Vanessa Jordan

Tumor Necrosis Factor-Alpha, Interleukin-6, and Interleukin-10 Levels are Altered in Preeclampsia: A Systematic Review and Meta-Analysis

Published reports testing the association between cytokine levels and preeclampsia are conflicting. This comprehensive systematic review and meta‐analysis aimed at testing the association between preeclampsia and maternal circulating tumor necrosis factor‐alpha (TNF‐α), interleukin (IL)‐6, and IL‐10.

Acidic isoforms of chorionic gonadotrophin in European and Samoan women are associated with hyperemesis gravidarum and may be thyrotrophic.

There is conflicting evidence concerning the role of human chorionic gonadotrophin (hCG) in the aetiology of hyperemesis gravidarum (HG); particular isoforms of hCG may be the critical factor. Ethnic differences in HG prevalence and putative thyrotrophic effects of hCG may also relate to differences in hCG isoform profiles. To address these issues we examined the relationship of hCG isoforms to HG and thyroid function tests in two groups of women from ethnic backgrounds with significantly different HG prevalence rates.

Time-lapse in the IVF-lab: how should we assess potential benefit?

Time-lapse imaging of embryos has been widely introduced to fertility laboratories worldwide with the aim of identifying the best quality embryos to transfer that will ultimately improve IVF success rates. In this opinion paper, we explore the lack of evidence of benefit of this novel intervention, analyse the methodological flaws of current studies, offer ideal study designs that assess the various features of time-lapse imaging, and discuss forthcoming studies. In particular, we emphasize the ethical aspects of hastily adopting a costly technology without current high level evidence of improved live birth rates, safety and cost effectiveness.

Muscle activity during forelimb reaching movements in rats

The absolute timing, and correlation in time of activity in a number of shoulder, elbow and wrist muscles in the rat was analysed in relation to onset and termination of the extension phase of a skilled forelimb reaching movement. Movement onsets were analysed separately in the component upward, forward and medial directions. On average, movements in the upward and medial directions occurred together, prior to forward movement. Latissimus dorsi activity was the earliest muscle event, occurring approximately 150 ms prior to movement, whilst onset of teres major activity, possibly related to paw elevation, had the highest temporal correlation with movement onset. Triceps activity was strongly time locked to the end of the reach, and may have provided final extensor thrust to complete the reaching movement. Although it is possible to speculate on possible roles of particular EMG bursts, multiple (often anatomically antagonistic) muscles were active at all stages of the reach, and no unique muscle relationships to initiation of individual movement components could be identified. It is concluded that reaching movements are produced by temporal variation in distributed activity among all available muscles.

Methodological Quality of Systematic Reviews in Subfertility: A Comparison of Two Different Approaches

Background Systematic reviews are used widely to guide health care decisions. Several tools have been created to assess systematic review quality. The measurement tool for assessing the methodological quality of systematic reviews known as the AMSTAR tool applies a yes/no score to eleven relevant domains of review methodology. This tool has been reworked so that each domain is scored based on a four point scale, producing R-AMSTAR. Methods and Findings We aimed to compare the AMSTAR and R-AMSTAR tools in assessing systematic reviews in the field of assisted reproduction for subfertility. All published systematic reviews on assisted reproductive technology, with the latest search for studies taking place from 2007–2011, were considered. Reviews that contained no included studies or considered diagnostic outcomes were excluded. Thirty each of Cochrane and non-Cochrane reviews were randomly selected from a search of relevant databases. Both tools were then applied to all sixty reviews. The results were converted to percentage scores and all reviews graded and ranked based on this. AMSTAR produced a much wider variation in percentage scores and achieved higher inter-rater reliability than R-AMSTAR according to kappa statistics. The average rating for Cochrane reviews was consistent between the two tools (88.3% for R-AMSTAR versus 83.6% for AMSTAR) but inconsistent for non-Cochrane reviews (63.9% R-AMSTAR vs. 38.5% AMSTAR). In comparing the rankings generated between the two tools Cochrane reviews changed an average of 4.2 places, compared to 2.9 for non-Cochrane. Conclusion R-AMSTAR provided greater guidance in the assessment of domains and produced quantitative results. However, there were many problems with the construction of its criteria and AMSTAR was much easier to apply consistently. We recommend that AMSTAR incorporates the findings of this study and produces additional guidance for its application in order to improve its reliability and usefulness.

Methodological quality of systematic reviews in subfertility: a comparison of Cochrane and non-Cochrane systematic reviews in assisted reproductive technologies

STUDY QUESTION Are there differences in the methodological quality of Cochrane systematic reviews (CRs) and non-Cochrane systematic reviews (NCRs) of assisted reproductive technologies? SUMMARY ANSWER CRs on assisted reproduction are of higher methodological quality than similar reviews published in other journals. WHAT IS KNOWN ALREADY The quality of systematic reviews varies. STUDY DESIGN, SIZE AND DURATION This was a cross-sectional study of 30 CR and 30 NCR systematic reviews that were randomly selected from the eligible reviews identified from a literature search for the years 2007-2011. MATERIALS, SETTING AND METHODS We extracted data on the reporting and methodological characteristics of the included systematic reviews. We assessed the methodological quality of the reviews using the 11-domain Measurement Tool to Assess the Methodological Quality of Systematic Reviews (AMSTAR) tool and subsequently compared CR and NCR systematic reviews. MAIN RESULTS AND THE ROLE OF CHANCE The AMSTAR quality assessment found that CRs were superior to NCRs. For 10 of 11 AMSTAR domains, the requirements were met in >50% of CRs, but only 4 of 11 domains showed requirements being met in >50% of NCRs. The strengths of CRs are the a priori study design, comprehensive literature search, explicit lists of included and excluded studies and assessments of internal validity. Significant failings in the CRs were found in duplicate study selection and data extraction (67% meeting requirements), assessment for publication bias (53% meeting requirements) and reporting of conflicts of interest (47% meeting requirements). NCRs were more likely to contain methodological weaknesses as the majority of the domains showed <40% of reviews meeting requirements, e.g. a priori study design (17%), duplicate study selection and data extraction (17%), assessment of study quality (27%), study quality in the formulation of conclusions (23%) and reporting of conflict of interests (10%). LIMITATIONS, REASONS FOR CAUTION The AMSTAR assessment can only judge what is reported by authors. Although two of the five authors are involved in the production of CRs, the risk of bias was reduced by not involving these authors in the assessment of the systematic review quality. WIDER IMPLICATIONS OF THE FINDINGS Not all systematic reviews are equal. The reader needs to consider the quality of the systematic review when they consider the results and the conclusions of a systematic review. STUDY FUNDING/COMPETING INTEREST(S) There are no conflicts with any commercial organization. Funding was provided for the students by the summer studentship programme of the Faculty of Medical and Health Sciences of the University of Auckland.

There were large discrepancies in risk of bias tool judgments when a randomized controlled trial appeared in more than one systematic review

OBJECTIVES To assess the consistency in risk of bias (RoB) judgments across Cochrane reviews for studies appearing in more than one Cochrane review in the field of subfertility. STUDY DESIGN AND SETTING We retrieved any study that had been used more than once in systematic reviews present on the Cochrane Database of Systematic Reviews in the area of subfertility. We then retrieved the recorded RoB assessments for these studies and looked at the consistency of judgments made between different authoring teams on the same trials. RESULTS From the 156 bias judgments that were completed by at least two separate groups of authors, 45% of these judgments differed. For the domains of random sequence generation and incomplete outcome data, there was reasonably high level of agreement (71% and 79%, respectively). However, for the domain of blinding, agreement was reached in only 35% of cases. CONCLUSION This assessment of how consistently the RoB is being applied in Cochrane reviews has shown that, especially in some domains, there are large discrepancies in how RoB is being evaluated. Further work needs to be undertaken to improve the application of this tool.

Clinical trial registration in fertility trials – a case for improvement?

STUDY QUESTION What is the prevalence and source of prospectively and retrospectively registered and unregistered trials in fertility treatments? SUMMARY ANSWER Trial registration is low and does not appear to be changing over the 5 years studied. WHAT IS KNOWN ALREADY Trial registration is associated with lower risk of bias than in unregistered trials. STUDY DESIGN, SIZE, DURATION The Cochrane Gynaecology and Fertility Groups specialised register was searched on 5 November 2015 for randomised controlled trials (RCTs) published from January 2010 to December 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS Eligible trials included randomised women or men for fertility treatments, were published in full text, and written in English. Two reviewers independently assessed trial registration status for each trial, by searching the publication, trial registries, and by contacting the original authors. MAIN RESULTS AND ROLE OF CHANCE Of 693 eligible RCTS, only 44% were registered trials. Of 309 registered trials, 21.7% were prospectively registered, 15.8% were registered within 6 months of first patient enrolment and 62.5% were retrospectively registered trials. Prospective trial registration by country varied from 0% to 100%. The highest frequency of prospective trial registration amongst the top 10 publishing countries was 31% in the Netherlands. LIMITATIONS, REASONS FOR CAUTION Only English language trials were included in this review. WIDER IMPLICATIONS OF THE FINDINGS Prospective trial registration is still low. Journals, funders and ethics committees could have a greater role to increase trial registration. STUDY FUNDING/COMPETING INTERESTS University of Auckland. No competing interests.

Using the STROBE statement to assess reporting in blindness prevalence surveys in low and middle income countries.

Objective Cross-sectional blindness prevalence surveys are essential to plan and monitor eye care services. Incomplete or inaccurate reporting can prevent effective translation of research findings. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement is a 32 item checklist developed to improve reporting of observational studies. The aim of this study was to assess the completeness of reporting in blindness prevalence surveys in low and middle income countries (LMICs) using STROBE. Methods MEDLINE, EMBASE and Web of Science databases were searched on April 8 2016 to identify cross-sectional blindness prevalence surveys undertaken in LMICs and published after STROBE was published in December 2007. The STROBE tool was applied to all included studies, and each STROBE item was categorized as ‘yes’ (met criteria), ‘no’ (did not meet criteria) or ‘not applicable’. The ‘Completeness of reporting (COR) score’ for each manuscript was calculated: COR score = yes / [yes + no]. In journals with included studies the instructions to authors and reviewers were checked for reference to STROBE. Results The 89 included studies were undertaken in 32 countries and published in 37 journals. The mean COR score was 60.9% (95% confidence interval [CI] 58.1–63.7%; range 30.8–88.9%). The mean COR score did not differ between surveys published in journals with author instructions referring to STROBE (10/37 journals; 61.1%, 95%CI 56.4–65.8%) or in journals where STROBE was not mentioned (60.9%, 95%CI 57.4–64.3%; p = 0.93). Conclusion While reporting in blindness prevalence surveys is strong in some areas, others need improvement. We recommend that more journals adopt the STROBE checklist and ensure it is used by authors and reviewers.

What is the best oral treatment for those nasty looking toes

THE PROBLEM: Onychomycosis is a fungal infection of the nail. it is a common condition that accounts for 50% of all nail diseases. it has a worldwide prevalence of 2–8%.1 Onychomycosis is more likely to affect older adults, people with diabetes, people with psoriasis and people who are immunosuppressed.1 Griseofulvin was the first oral antifungal agent used to treat this condition2 with the azole group of medications coming next, followed by terbinafine.2