGNIFICANCE: A systematic search for patient-reported outcome measures assessing postoperative, pain-related physical function after total knee arthroplasty in clinical trials and assessment of their content validity revealed none that fulfilled requirements based on COSMIN recommendations.

Multiscale simulation of plasma flows using active learning.

Plasma flows encountered in high-energy-density experiments display features that differ from those of equilibrium systems. Nonequilibrium approaches such as kinetic theory (KT) capture many, if not all, of these phenomena. However, KT requires closure information, which can be computed from microscale simulations and communicated to KT. We present a concurrent heterogeneous multiscale approach that couples molecular dynamics (MD) with KT in the limit of near-equilibrium flows. To reduce the cost of gathering information from MD, we use active learning to train neural networks on MD data obtained by randomly sampling a small subset of the parameter space. We apply this method to a plasma interfacial mixing problem relevant to warm dense matter, showing considerable computational gains when compared with the full kinetic-MD approach. We find that our approach enables the probing of Coulomb coupling physics across a broad range of temperatures and densities that are inaccessible with current theoretical models.

Homocysteine enriched diet leads to prolonged QT interval and reduced left ventricular performance in telemetric monitored mice.

BACKGROUND AND AIMS: Homocysteine (Hcy) is a sulfur-containing, non-protein amino acid produced in the metabolic pathway of methionine. Hyperhomocysteinemia is associated with cerebro- and cardiovascular disease in industrialized countries, mostly resulting from protein rich diet and sedentary life style. Matrix metalloproteinases are involved in cardiac remodeling, leading to degradation of intercellular junctions, cardiac connexins and basement membranes. The study was designed to investigate the relationship between Hcy, cardiac remodeling, cardiac performance, and rhythm disturbances in an animal model of hyperhomocysteinemia. We tested the hypothesis that induction of matrix metalloproteinase-2 and matrix metalloproteinase-9 leads to connexin 40, connexin 43, connexin 45 expression changes contributing to decreased cardiac performance and disturbed atrioventricular conduction. METHODS AND RESULTS: Hcy was added to drinking water of male C57/BL6J mice to achieve moderate Hcy blood levels. ECG was monitored in conscious mice with a telemetric ECG device; echocardiography was used for assessment of left ventricular function. Immunoblotting was used to evaluate matrix metalloproteinase-2, matrix metalloproteinase-9, connexin 40, connexin 43, and connexin 45 expression in cardiac tissue. Animals fed Hcy showed significant prolongation of QRS, QTc, and PR intervals along with reduced left ventricular function. Western blotting showed increased expression of matrix metalloproteinase-2, matrix metalloproteinase-9 and decreased expression of connexin 40, 43, and 45. CONCLUSION: Hcy has been identified as a nutritional factor contributing to cardiovascular disease. Cardiac remodeling induced by matrix metalloproteinase-2 and matrix metalloproteinase-9 and decreased expression of connexin 40, 43, and 45 appears to play a role in the pathomechanism of atrioventricular conduction delay and ventricular dilatation in hyperhomocysteinemia.

[The incidence of Frey syndrome following parotidectomy: results of a survey and follow-up]. / Inzidenz des Frey-Syndroms nach Parotidektomie: Ergebnisse einer Befragung und Nachuntersuchung.

BACKGROUND: Frey's syndrome (FS) is defined as facial sweating due to gustatory stimuli following surgery or trauma of the parotid gland. Concomitant symptoms may occur in the area of the auriculotemporal nerve: swelling, facial flushing, and paresthesia. A misguided re-innervation of perspiratory glands by secretory parasympathetic fibres is likely responsible in the pathogenesis. The reported incidence in the literature varies considerably from 1.7% to 97.6%. The present study aims to clarify the incidence of FS. PATIENTS AND METHODS: A questionnaire was sent to 221 consecutive patients who underwent parotidectomy between 07/2005 and 07/2008. No selection for type of parotidectomy or histological result was made. Patients were invited to undergo a follow-up examination including Minor's iodine starch test. RESULTS: A total of 135 of 221 (61%) questionnaires were available for evaluation. In all, 82 patients took part in the follow-up, with a follow-up period of 2.8 years (15-51 months). According to the questionnaire, 54% of patients claimed to be free of symptoms. Sweating following gustatory stimuli was reported by 23% of patients. Of the 82 Minor's tests performed, 62.2% were positive. All patients with subjective presence of FS had a positive Minor's test. In 27%, Minor's test was positive although patients did not suffer from facial sweating subjectively ("subclinical FS"). In all, 39% had no subjective complaints and Minor's test was also negative. Cases with a positive Minor's test showed no statistically significant relation to the patients' age, gender or to the histological diagnosis or type of parotidectomy. CONCLUSION: The clinical incidence of FS in our study is 23%, although a positive Minor's iodine starch test was observed in 62% of cases. Therefore, it seems justifiable to differentiate between a symptomatic or clinical FS and a merely asymptomatic or subclinical FS. No correlation was observed between epidemiological factors and the occurrence of FS.

[Value of nerve monitoring in thyroid surgery]. / Stellenwert des Nervenmonitorings für die Schilddrüsenchirurgie.

Aim of this study is to investigate the influence of nerve monitoring for protection of recurrent nerve function in thyroid surgery. We analysed retrospectively the data of 369 patients, who underwent thyroid surgery at our clinic between 2000 and 2006. In 129 cases (35%) a hemithyroidectomy and in 236 cases (64%) a total thyroidectomy were performed. A single node in the isthmus was removed in 4 patients. In thyroidectomy we strove for identification of the recurrent nerve. This was performed successful in 96% (577 of 601) of the cases. In 94% of all thyroid surgeries nerve monitoring (NIM-Response/Medtronic) to watch the recurrent nerve were used. In 5 cases (0.83%) a permanent recurrent laryngeal nerve paralysis occurred. There was temporary recurrent laryngeal nerve paresis in 11 cases (1.84%). The use of nerve monitoring could not significantly lower the risk for laryngeal nerve paralysis or paresis (Fischer's exact test, p>0.05). As expected we found no influence of nerve monitoring on other surgical complications. The apply of intraoperative nerve monitoring is a useful tool in thyroid surgery and is described to lower the risk of recurrent laryngeal nerve damage, but to our opinion it does not replace the intraoperative preparation of the recurrent laryngeal nerve. Sound anatomical knowledge of the head- & neck region is an important requirement for save thyroid surgery.

Comparison of opiate addicts' reports of psychiatric history with reports of significant-other informants.

This study compares self-reports by a sample of 50 opiate addicts with reports of 50 "significant other" informants, on past and current functioning. Moderate to high levels of agreement are found using the Intraclass Correlation Coefficient (ICC) in reporting current opiate use, current employment, and current legal pressures. This finding is consistent with previous studies which found good agreement between addicts and informants in these areas. However, much poorer agreement between addicts and informants is found in assessing the severity of addict's social, employment, and psychological problems, and in assessing the more detailed aspects of drug use. A comparison of the percent agreement data with ICC data used in this study provides empirical support for the argument that percent agreement data represents an inflated estimate of concordance between raters. These findings suggest that addicts and their families have rather divergent perceptions of the addict's problems and, in addition, indicate the value of including family members or significant others in the process of evaluating and treating opiate addicts. The results of the statistical analysis underscore the need in reliability studies of rigorous statistics that take into account chance agreement.