Mesangial expansion at 5 years predicts death and death‐censored graft loss after renal transplantation

Death with a functioning graft and death‐censored renal allograft failure remain major problems for which effective preventative protocols are lacking. The retrospective cohort study aimed to determine whether histologic changes on a 5‐year surveillance kidney biopsy predict adverse outcomes after transplantation in recipients who had: both Type 2 diabetes (T2DM) and obesity (BMI ≥ 30 kg/m²) at the time of transplantation (T2DM/Obesity, n = 75); neither (No T2DM/No obesity, n = 78); No T2DM/Obesity (n = 41), and T2DM/No obesity (n = 47). On 5‐year biopsies, moderate‐to‐severe mesangial expansion was more common in the T2DM/Obesity group (Banff mm score ≥2 = 49.3%; Tervaert classification MS ≥ 2b = 26.7%) compared to the other groups (p < .001 for both scores). Risk factors included older age, higher BMI, HbA1C, and triglycerides at 1‐year post‐transplant. Moderate‐to‐severe mesangial expansion correlated with death with function (HR 1.74 (1.01, 2.98), p = .045 Banff and 1.89 (1.01, 3.51) p = .045 Tervaert) and with death‐censored graft loss (HR 3.2 (1.2, 8.8), p = .02 Banff and HR 3.8 (1.3, 11.5), p = .01 Tervaert) over a mean of 11.6 years of recipient follow‐up post‐transplant. These data suggest that mesangial expansion in recipients with T2DM and obesity may reflect systemic vascular injury and might be a novel biomarker to predict adverse outcomes post renal transplant.     

Reporting quality in systematic reviews of in vitro studies: a systematic review

Background: Systematic reviews (SRs) and/or meta-analyses of in vitro research have an important role in establishing the foundation for clinical studies. In this study, we aimed to evaluate the reporting quality of SRs of in vitro studies using the PRISMA checklist.

Method: Four databases were searched including PubMed, Virtual Health Library (VHL), Web of Science (ISI) and Scopus. The search was limited from 2006 to 2016 to include all SRs and/or meta-analyses (MAs) of pure in vitro studies. The evaluation of reporting quality was done using the PRISMA checklist.

Results: Out of 7702 search results, 65 SRs were included and evaluated with the PRISMA checklist. Overall, the mean overall quality score of reported items of the PRISMA checklist was 68%. We have noticed an increasing pattern in the numbers of published SRs of in vitro studies over the last 10 years. In contrast, the reporting quality was not significantly improved over the same period (p?=?.363). There was a positive but not significant correlation between the overall quality score and the journal impact factor of the included studies.

Conclusions: The adherence of SRs of in vitro studies to the PRISMA guidelines was poor. Therefore, we believe that using reporting guidelines and journals paying attention to this fact will improve the quality of SRs of in vitro studies.     

Safety assessment of methanol extract of red dragon fruit (Hylocereus polyrhizus): Acute and subchronic toxicity studies

Recently, the fruits of Hylocereus polyrhizus, known as red dragon fruit, have received much attention from growers worldwide. However, there is little toxicological information regarding the safety of repeated exposure to these fruits. The present study evaluated the potential toxicity of a methanol extract of H. polyrhizus fruit after acute and subchronic administration in rats. In the acute toxicity study, single doses of fruit extract (1250, 2500 and 5000 mg/kg) were administered to rats by oral gavage, and the rats were then monitored for 14 days. In the subchronic toxicity study, the fruit extract was administered orally to rats at doses of 1250, 2500 and 5000 mg/kg/day for 28 days. There was no mortality or signs of acute or subchronic toxicity. There was no significant difference in body weight, relative organ weight or hematological parameters in the subchronic toxicity study. Biochemical analysis showed some significant changes, including creatinine, globulin, total protein and urea levels. No abnormality of internal organs was observed between treatment and control groups. The lethal oral dose of the fruit extract is more than 5000 mg/kg and the no-observed-adverse-effect level (NOAEL) of the extract for both male and female rats is considered to be 5000 mg/kg per day for 28 days.     

Fetal Intra‐pericardial Morgagni Hernia with effusion affecting one member of a twin gestation

Congenital diaphragmatic hernia (CDH) is a rare type of developmental defect of the diaphragm, occurring in 1 per 2000 pregnancies. Morgagni hernia, in particular, which results from an anterior defect of the diaphragm, is the least common type of CDH (5%). Herniation of the liver into the pericardial space, presenting as a thoracic mass with pericardial effusion, is an extremely rare form of Morgagni hernia. Such reported cases are few and occurred only in singleton pregnancies. To the best of our knowledge, we report the first case of fetal echocardiography and fetal MRI following referral due to large pericardial effusion.     

Braden scale for pressure ulcer risk predicts rehabilitation placement after pancreatic resection

BackgroundPatients undergoing pancreatic resection frequently require rehabilitation facilities after hospital discharge. We evaluated the predictive role of validated markers of frailty on rehabilitation facility placement to identify patients who may require this service.MethodsSingle-center retrospective cohort study of patients who underwent pancreatic resection from 2010 to 2015. 90-day morbidity and mortality were calculated. Postoperative validated markers of frailty (Activities of Daily Living scale, Braden scale [assesses pressure ulcer risk, lower scores = higher risk] and Morse fall scale) were evaluated via multivariate regression to identify predictors of discharge to rehabilitation facility.Results470 patients with complete data were included. Mean age was 62 and 49.2% were male. Postoperative median length of stay (LOS) was 8 (IQR 7–10). 92 (19.66%) patients were discharged to rehabilitation facilities and 138 (29.49%) patients were readmitted within 90 days. On multivariate analysis, age, sex, LOS > 8 days, inpatient Comprehensive Complication Index (CCI) and initial Braden scale were predictive of rehabilitation placement.ConclusionA marker of frailty routinely collected daily by nursing staff, the Braden scale, is available to help surgeons predict the need for postoperative rehabilitation placement after pancreatic resection. Engaging discharge planning services for at-risk patients may help prevent delayed hospital discharge and should be further evaluated.     

Assessing the effect of Independent Prescribing for community optometrists and referral rates to Hospital Eye Services in Scotland

IntroductionSince 2010, General Ophthalmic Services (GOS) legislation and Independent Prescribing (IP) enable community optometrists to manage primary eye conditions. No studies have assessed the effect of IP. We wished to determine the distribution of IP optometrists and associated hospital referral rates across Scotland.MethodsIn 2019, FOI requests (General Optical Council and NHS Education Scotland) identified all registered IP optometrists in Scotland and their registered postcodes. Data regarding community eye examinations and referrals to HES since 2010 were gathered via Information Services Division of NHS Scotland.ResultsAs of March 2019, there were 278 IP optometrists in Scotland (278/1189; 23.4%). Two hundred eighteen IP optometrists work in 293 practices across 11 of Scotland’s 14 health boards. There was a strong correlation (r = +0.96) between population density and number of IP optometrists. Fifty-six percent of IP optometrists work in the two most deprived quintiles. Since IP’s introduction, there has been a marked increase in anterior segment supplementary visits (+290%). Optometry referrals to GPs have reduced by 10.5%, but referrals to HES have increased by 118% (to 96,315). There was no correlation between quantity of IP optometrists and referral rates to HES (r = −0.06, 95% CI −0.64 to 0.56, p = 0.86).ConclusionsThis is the first analysis of IP optometrists and associated referral rates in Scotland. Despite good geographical distribution and increased supplementary attendances, optometric referrals to HES have doubled and continue to rise. We propose a ratio of primary, supplementary, non-referral and referral rates to discern the true impact of IP versus non-IP community optometric behaviour.Subject terms: Education, Corneal diseases, Health occupations     

Similar hand shaping in reaching-for-food (skilled reaching) in rats and humans provides evidence of homology in release, collection, and manipulation movements

Many animal species use their forelimbs to assist in eating, such as occurs in a reach-to-eat task (skilled reaching) in which a forelimb is extended to grasp food that is placed in the mouth for eating. It is unclear the extent to which the skilled reaching movements of different species share common ancestry and so are homologous or evolved independently and so are analogous (homoplasy). Here hand shaping (the movements of the hand and digits) that occur as the hand is transported to the target, were examined using high-speed (1000 frames/s) video recording and kinematic measurement (Peak Motus) in the rat (Rattus norvegicus) and human (Homo sapiens). Ten movement similarities were identified from the point that the limb initiated transport towards the food item to the point that the food was grasped. The digits were closed and semi-flexed as the hand was lifted (released from a substrate) and supinated. They closed further as the hand was collected for aiming. They then extended as the hand was transported to the target and then opened in conjunction with pronation to orient the hand for grasping (manipulation). Finally the digits were flexed and closed for grasping. These movements occurred at approximately the same point of limb transport in both species even though the rat used a whole paw grasp and the humans used a pincer grasp. Bushbabies (Galago garnettii), titi monkeys (Callicebus brunneus), rhesus monkeys (Macaca mulatta) and the bonobo (Pan paniscus) displayed similar hand shaping in skilled reaching despite species differences in grasping movements. Homologous hand shaping in the rodent clade and the primate clade and within the primate lineage is discussed in relation to its possible derivation from hand shaping movements associated with stepping.