The developing world of pre-operative optimisation: a systematic review of Cochrane reviews

Pre-operative optimisation is a heterogenous group of interventions aimed at improving peri-operative outcomes. To understand the evidence for pre-operative optimisation in the developing world, we systematically reviewed Cochrane reviews on the topic according to the Human Developmental Index (HDI) of the country where patient recruitment occurred. We used summary statistics and cartograms to describe the HDI, year of publication, timing of pre-operative intervention and risk of bias associated with each included trial. We assessed the impact of multinational trials on the risk of bias introduced by countries of differing HDI. Four-hundred and nine trials representing 51 countries and 89,389 randomly allocated participants were summarised in this review. Four-hundred and nineteen out of 451 (93%) trial populations (i.e. a group of study participants from one country) were from high and very high HDI countries. The median (IQR [range]) HDI of countries were 0.862 (0.806–0.892 [0.445–0.949]). Three of the 409 included trials were multinational, representing 32 countries and 37,736 out of 89,389 (42.2%) included participants. Africa was the least represented continent, with only 4 included trials and 566 participants, of which 62.3% were from one multinational trial. The overall risk of bias was high or unclear in 381 out of 409 (93%) trials. Inclusion of multinational trials decreased the proportion of trial populations introducing high or unclear risk of bias by 9.4% (95%CI 5.1–13.7; p < 0.0001). Half of the world's population live in low- and middle-HDI countries. This population is poorly represented in systematically reviewed evidence on pre-operative optimisation. Multinational trials increase the knowledge contribution from low- and middle-HDI countries and decrease risk of bias in systematic reviews.     

地黄不同炮制品薄层色谱鉴别方法的建立

目的:建立地黄不同炮制品的薄层色谱鉴别方法。方法:以D-果糖、梓醇、蔗糖、棉子糖、水苏糖、蜜二糖及甘露三糖为对照品,考察提取溶剂(水,20%甲醇,50%甲醇,80%甲醇),展开剂(正丁醇-甲醇-三氯甲烷-冰乙酸-水,乙酸乙酯-吡啶-冰乙酸-水,正丁醇-冰乙酸-水),显色剂(苯胺-二苯胺-磷酸溶液,茚三酮溶液),点样量(2,4,6μL),检视条件(日光,日光底部灯,365 nm和254 nm)对薄层色谱分析的影响,确定生地黄及熟地黄饮片的供试品溶液制备方法和最佳薄层色谱条件。结果:采用薄层色谱高效硅胶G板,以正丁醇-甲醇-三氯甲烷-冰乙酸-水(13∶5∶5∶1∶2)为展开剂展开,喷以苯胺-二苯胺-磷酸溶液,110℃下加热显色,于日光底部灯下进行检视,所得地黄不同炮制品薄层色谱分离效果和显色效果较佳,斑点清晰且特征性好。结论:该薄层色谱鉴别方法操作简便易行,定性特征明显、结果直观,可有效鉴别地黄不同炮制品,并可为熟地黄的炮制终点确定提供实验依据。     

Exploring maximizing,satisficing and minimizing tendency in decision-making among autistic and neurotypical individuals

BackgroundThe tendency to maximize is one of the most frequently studied personal traits in choice-making and decision-making. In spite of the large resemblances between the decision behaviour that is characteristic for maximizers and the decision behaviour displayed by individuals with autism, and the considerable overlap in the list of decision problems and decision experiences commonly reported by maximizers and individuals with autism, the question whether individuals with autism are more maximizing in decision-making as compared to neurotypical controls, has remained unexamined in the literature. The paper measures and compares the tendency to maximize, satisfice, and minimize in choice- and decision-making among autistic individuals and age, gender- and education degree-matched neurotypical individuals.MethodThe Decision Making Tendency Inventory measurement scale (Misuraca et al., 2015) is used to measure six types of decision-making tendency: fearful maximizing, resolute maximizing, more ambitious satisficing, less ambitious satisficing, parsimonious minimizing, and indolent minimizing. A multi-group confirmatory factor analysis and comparison of the differences in latent means is performed.ResultsThe results demonstrate that autistic individuals are similar to neurotypical individuals when it comes to having a tendency to satisfice or minimize in decision-making, however, autistic individuals do score higher in terms of adopting a fearful and resolute maximizing tendency than neurotypical individuals.ConclusionsResults suggest that higher maximizing tendency may explain for some of the difficulties experienced by autistic individuals in decision-making     

阿萨伊油、醇提及水提物对虚热及虚寒小鼠温度趋向性及代谢水平的影响

通过考察阿萨伊油、醇提物和水提物等拆分组分对虚热及虚寒证小鼠的温度趋向性动物行为学表征,环核苷酸及代谢水平等内在生化指标的影响,探讨阿萨伊各拆分组分的寒热药性特点以及寒凉的物质基础。将昆明种雄性小鼠随机分为空白组、虚热模型组、虚热+阿萨伊冻干原粉组、虚热+阿萨伊油组、虚热+阿萨伊醇提物组、虚热+阿萨伊水提物组、虚寒模型组、虚寒+肉桂组、虚寒+阿萨伊冻干原粉组、虚寒+阿萨伊油组、虚寒+阿萨伊醇提物组、虚寒+阿萨伊水提物组共12个组。虚热组小鼠每天下午灌胃给予甲状腺片溶液160 mg·kg-1,虚寒组小鼠给予氢化可的松溶液25 mg·kg-1,连续14 d,各给药组灌胃相关药物,实验结束后测定动物温度趋向性、环核苷酸及代谢水平等相关指标。阿萨伊醇提物同阿萨伊原粉一致,表现出对虚热模型小鼠的调整作用;阿萨伊油及其水提物同肉桂一致,表现出对虚寒模型小鼠的调整作用。该研究基于中药性味可拆分理论,采用同类比较异类反证的方法证明了阿萨伊醇提物性偏凉,油及其水提物性偏温的特征,并明确了醇提物为阿萨伊性凉的物质基础。     

In vivo characterization of emerging white matter microstructure in the fetal brain in the third trimester

The third trimester of pregnancy is a period of rapid development of fiber bundles in the fetal white matter. Using a recently developed motion‐tracked slice‐to‐volume registration (MT‐SVR) method, we aimed to quantify tract‐specific developmental changes in apparent diffusion coefficient (ADC), fractional anisotropy (FA), and volume in third trimester healthy fetuses. To this end, we reconstructed diffusion tensor images from motion corrected fetal diffusion magnetic resonance imaging data. With an approved protocol, fetal MRI exams were performed on healthy pregnant women at 3 Tesla and included multiple (2–8) diffusion scans of the fetal head (1–2 b = 0 s/mm² images and 12 diffusion‐sensitized images at b = 500 s/mm²). Diffusion data from 32 fetuses (13 females) with median gestational age (GA) of 33 weeks 4 days were processed with MT‐SVR and deterministic tractography seeded by regions of interest corresponding to 12 major fiber tracts. Multivariable regression analysis was used to evaluate the association of GA with volume, FA, and ADC for each tract. For all tracts, the volume and FA increased, and the ADC decreased with GA. Associations reached statistical significance for: FA and ADC of the forceps major; volume and ADC for the forceps minor; FA, ADC, and volume for the cingulum; ADC, FA, and volume for the uncinate fasciculi; ADC of the inferior fronto‐occipital fasciculi, ADC of the inferior longitudinal fasciculi; and FA and ADC for the corticospinal tracts. These quantitative results demonstrate the complex pattern and rates of tract‐specific, GA‐related microstructural changes of the developing white matter in human fetal brain.     

Developing collaborative approaches to international research: Perspectives of new global health researchers

Within a global context of growing health inequities, the fostering of partnerships and collaborative research have been promoted as playing a critical role in tackling health inequities and health system problems worldwide. Since 2004, the Canadian Coalition for Global Health Research (CCGHR) has facilitated annual Summer Institutes for new global health researchers aimed at strengthening global health research competencies and partnerships among participants. We sought to explore CCGHR Summer Institute alumni perspectives on the Summer Institute experience, particularly on the individual research pairings of Canadian and low- and middle-income countries researchers that have characterised the program. The results reveal that the Summer Institute offered an enriching learning opportunity for participants and worked to further their collaborative projects through providing dedicated one-on-one time with their international research partner, feedback from colleagues from around the world and mentorship by more senior researchers. Positive individual relationships among researchers, as well as the existence of institutional collaborations, employer and funding support, and agendas of local and national politicians were factors that have influenced the ongoing collaboration of partners. There is a need to more fully examine the interplay between individual and institutional-level collaborations, as well as their social and political contexts.     

Identifying signatures of the impact of rotavirus vaccines on hospitalizations using sentinel surveillance data from Latin American countries

BackgroundPassive surveillance data are often the only available source of data that can be used to evaluate the population-level impact of vaccination, but such data often suffer from important limitations such as changes in surveillance efforts. This study provides an example of how to identify important signatures of rotavirus vaccine impact, including evaluating the overall effectiveness and changes in rotavirus seasonal dynamics.MethodsWe used data from a standardized sentinel rotavirus surveillance network in six Latin American countries (Bolivia, El Salvador, Guatemala, Honduras, Paraguay, and Venezuela) from 2004 to 2017. A random-effects model was used to evaluate changes in the proportion of rotavirus-associated hospitalizations following vaccine introduction. Harmonic regression models were used to estimate vaccine impact on the number of rotavirus hospitalizations, controlling for trends in rotavirus-negative cases. Changes to rotavirus seasonality were evaluated using center of gravity analysis, wavelet analysis, and harmonic regression.ResultsAll countries observed declines in the proportion of rotavirus-positive acute diarrhea samples with a mean reduction of 16% (95% confidence interval: 10–22%). We estimate that each 10% increase in vaccine coverage was associated with declines in the number of rotavirus-positive cases, ranging from 4.3% (1.3–7.2%) in Honduras to 21.4% (16.8–25.9%) in Venezuela. The strength of the seasonal peak in rotavirus incidence became smaller after vaccine introduction in Guatemala, Honduras, and Venezuela. Seasonal peaks also shifted later in the surveillance year, especially in higher-mortality countries.ConclusionsThe combination of methods we applied have different strengths that allow us to identify common signatures of rotavirus vaccine impact.     

Preoperative Patient Education Class During an Orthopedic Mission Trip: Effects on Knowledge,Anxiety, and Informed Consent

BackgroundPatient knowledge about arthritis and risks, benefits, and outcomes of joint arthroplasty in developing countries is unknown. We evaluated the effectiveness of a preoperative class on improving knowledge and decreasing anxiety during a surgical mission trip offering total joint arthroplasty.MethodsA team of US health care providers taught a preoperative class to 41 patients selected for total joint arthroplasty during a surgical mission trip to Guyana. Participants completed a 32-point survey about arthritis; indications, risks, and benefits of joint arthroplasty; and postoperative, in-patient rehabilitation expectations. The State-Trait Anxiety Inventory was used to measure participant anxiety. Participants completed identical surveys before and after class. Matched-pairs Student t tests were used to compare means between preclass and postclass surveys. Significance was accepted at P < .05.ResultsSeventy-eight percent of patients (31 of 41) scored less than 12 of 32 possible points (40%) on the preclass knowledge questionnaire. Mean ± standard deviation knowledge scores improved from 14.0 ± 4.5 before the class to 16.5 ± 6.5 after the class (P = .008). Anxiety scores (n = 33) improved from 35 ± 13 before the class to 33 ± 12 after the class (P = .047).ConclusionOn this surgical mission trip, underserved patients' knowledge about total joint arthroplasty increased only modestly after taking a preoperative class. Greater understanding of how to educate patients and reduce their anxiety on medical missions is needed.