Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review

ObjectiveTo summarise the evidence on accuracy of the Ottawa ankle rules, a decision aid for excluding fractures of the ankle and mid-foot.DesignSystematic review.Results32 studies met the inclusion criteria and 27 studies reporting on 15 581 patients were used for meta-analysis. The pooled negative likelihood ratios for the ankle and mid-foot were 0.08 (95% confidence interval 0.03 to 0.18) and 0.08 (0.03 to 0.20), respectively. The pooled negative likelihood ratio for both regions in children was 0.07 (0.03 to 0.18). Applying these ratios to a 15% prevalence of fracture gave a less than 1.4% probability of actual fracture in these subgroups.ConclusionEvidence supports the Ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and mid-foot. The instrument has a sensitivity of almost 100% and a modest specificity, and its use should reduce the number of unnecessary radiographs by 30-40%.

What is already known on this topic

Although most patients with ankle sprains who present to emergency departments undergo radiography, less than 15% have a fractureThe Ottawa ankle rules is a clinical decision aid designed to avoid unnecessary radiography

What this paper adds

The Ottawa ankle rules is highly accurate at excluding ankle fractures after sprain injury     

Call for papers: Symposium on “Tautomers and biology,” American Chemical Society National Meeting, Boston, MA, USA, August 2010

Announcement

Call for papers: Symposium on “Tautomers and biology,” American Chemical Society National Meeting, Boston, MA, USA, August 2010     

International Symposium on Chemistry and Biology of Municipal Water Treatment: Current status and future directions October 24–29, 1993 Call for papers

Aquatic Ecosystem Health and Management Society

International Symposium on Chemistry and Biology of Municipal Water Treatment: Current status and future directions October 24–29, 1993 Call for papers     

Call for papers oral and poster presentations are invited for the International Symposium: Exploring the Greet Lakes of the World: Food Web Dynamics,Health & Integrity

Aquatic Ecosystem Health and Management Society

Call for papers oral and poster presentations are invited for the International Symposium: Exploring the Greet Lakes of the World: Food Web Dynamics, Health & Integrity     

Symposium of fish behaviour in relation to fishing operations

Conference Report

Symposium of fish behaviour in relation to fishing operations(organized by the International Council for the Exploration of the Sea) 11–13 June 1992, Bergen, Norway     

Plasma PCSK9 Levels Are Elevated with Acute Myocardial Infarction in Two Independent Retrospective Angiographic Studies

Objective

Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a circulating protein that promotes degradation of the low density lipoprotein (LDL) receptor. Mutations that block PCSK9 secretion reduce LDL-cholesterol and the incidence of myocardial infarction (MI). However, it remains unclear whether elevated plasma PCSK9 associates with coronary atherosclerosis (CAD) or more directly with rupture of the plaque causing MI.

Methods and Results

Plasma PCSK9 was measured by ELISA in 645 angiographically defined controls (<30% coronary stenosis) and 3,273 cases of CAD (>50% stenosis in a major coronary artery) from the Ottawa Heart Genomics Study. Because lipid lowering medications elevated plasma PCSK9, confounding association with disease, only individuals not taking a lipid lowering medication were considered (279 controls and 492 with CAD). Replication was sought in 357 controls and 465 with CAD from the Emory Cardiology Biobank study. PCSK9 levels were not associated with CAD in Ottawa, but were elevated with CAD in Emory. Plasma PCSK9 levels were elevated in 45 cases with acute MI (363.5±140.0 ng/ml) compared to 398 CAD cases without MI (302.0±91.3 ng/ml, p = 0.004) in Ottawa. This finding was replicated in the Emory study in 74 cases of acute MI (445.0±171.7 ng/ml) compared to 273 CAD cases without MI (369.9±139.1 ng/ml, p = 3.7×10⁻⁴). Since PCSK9 levels were similar in CAD patients with or without a prior (non-acute) MI, our finding suggests that plasma PCSK9 is elevated either immediately prior to or at the time of MI.

Conclusion

Plasma PCSK9 levels are increased with acute MI.     

A Comparison of Statistical Methods for Identifying Out-of-Date Systematic Reviews

Background

Systematic reviews (SRs) can provide accurate and reliable evidence, typically about the effectiveness of health interventions. Evidence is dynamic, and if SRs are out-of-date this information may not be useful; it may even be harmful. This study aimed to compare five statistical methods to identify out-of-date SRs.

Methods

A retrospective cohort of SRs registered in the Cochrane Pregnancy and Childbirth Group (CPCG), published between 2008 and 2010, were considered for inclusion. For each eligible CPCG review, data were extracted and “3-years previous” meta-analyses were assessed for the need to update, given the data from the most recent 3 years. Each of the five statistical methods was used, with random effects analyses throughout the study.

Results

Eighty reviews were included in this study; most were in the area of induction of labour. The numbers of reviews identified as being out-of-date using the Ottawa, recursive cumulative meta-analysis (CMA), and Barrowman methods were 34, 7, and 7 respectively. No reviews were identified as being out-of-date using the simulation-based power method, or the CMA for sufficiency and stability method. The overall agreement among the three discriminating statistical methods was slight (Kappa = 0.14; 95% CI 0.05 to 0.23). The recursive cumulative meta-analysis, Ottawa, and Barrowman methods were practical according to the study criteria.

Conclusion

Our study shows that three practical statistical methods could be applied to examine the need to update SRs.     

Symposium announcement

Announcement

Symposium announcement     

Eight International Symposium of the Biology of the Turbellaria

Announcement

Eight International Symposium of the Biology of the Turbellaria     

XIIIth International Symposium on Respiratory Psychophysiology

Announcement

XIIIth International Symposium on Respiratory Psychophysiology     

1st UK Purine Symposium

Abstract

1st UK Purine Symposium 19th November 2009     

Abstracts of the Annual Symposium of the Czech Society of Histochemistry and Cytochemistry. Brno, Czech Republic, 1-2 December 2000

Abstract List

Abstracts of the Annual Symposium of the Czech Society of Histochemistry and Cytochemistry     

Abstracts of 40th Annual Symposium of the Czech Society of Histochemistry and Cytochemistry

Conference Report

Abstracts of 40th Annual Symposium of the Czech Society of Histochemistry and Cytochemistry     

2nd Australasian Symposium on Metabolomics

News

2nd Australasian Symposium on Metabolomics 3rd–5th October 2010, The Sebel, Albert Park, Melbourne, Australia     

Pesticide formulations: Innovations and developments

Book Review

Pesticide formulations: Innovations and developmentsB. Cross and H.B. Scher (Eds.), ACS Symposium Series 371. Washington DC: American Chemical Society, 1988. xi + 288 pages. £54.00. ISBN 0-8412-1483-2     

Applications of chlorophyll fluorescence: In photosynthesis research,stress physiology,hydrobiology and remote sensing

Book reviews

Applications of chlorophyll fluorescence: In photosynthesis research, stress physiology, hydrobiology and remote sensingH.K. Lichtenthaler (Ed.), Proceedings of the International Chlorophyll Fluorescence Symposium, 6–8 June 1988. Dordrecht: Kluwer Academic Publishers, 1988. xiv + 366 pages. £54. ISBN 90-247-3787-7     

Biotechnology in agricultural chemistry

Book Review

Biotechnology in agricultural chemistryH.M. LeBaron, R.O. Mumma, R.C. Honeycutt and J.H. Duesing (Eds.), ACS Symposium Series 334, Washington, DC. American Chemical Society, 1987. xxii + 367 pages. US $77.95 ISBN 0-8412-1010-5     

Air pollution and plant metabolism: Proceedings of the 2nd International Symposium on Air Pollution and Plant Metabolism,Munich, 1987

Book reviews

Air pollution and plant metabolism: Proceedings of the 2nd International Symposium on Air Pollution and Plant Metabolism, Munich, 1987S. Schulte-Hostede, N.M. Darrall, L.W. Blank and A.R. Wellburn (Eds.), London and New YorkL Elsevier Applied Science, 1988. xiv + 381 pages. £44.00. ISBN 1-85166-2830-8.     

Environmental Particulate Matter Induces Murine Intestinal Inflammatory Responses and Alters the Gut Microbiome

Background

Particulate matter (PM) is a key pollutant in ambient air that has been associated with negative health conditions in urban environments. The aim of this study was to examine the effects of orally administered PM on the gut microbiome and immune function under normal and inflammatory conditions.

Methods

Wild-type 129/SvEv mice were gavaged with Ottawa urban PM₁₀ (EHC-93) for 7–14 days and mucosal gene expression analyzed using Ingenuity Pathways software. Intestinal permeability was measured by lactulose/mannitol excretion in urine. At sacrifice, segments of small and large intestine were cultured and cytokine secretion measured. Splenocytes were isolated and incubated with PM₁₀ for measurement of proliferation. Long-term effects of exposure (35 days) on intestinal cytokine expression were measured in wild-type and IL-10 deficient (IL-10^−/−) mice. Microbial composition of stool samples was assessed using terminal restriction fragment length polymorphism. Short chain fatty acids were measured in caecum.

Results

Short-term treatment of wild-type mice with PM₁₀ altered immune gene expression, enhanced pro-inflammatory cytokine secretion in the small intestine, increased gut permeability, and induced hyporesponsiveness in splenocytes. Long-term treatment of wild-type and IL-10^−/− mice increased pro-inflammatory cytokine expression in the colon and altered short chain fatty acid concentrations and microbial composition. IL-10^−/− mice had increased disease as evidenced by enhanced histological damage.

Conclusions

Ingestion of airborne particulate matter alters the gut microbiome and induces acute and chronic inflammatory responses in the intestine.