Search

Abstract Background We are performing a combined randomised and observational study comparing internal fixation to non-surgical management for common wrist fractures in older patients. This paper describes the statistical analysis plan. Methods/design A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE) is a randomised controlled trial comparing two types of usual care for treating wrist fractures in older patients, surgical fixation using volar locking plates and non-surgical treatment using closed reduction and plaster immobilisation. The primary aim of this comparative-effectiveness study is to determine whether surgery is superior to non-surgical treatment with respect to patient-reported wrist function at 12 months post treatment. The secondary outcomes include radiographic outcomes, complication rates and patient-reported outcomes including quality of life, pain, treatment success and cosmesis. Primary analysis will use a two-sample t test and an intention-to-treat analysis using the randomised arm of the study. Statistical analyses will be two-tailed and significance will be determined by p

By means of an integrated approach, including molecular, morphological, anatomical and histological data, we describe a new species of freshwater flatworm of the genus Dugesia from southwest China, representing the third species recorded for the country. Morphologically, the new species, Dugesia umbonata Song & Wang, sp. nov., is particularly characterised by the presence of a muscularised hump immediately antero-dorsally to a knee-shaped bend in its bursal canal and by an ejaculatory duct that opens subterminally through the dorsal side of the penis papilla. Four molecular datasets (18S rDNA; ITS-1; 28S rDNA; COI) facilitated determination of the phylogenetic position of the new species, which belongs to a clade comprising other species from the Australasian and Oriental regions. We also analysed the structure of its major nervous system by means of the acetylcholinesterase (AChE) histochemical method and compared these results with data available for three other species of Dugesia.

Abstract Background Retrospective studies have found that daily opioid use pre-arthroplasty predicts worse longer-term service, clinical and patient-reported outcomes. Prospective studies are needed to confirm these observations. This prospective, exploratory study aimed to determine: the proportion of total knee or hip arthroplasty (TKA, THA) patients who use opioids regularly (daily) pre-surgery; if opioid use pre-surgery is associated with acute and sub-acute outcomes to 12-weeks post-surgery. Methods Consecutive patients undergoing primary TKA or THA were prospectively enrolled pre-surgery and followed-up by telephone to 12-weeks post-surgery. Acute-care (oral morphine equivalent dosage (OMED), length of stay, discharge to inpatient rehabilitation, complications) and 12-week outcomes (Oxford Knee or Hip Score, Euroqol ‘today’ health score, current use of opioids, and complications including readmissions) were monitored. Unadjusted and adjusted Odds Ratios (ORs) (95% Confidence Interval, CI), Rate Ratios and β coefficients (standard error) were calculated. Results Five Hundred Twenty-One patients were included (TKA n = 381). 15.7% (95%CI 12.6 to 18.9) used opioids regularly pre-surgery. 86.8% (452/521) were available for follow-up at 12-weeks. In unadjusted analyses, pre-surgical opioid use was significantly associated with higher average acute daily OMED [β 0.40 (0.07), p

Abstract Background Tea plant (Camellia sinensis) is one of the most popular non-alcoholic beverages worldwide. In tea, lateral roots (LRs) are the main organ responsible for the absorption of moisture and mineral nutrients from the soil. Lateral roots formation and development are regulated by the nitrogen and auxin signaling pathways. In order to understand the role of auxin and nitrogen signaling in LRs formation and development, transcriptome analysis was employed to investigate the differentially expressed genes involved in lateral roots of tea plants treated with indole-3-butyric acid (IBA), N-1-naphthylphthalamic acid (NPA), low and high concentrations of nitrogen. Results A total of 296 common differentially expressed genes were identified and annotated to four signaling pathways, including nitrogen metabolism, plant hormone signal transduction, glutathione metabolism and transcription factors. RNA-sequencing results revealed that majority of differentially expressed genes play important roles in nitrogen metabolism and hormonal signal transduction. Low nitrogen condition induced the biosynthesis of auxin and accumulation of transcripts, thereby, regulating lateral roots formation. Furthermore, metabolism of cytokinin and ethylene biosynthesis were also involved in lateral roots development. Transcription factors like MYB genes also contributed to lateral roots formation of tea plants through secondary cell wall biosynthesis. Reversed phase ultra performance liquid chromatography (RP-UPLC) results showed that the auxin concentration increased with the decreased nitrogen level in lateral roots. Thus, tea plant lateral roots formation could be induced by low nitrogen concentration via auxin biosynthesis and accumulation. Conclusion This study provided insights into the mechanisms associated with nitrogen and auxin signaling pathways in LRs formation and provides information on the efficient utilization of nitrogen in tea plant at the genetic level.

Improving crop nitrogen use efficiency can facilitate sustainable production, however, the genetic mechanisms have not been fully revealed. Here, the authors discover the NAC42-NPF6.1 signaling cascade mainly derives from indica and wild rice and demonstrate the potential of using the allele for cultivar improvement.

Abstract Background Despite the advances of cardiac surgery in the last decades, the incidence of acute kidney insufficiency (AKI) post isolated coronary artery bypass grafting surgery (iCABG) is increasing. The purpose of this study was to identify the potential predictors of postoperative AKI in iCABG in order to implement measures to reduce its incidence. Results We reviewed the data of 1914 patients who had on-pump iCABG from January 2008 to December 2015, using the cardiothoracic surgery unit database of Liverpool Hospital, Sydney, New South Wales, Australia. Patients were divided into two groups according to the occurrence of postoperative AKI. The incidence of postoperative AKI was 5.3% in 8 years (n = 101/1914 patients). Multivariable analysis has identified the following independent predictors of postoperative AKI; age older than 80 years (OR 4.27; 95% CI 1.6–11.81) (p

Background and Aims: Spontaneous bacterial peritonitis (SBP) is a common and potentially fatal complication of liver cirrhosis. This study aims to analyze the prevalence of SBP among liver cirrhotic patients according to geographical location and income level, and risk factors and outcomes of SBP.Methods: A systematic search for articles describing prevalence, risk factors and outcomes of SBP was conducted. A single-arm meta-analysis was performed using generalized linear mix model (GLMM) with Clopper-Pearson intervals.Results: Ninety-Nine articles, comprising a total of 5,861,142 individuals with cirrhosis were included. Pooled prevalence of SBP was found to be 17.12% globally (CI: 13.63–21.30%), highest in Africa (68.20%; CI: 12.17–97.08%), and lowest in North America (10.81%; CI: 5.32–20.73%). Prevalence of community-acquired SBP was 6.05% (CI: 4.32–8.40%), and 11.11% (CI: 5.84–20.11%,) for healthcare-associated SBP. Antibiotic-resistant microorganisms were found in 11.77% (CI: 7.63–17.73%) of SBP patients. Of which, methicillin-resistant Staphylococcus aureus was most common (6.23%; CI: 3.83–9.97%), followed by extended-spectrum beta-lactamase producing organisms (6.19%; CI: 3.32–11.26%), and lastly vancomycin-resistant enterococci (1.91%; CI: 0.41–8.46%). Subgroup analysis comparing prevalence, antibiotic resistance, and outcomes between income groups was conducted to explore a link between socioeconomic status and SBP, which revealed decreased risk of SBP and negative outcomes in high-income countries.Conclusion: SBP remains a frequent complication of liver cirrhosis worldwide. The drawn link between income level and SBP in liver cirrhosis may enable further insight on actions necessary to tackle the disease on a global scale.

Introduction Perianal fistulising Crohn’s disease (pfCD) can be somewhat treatment refractory. Higher infliximab trough levels (TLIs) may improve fistula healing rates; however, it remains unclear whether escalating infliximab therapy to meet higher TLI targets using proactive, or routine, therapeutic drug monitoring (TDM) improves outcomes. This randomised controlled trial aimed to assess whether infliximab therapy targeting higher TLIs guided by proactive TDM improves outcomes compared with standard therapy.Methods and analysis Patients with active pfCD will be randomised 1:1 to either the proactive TDM arm or standard dosing arm and followed up for 54 weeks. Patients in the proactive TDM arm will have infliximab dosing optimised to target higher TLIs. The targets will be TLI ≥ 25 µg/mL at week 2, ≥ 20 µg/mL at week 6 and ≥ 10 µg/mL during maintenance therapy. The primary objective will be fistula healing at week 32. Secondary objectives will include fistula healing, fistula closure, radiological fistula healing, patient-reported outcomes and economic costs up to 54 weeks. Patients in the standard dosing arm will receive conventional infliximab dosing not guided by TLIs (5 mg/kg at weeks 0, 2 and 6, and 5 mg/kg 8 weekly thereafter). Patients aged 18–80 years with pfCD with single or multiple externally draining complex perianal fistulas who are relatively naïve to infliximab treatment will be included. Patients with diverting ileostomies or colostomies and pregnant or breast feeding will be excluded. Fifty-eight patients per arm will be required to detect a 25% difference in the primary outcome measure, with 138 patients needed to account for an estimated 6.1% primary non-response rate and 10% dropout rate.Ethics and dissemination Results will be presented in peer-reviewed journals and international conferences. Ethics approval has been granted by the South Western Sydney Local Health District Human Research Ethics Committee in Australia.Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12621000023853); Pre-results.

Global Navigation Satellite System (GNSS) can provide high-precision three-dimensional real-time or quasi-real-time changes of monitoring points automatically in house monitoring applications. However, due to the signal sheltering problem, large observation noise and multipath effects in urban observing environment with dense buildings, ambiguity resolution would be hard, and GNSS accuracy cannot always achieve millimeter level to satisfy the requirement of house monitoring. Static level is a precision instrument for measuring elevation difference and its variations, with a precision up to sub-millimeter level. It could be integrated with GNSS to improve the positioning accuracy in height direction. However, the existing integration of GNSS and static level is mostly on a respective results level. In this study, we proposed a method of integrating GNSS and static level observations tightly to enhance the GNSS positioning performance. The hardware design and integration mathematic model in data processing were introduced, and a group of experiments were carried out to verify the performance in positioning with and without the static level observation constraints. It found that the vertical monitoring measurement results of static level can achieve less than 1 mm. The GNSS ambiguity resolution performance can be improved by incorporating the measurement of static level into GNSS positioning equation as external constraints, and the precision of GNSS float solutions was significantly improved. Finally, the static level constraint can further improve the accuracy of the fixed solution from about 2 cm to better than 2 mm in vertical direction, which is even better than the accuracy in horizontal directions with about 3–6 mm with the static level constraint. The tight combination data processing algorithm can significantly improve the working efficiency, accuracy, and reliability of the application of dangerous house monitoring.

Vegetation and groundwater are important components of the ecological environment of oases in desert hinterlands and their relationship is crucial to ecosystem stability. In this study, Sentinel-2 data for 2016–2022 and measured groundwater burial depths were analysed for the Dariyabui Oasis in the hinterland of the Taklamakan Desert. The spatial and temporal changes in vegetation and groundwater burial depth from 2019 to 2022 were analysed based on the image–element dichotomous model of the normalised difference vegetation index, utilising the inverse distance weight interpolation method, cubic curve regression, image–element difference, slope trend analysis, and the Markov transfer matrix for determining the temporal and spatial response law between the two. Finally, the threshold value of groundwater burial depth for different vegetation cover types was clarified. The fractional vegetation cover of the Dariyabui Oasis showed a slight increase from 2016 to 2022. Vegetation in the northwest and southeast of the oasis increased, whereas vegetation decreased in the mid-north and northeast regions; 5.14% of the total area experienced increased coverage, whereas 3.35% experienced decreased coverage. The depth of groundwater in the oasis showed a pattern of gradual increase from the entrance to the end of the oasis, that is, south to north. The depth of groundwater in the oasis from 2019 to 2022 was stable, with a 4-year average depth of 4.1069 m and a maximum fluctuation of 0.4560 m. The interannual changes in the groundwater level showed an increasing trend in January–April, while groundwater levels showed a decreasing trend in May–July and August–October and remained constant in June–July and October–December. Oasis vegetation cover showed a negative correlation with groundwater depth, with a depth interval for the highest low-cover vegetation distribution of 3–6 m, and an ultimate depth threshold of 7 m. The depth interval with the highest medium-cover vegetation distribution was 3–4 m, that with the highest high-cover distribution was 2–4 m, and the ultimate depth threshold was 6 m. The depth of the oasis ranged from 3 to 6 m and the ultimate depth threshold was 7 m. [ABSTRACT FROM AUTHOR]

Background: Enhanced Recovery After Surgery (ERAS) is a "fast-track", perioperative, multi-disciplinary concept aimed at improving recovery time and reducing length of hospital stay. Objective: This study aims to compare the postoperative outcomes of ERAS versus non-ERAS Total Knee Arthroplasty (TKA), with the primary outcomes being day 0 pain score, days 1-2 range of motion (ROM), days 1-2 distance walked and hospital length of stay (LOS). Methods: A retrospective analysis was performed for 111 consecutive patients who had undergone primary unilateral TKA from November 2019 to October 2020 at a single tertiary hospital by fellowship-trained arthroplasty surgeons. Three independent, blinded observers extracted patient data from our institution's Electronic Medical Records. The ERAS protocol included preoperative smoking and alcohol cessation, preoperative physiotherapy, intraoperative local infiltration analgesia using a drug cocktail, postoperative multimodal analgesia and postoperative day 0 physiotherapy, while any patient who deviated from any step were classified as non-ERAS. Two-sample t-tests, Wilcoxon rank-sum tests and Chi-squared tests were used to compare the outcome variables between ERAS and non-ERAS patients. Results: Patients under the ERAS protocol (n = 67) reported a significantly lower postoperative day 0 pain score (p = .0480) and a shorter hospital LOS (p = .0189) than non-ERAS patients (n = 44). No significant difference (p > .05) was observed for ROM and distance walked on days 1-2. Conclusion: Our study demonstrates that the ERAS protocol improves day 0 postoperative pain and shortens hospital LOS while being non-inferior for ROM and distance walked on days 1-2. [ABSTRACT FROM AUTHOR]

Background and Objectives Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programs in randomized controlled trials demonstrate effectiveness in reducing falls; however, the translation of research into the community remains challenging. Although there is an increasing interest to understand the factors contributing to implementation barriers, the dynamic relationships between factors are less well examined. Furthermore, evidence on implementation barriers from Asia is lacking as most of these studies originate from the West. As such, this study aims to engage stakeholders in uncovering the factors that facilitate or inhibit implementing community-based fall prevention programs in Singapore, with a focus on the interrelationship between those factors. Research Design and Methods Health care professionals familiar with fall prevention programs were invited to discuss the enablers and challenges to the implementation. This effort was facilitated using a systems modeling methodology of Group Model Building (GMB) to share ideas and create a common conceptual model of the challenges. The GMB employs various engagement techniques to draw on the experiences and perceptions of all stakeholders involved. Results This process led to the development of a Causal Loop Diagram (CLD), a qualitative conceptual model of the dynamic relationships between the barriers and facilitators of implementing fall prevention programs. Results from the CLD show that implementation is influenced by two main drivers: health care provider factors that influenced referrals, and patient factors that influenced referral acceptance and long-term adherence. Key leverage points for potential interventions were identified as well. Discussion and Implications The overall recommendation emphasized closer coordination and collaboration across providers to ensure sustainable and effective community-based fall prevention programs. This has to be supported by a national effort, involving a multidisciplinary stakeholder advisory group. These findings generated would be promising to guide future approaches to fall prevention. [ABSTRACT FROM AUTHOR]