Poor Reliability between Cochrane Reviewers and Blinded External Reviewers When Applying the Cochrane Risk of Bias Tool in Physical Therapy Trials

Objectives

To test the inter-rater reliability of the RoB tool applied to Physical Therapy (PT) trials by comparing ratings from Cochrane review authors with those of blinded external reviewers.

Methods

Randomized controlled trials (RCTs) in PT were identified by searching the Cochrane Database of Systematic Reviews for meta-analysis of PT interventions. RoB assessments were conducted independently by 2 reviewers blinded to the RoB ratings reported in the Cochrane reviews. Data on RoB assessments from Cochrane reviews and other characteristics of reviews and trials were extracted. Consensus assessments between the two reviewers were then compared with the RoB ratings from the Cochrane reviews. Agreement between Cochrane and blinded external reviewers was assessed using weighted kappa (κ).

Results

In total, 109 trials included in 17 Cochrane reviews were assessed. Inter-rater reliability on the overall RoB assessment between Cochrane review authors and blinded external reviewers was poor (κ  =  0.02, 95%CI: −0.06, 0.06]). Inter-rater reliability on individual domains of the RoB tool was poor (median κ  = 0.19), ranging from κ  =  −0.04 (“Other bias”) to κ  =  0.62 (“Sequence generation”). There was also no agreement (κ  =  −0.29, 95%CI: −0.81, 0.35]) in the overall RoB assessment at the meta-analysis level.

Conclusions

Risk of bias assessments of RCTs using the RoB tool are not consistent across different research groups. Poor agreement was not only demonstrated at the trial level but also at the meta-analysis level. Results have implications for decision making since different recommendations can be reached depending on the group analyzing the evidence. Improved guidelines to consistently apply the RoB tool and revisions to the tool for different health areas are needed.     

Efficacy and Safety of an Everolimus- vs. a Mycophenolate Mofetil-Based Regimen in Pediatric Renal Transplant Recipients

Introduction

Data on the efficacy and safety of everolimus in pediatric renal transplantation compared to other immunosuppressive regimens are scarce.

Patients/Methods

We therefore performed a multicenter, observational, matched cohort study over 4 years post-transplant in 35 patients on everolimus plus low-dose cyclosporine, who were matched (1:2) with a control group of 70 children receiving a standard-dose calcineurin-inhibitor- and mycophenolate mofetil-based regimen.

Results

Corticosteroids were withdrawn in 83% in the everolimus vs. 39% in the control group (p<0.001). Patient and graft survival were comparable. The rate of biopsy-proven acute rejection episodes Banff score ≥ IA during the first year post-transplant was 6% in the everolimus vs. 13% in the control group (p = 0.23). The rate of de novo donor-specific HLA antibodies (11% in everolimus, 18% in controls) was comparable (p = 0.55). At 4 years post-transplant, mean eGFR in the everolimus group was 56±33 ml/min per 1.73 m² vs. 63±22 ml/min per 1.73 m² in the control group (p = 0.14). Everolimus therapy was associated with less BK polyomavirus replication (3% vs. 17% in controls; p = 0.04), but with a higher percentage of arterial hypertension and more hyperlipidemia (p<0.001).

Conclusion

In pediatric renal transplantation, an everolimus-based regimen with low-dose cyclosporine yields comparable four year results as a standard regimen, but with a different side effect profile.     

STUDIES IN PENNATE DIATOMS: VALVE MORPHOLOGIES OF LICMOPHORA AND CAMPYLOSTYLUS1

Using scanning electron and light, microscopy, several hundred specimens of Campylostylus normanianus (Grev.) Gerloff, Licmophora abbreviata Agardh, L. gracilis var. anglica (Kütz) Per. et Per., and L. flabellata (Carm.) Agardh were examined to elucidate their valve morphology. These species were found to be heterovalvar with respect to the presence of the labiate process in the basal apices of the cell, although one was always present at the head pole of each valve. This form of heterovalvar may be one basis for partitioning the large and variable family Diatomaceae. Because of the similar valve morphologies exhibited by C. normanianus and Licmophora species examined, it is recommended that Campylostylus normanianus be placed in the older genus Licmophora, as L. normaniana (Grev.) Wahrer.     

PSEUDO-NITZSCHIA SPECIES (BACILLARIOPHYCEAE) IN LOUISIANA COASTAL WATERS: MOLECULAR PROBE FIELD TRIALS, GENETIC VARIABILITY, AND DOMOIC ACID ANALYSES

An 18-month field survey of the Pseudo-nitzschia population present in Louisiana coastal waters was conducted comparing species abundance estimates by novel fluorescent molecular probes (16S large subunit rDNA oligonucleotide sequences) with traditional electron and differential-interference light microscopy. While the probe and microscopic analyses agreed on the presence or absence of four common Pseudo-nitzschia species ( P. multiseries (Hasle) Hasle, P. pseudodelicatissima (Hasle) Hasle, P. delicatissima (P.T. Cleve) Heiden, and P. pungens (Grunow) Hasle in 66% of the samples analyzed, the probes gave conflicting results with the microscopic methods in the remaining 34% of the samples. The majority of the discrepancies appear to be because of genetic variation within the Pseudo-nitzschia population, especially in P. pseudodelicatissima, indicating that the Monterey Bay Pseudo-nitzschia spp. may not be appropriate reference strains for distinguishing Louisiana Pseudo-nitzschia spp. Additionally, P. pseudodelicatissima has been associated with domoic acid (DA) activity in three field samples, at levels up to 22 times higher than the highest value given inother published reports of DA production by this species. The contemporaneous existence of multiple strains of P. pseudodelicatissima (toxic and non-toxic) presents new challenges to the study of the ecophysiology and population dynamics of this bloom-forming species.     

Intermediate host switches drive diversification among the largest trematode family: evidence from the Polypipapiliotrematinae n. subf. (Opecoelidae), parasites transmitted to butterflyfishes via predation of coral polyps

Podocotyloides stenometra Pritchard, 1966 (Digenea: Opecoelidae) is the only trematode known to infect anthozoan corals. It causes disease in coral polyps of the genus Porites Link (Scleractinia: Poritidae) and its life-cycle depends on ingestion of these polyps by butterflyfishes (Perciformes: Chaetodontidae). This species has been reported throughout the Indo-Pacific, from the Seychelles to the Galápagos, but no study has investigated whether multiple species are involved. Here, we recollect P. stenometra from its type-host and type-locality, in Hawaiian waters, and describe four new species from examination of 768 butterflyfishes from French Polynesia. On the basis of morphology, phylogeny and life-history, we propose Polypipapiliotrema Martin, Cutmore & Cribb n. gen. and the Polypipapiliotrematinae Martin, Cutmore & Cribb n. subf., for P. stenometra (Pritchard) n. comb., P. citerovarium Martin, Cutmore & Cribb n. sp., P. hadrometra Martin, Cutmore & Cribb n. sp., P. heniochi Martin, Cutmore & Cribb n. sp., and P. ovatheculum Martin, Cutmore & Cribb n. sp. Given the diversity uncovered here and the ubiquity, abundance and diversity of butterflyfishes on coral reefs, we predict that Polypipapiliotrema will prove to comprise a rich complex of species causing disease in corals across the Indo-Pacific. The unique life-cycle of these taxa is consistent with phylogenetic distinction of the group and provides evidence for a broader basis of diversification among the family. We argue that life-cycle specialisation, in terms of adoption of disparate second intermediate host groups, has been a key driver of the diversification and richness of the Opecoelidae, the largest of all trematode families and the group most frequently encountered in coral reef fishes.     

Scent-marking in captive red pandas (Ailurus fulgens)

Three male and three female captive red pandas (Ailurus fulgens) were observed during and outside of the breeding season to examine changes in scent-marking behavior. Variation in scent-marking was analyzed with respect to site preferences, sex differences, onset of breeding, behavioral correlates, and environmental factors. Both males and females exhibited significant preferences for particular marking sites, those being prominent points in the enclosures. Males showed significantly higher scent-marking frequencies than females, except in one enclosure where increased marking behavior was associated with the presence of young. Sexual dimorphism in the pattern of marking was also observed, with males showing a bidirectional mark and females a unidirectional mark. Female marking was greater during the breeding season. Sniffing and number of waddles per mark were associated with scent-marking. Temperature change was not related to frequency of scent-marking. These results are compared with scent-marking behaviors in other species of carnivores and functional explanations are suggested.     

Marine phytoplankton at the Weddell Sea ice edge: Seasonal changes at the specific level

Summary The Antarctic ice edge acts as a dynamic frontal system on the phytoplankton in the water column. Austral spring and autumn cruises to the Weddell Sea ice edge provided the opportunity to compare phytoplankton at the beginning of biological spring and at the end of biological autumn. The USCGC icebreakers Westwind (1983) and Glacier (1986) went into the sea ice, and the RV Melville (1983 and 1986) completed the transects in the adjacent open ocean. Field samples were observed alive on board ship to record different lifestages near the ice edge. In both seasons cell numbers were low under the ice, and single cells or short chains were the common growth habit. In spring in the open ocean, long chains of vegetative cells with large vacuoles and gelatinous colonies of diatoms and of prymnesiophytes dominated; in autumn in the open ocean close to the accreting ice edge, short chains, single cells, and resting spores were mostly packed with storage products. Enlarged cell diameters and auxospores also occurred near the ice cover in the autumn. Species from the following genera are included: the diatoms Leptocylindrus, Stellarima, Thalassiosira, Eucampia, Corethron, and Chaetoceros, the prymnesiophyte Phaeocystis, and the chrysophyte Distephanus.     

Surface-core correlations in serum lipoproteins

It has been found that the capacity of lipoproteins for binding Mn(II) ions is dependent on the arrangement of the Iipoprotein core. A change in the molecular organization of the LDL core (thermotropic transition) is associated with the change on the lipoprotein surface. In HDL there is no thermotropic transition and no abrupt change of the binding capacity.. The observed surface-core correlation might be an important link in understanding how dietary fat influences the lipoprotein metabolism.     

Cardiovascular Comorbidities Relate More than Others with Disease Activity in Rheumatoid Arthritis

Objectives

To explore the influence of comorbidities on clinical outcomes and disease activity in rheumatoid arthritis (RA).

Methods

In patients included in the cross-sectional observational multicenter international study COMORA, demographics, disease characteristics and comorbidities (hypertension, diabetes, hyperlipidemia, renal failure, ischemic heart disease, stroke, cancer, gastro-intestinal ulcers, hepatitis, depression, chronic pulmonary disease, obesity) were collected. Multivariable linear regression models explored the relationship between each comorbidity and disease activity measures: 28-swollen joint count (SJC), 28-tender joint count (TJC), erythrocyte sedimentation rate (ESR), patient’s and physician’s global assessment (PtGA, PhGA), patient reported fatigue and 28-Disease Activity Score (DAS28). Results are expressed as mean difference (MD) adjusted for the main confounders (age, gender, disease characteristics and treatment).

Results

A total of 3,920 patients were included: age (mean ±SD) 56.27 ±13.03 yrs, female 81.65%, disease duration median 7.08 yrs (IQR 2.97–13.27), DAS28 (mean ±SD) 3.74 ± 1.55. Patients with diabetes had more swollen and tender joints and worse PtGA and PhGA (MD +1.06, +0.93, +0.53 and +0.54, respectively). Patients with hyperlipidemia had a lower number of swollen and tender joints, lower ESR and better PtGA and PhGA (MD -0.77, -0.56, -3.56, -0.31 and -0.35, respectively). Patients with history of ischemic heart disease and obese patients had more tender joints (MD +1.27 and +1.07) and higher ESR levels (MD +5.64 and +5.20). DAS28 is influenced exclusively by cardiovascular comorbidities, in particular diabetes, hyperlipidemia, ischemic heart disease and obesity.

Conclusions

Cardiovascular comorbidities relate more than others with disease activity in RA. Diabetes and hyperlipidemia in particular seem associated with higher and lower disease activity respectively influencing almost all considered outcomes, suggesting a special importance of this pattern of comorbidities in disease activity assessment and clinical management.     

CHAIN-FORMING DIATOMS: THREE SPECIES OF CHAETOCERACEAE1,2

Bacteriastrum furcatum Shadbolt, Chaetoceros bacteriastroides Karsten and C. pseudocurvisetum Mangin are each connected in chains by fusion of silica between setae. The first two have specialized heterovalvate end cells indicating physiological control of the length of chains, but chains of C. pseudocurvisetum have usually been seen broken. There are specialized deeply lobed connecting bands in B. furcatum and C. pseudocurvisetum, allowing the setae of sibling valves to protrude outside the diameter of the chain during their formation. C. bacteriastroides and C. pseudocurvisetum are not identical; differences include presence of small setae, fusion of large setae some distance from the valves, symmetry of apertures between cells, and straight chains of C. bacteriastroides, compared with valve mantle connections with no small setae, large setae joined by crossing over, asymmetry of windows between cells, and curved chains of C. pseudocurvisetum. The evolutionary direction is hypothesized to be from Bacteriastrum to Chaetoceros through C. bacteriastroides.