RESUMO
PURPOSE: This systematic review (SR) assessed the efficacy, safety and cost-effectiveness of cell-based therapy to manage limbal stem cell deficiency (LSCD), a sight-threatening orphan condition most frequently associated with severe chemical or thermal burns. LSCD has historically been treated by transplanting limbal tissue. In 1997, a new treatment, cultured limbal epithelial autografts, was described for unilateral LSCD. In cases of bilateral disease cultured autologous oral mucosa stem cells have been used. The relative efficacy of different cultured tissue procedures is unknown. METHODS: A protocol was registered with PROSPERO (CRD42017081117). Searches were conducted in 14 databases and 6 conference websites. Two reviewers independently selected studies, conducted data extraction and assessed risk of bias. One reviewer extracted individual patient data (IPD); a second checked extracted data. Data were assessed to determine the feasibility of statistical analysis, with Bayesian synthesis used to estimate improvement achieved by different treatments. RESULTS: Fifty-two studies were eligible for inclusion (1113 eyes); 41 studies (716 eyes) reported IPD. No evidence was identified on cost-effectiveness. This SR was unable to confirm that any of the types of ex vivo cultured stem cell transplants identified for LSCD treatment were statistically superior when assessed against the outcomes of interest. CONCLUSIONS: We believe this SR is the first to include IPD analysis of LSCD data. There is no evidence for the superiority of any method of limbal stem cell transplant. Confirmation of the safety and efficacy of this treatment modality is challenging due to heterogeneity within and between the studies identified. Therefore, recommendations for future research are proposed.
Assuntos
Doenças da Córnea , Epitélio Corneano , Limbo da Córnea , Teorema de Bayes , Humanos , Transplante de Células-Tronco , Células-Tronco , Transplante AutólogoRESUMO
SUMMARY: The occurrence of Anaplasma phagocytophilum was investigated in spleen and serum samples from Swedish moose (Alces alces) in southern Sweden (island and mainland). Samples were analysed for presence of A. phagocytophilum DNA by real-time PCR (n = 263), and for Anaplasma antibodies with ELISA serology (n = 234). All serum samples had antibodies against A. phagocytophilum. The mean DNA-based prevalence was 26·3%, and significant (P < 0·01) temporal, and spatial variation was found. Island moose had significantly (P < 0·001) higher prevalence of A. phagocytophilum DNA than moose from the mainland areas. Two samples were sequenced to determine genetic variation in the 16S rRNA and groESL genes. Genetic sequence similarity with the human granulocytic anaplasmosis agent, equine granulocytic ehrlichiosis agent, and different wildlife-associated A. phagocytophilum variants were observed in the 16S rRNA and groESL genes. Our study shows that moose are exposed to A. phagocytophilum in Sweden, and represent a potential wildlife reservoir of the pathogen.
Assuntos
Anaplasma phagocytophilum/isolamento & purificação , Cervos , Ehrlichiose/veterinária , Anaplasma phagocytophilum/genética , Animais , Anticorpos Antibacterianos/sangue , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Chaperoninas/genética , Chaperoninas/metabolismo , DNA Bacteriano/genética , Reservatórios de Doenças , Ehrlichiose/epidemiologia , Ehrlichiose/microbiologia , Ensaio de Imunoadsorção Enzimática/veterinária , Feminino , Regulação Bacteriana da Expressão Gênica , Variação Genética , Masculino , RNA Bacteriano/genética , RNA Bacteriano/isolamento & purificação , RNA Ribossômico 16S/genética , Reação em Cadeia da Polimerase em Tempo Real/veterinária , Suécia/epidemiologia , Fatores de TempoRESUMO
At the Swedish Institute for Communicable Disease Control, statistical models based on queries submitted to a Swedish medical website are used as a complement to the regular influenza surveillance. The models have previously been shown to perform well for seasonal influenza. The purpose of the present study was to evaluate the performance of the statistical models in the context of the influenza A(H1N1)2009 pandemic, a period when many factors, for example the media, could have influenced people's search behaviour on the Internet and consequently the performance of the models. Our evaluation indicates consistent good reliability for the statistical models also during the pandemic. When compared to Google Flu Trends for Sweden, they were at least equivalent in terms of estimating the influenza activity, and even seemed to be more precise in estimating the peak incidence of the influenza pandemic.
