Completion and Publication Rates of Randomized Controlled Trials in Surgery: An Empirical Study.

OBJECTIVE: To investigate the prevalence of discontinuation and nonpublication of surgical versus medical randomized controlled trials (RCTs) and to explore risk factors for discontinuation and nonpublication of surgical RCTs. BACKGROUND: Trial discontinuation has significant scientific, ethical, and economic implications. To date, the prevalence of discontinuation of surgical RCTs is unknown. METHODS: All RCT protocols approved between 2000 and 2003 by 6 ethics committees in Canada, Germany, and Switzerland were screened. Baseline characteristics were collected and, if published, full reports retrieved. Risk factors for early discontinuation for slow recruitment and nonpublication were explored using multivariable logistic regression analyses. RESULTS: In total, 863 RCT protocols involving adult patients were identified, 127 in surgery (15%) and 736 in medicine (85%). Surgical trials were discontinued for any reason more often than medical trials [43% vs 27%, risk difference 16% (95% confidence interval [CI]: 5%-26%); P = 0.001] and more often discontinued for slow recruitment [18% vs 11%, risk difference 8% (95% CI: 0.1%-16%); P = 0.020]. The percentage of trials not published as full journal article was similar in surgical and medical trials (44% vs 40%, risk difference 4% (95% CI: -5% to 14%); P = 0.373). Discontinuation of surgical trials was a strong risk factor for nonpublication (odds ratio = 4.18, 95% CI: 1.45-12.06; P = 0.008). CONCLUSIONS: Discontinuation and nonpublication rates were substantial in surgical RCTs and trial discontinuation was strongly associated with nonpublication. These findings need to be taken into account when interpreting surgical literature. Surgical trialists should consider feasibility studies before embarking on full-scale trials.

AVALIAÇÃO DA QUALIDADE FÍSICO-QUÍMICA DE POLPAS DE FRUTA CONGELADAS COMERCIALIZADAS NA CIDADE DE CUIABÁ-MT

RESUMO O presente trabalho teve como objetivo avaliar a qualidade físico-química das polpas de frutas congeladas comercializadas na cidade de Cuiabá-MT, comparando com os padrões estabelecidos pela legislação vigente. O experimento foi desenvolvido em delineamento inteiramente casualizado, sendo cinco tratamentos (marcas denominadas A, B, C, D e E) e três repetições, para as polpas de abacaxi, acerola, caju, goiaba e maracujá. Foram analisados os parâmetros pH, acidez titulável expressa em ácido cítrico, sólidos solúveis, ratio, vitamina C, açúcar redutor e quantificação da perda de vitamina C após 90 dias de armazenamento sob congelamento, em polpas de acerola e caju. Os dados obtidos foram submetidos à análise de variância, e as médias, comparadas pelo teste de Tukey, ao nível de 5% de probabilidade. A marca D apresentou não conformidade com a legislação para todas as polpas em, pelo menos, um dos parâmetros avaliados. Foi observado maior número de amostras em inadequação para o teor de vitamina C e, de forma geral, as polpas avaliadas apresentaram valores abaixo das especificações exigidas pelos Padrões de Identidade e Qualidade (PIQ) para as mesmas. Todas as amostras avaliadas tiveram redução do teor de vitamina C durante armazenamento sob congelamento, sendo que nenhuma marca de polpa de acerola e apenas uma de caju apresentou, ao final de 90 dias, teor de vitamina C de acordo com o estabelecido pelo PIQ. Conclui-se que é necessária uma intensificação na fiscalização no processamento de polpas de frutas congeladas para garantia da saúde do consumidor.

La desaparición de los espectáculos de gladiadores en Hispania

Tradicionalmente se ha sostenido que los espectáculos de gladiadores desaparecieron en Hispania durante los primeros decenios del siglo IV. Sin embargo, un examen critico de las fuentes aducidas -cánones pseudoiliberritanos, mosaico de Rielves e inscripciones constantinianas del anfiteatro de Tarragona- pone de manifiesto que no pueden utilizarse para sostener este aserto. En nuestra opinión, tal desaparición está relacionada con el declive municipal iniciado en Hispania en época de los Severos, por lo que cabria fechar los últimos espectáculos de gladiadores celebrados en Hispania durante el primer tercio del siglo III.

Role of Chlamydia trachomatis and emerging Chlamydia-related bacteria in ectopic pregnancy in Vietnam.

In this case-control study, we investigated the seroprevalence and molecular evidence of Chlamydia trachomatis and Waddlia chondrophila in ectopic pregnancies (EP) and uneventful control pregnancies in 343 women from Vietnam. Whereas presence of C. trachomatis IgG was strongly associated with EP [adjusted odds ratio (aOR) 5·41, 95% confidence interval (CI) 2·58-11·32], its DNA remained undetected in all tubal lesions. We confirmed an independent association between antibodies against Waddlia and previous miscarriage (aOR 1·87, 95% CI 1·02-3·42). Further investigations are needed to understand the clinical significance of Waddlia's high seroprevalence (25·9% in control pregnancies) in this urban population.

A mouse peritonitis model for the study of glycopeptide efficacy in GISA infections

In recent years, the emergence of Staphylococcus aureus strains with reduced susceptibility to glycopeptides has raised considerable concern. We studied the efficacy of vancomycin and teicoplanin, as well as cloxacillin and cefotaxime, against the infection caused by four S. aureus strains with different glycopeptide and β-lactam susceptibilities (strains A, B, C, and D; MICs for vancomycin of 1, 2, 4, and 8 µg/ml respectively), using a modified model of mouse peritonitis. This optimized model appeared to be straightforward and reproducible, and was able to detect low differences in bacterial killing between antibiotics and also between different S. aureus strains. Bactericidal activities in peritoneal fluid for vancomycin, teicoplanin, cloxacillin, and cefotaxime decreased from -2.98, -2.36, -3.22, and -3.57 log10 cfu/ml, respectively, in infection by strain A (MICs for vancomycin and cloxacillin of 1 and 0.38 µg/ml, respectively) to -1.22, -0.65, -1.04, and +0.24 in peritonitis due to strain D (MICs for vancomycin and cloxacillin of 8 and 1,024 µg/ml). Our data confirm the superiority of β-lactams against methicillin-susceptible S. aureus and show that bactericidal activity of glycopeptides decreases significantly with slight increases in MICs; this finding suggests a reduced efficacy of glycopeptides in the treatment of serious glycopeptide-intermediate S. aureus infections

El cos molest en l'obra d'Epictet

The work by Epictetus shows a remarkable amount of allusions to unpleasant aspects of the human body. It deals with expressions which sometimes could be almost considered aischrologia and, on other occasions, they really are. Our contribution approaches this subject and asks which might be the origin of this practice. We suggest the use of those expressions describes the body in terms fitting with Epictetus" stoic philosophy aimed to establish an inner separation between body and the right use of reason leading us into virtue. Furthermore his humble origin as a slave could help him in using unpleasant words without prejudices. Also Arrian could insist on that characteristic when transmitting Epictetus" teachings.

A mouse peritonitis model for the study of glycopeptide efficacy in GISA infections

In recent years, the emergence of Staphylococcus aureus strains with reduced susceptibility to glycopeptides has raised considerable concern. We studied the efficacy of vancomycin and teicoplanin, as well as cloxacillin and cefotaxime, against the infection caused by four S. aureus strains with different glycopeptide and β-lactam susceptibilities (strains A, B, C, and D; MICs for vancomycin of 1, 2, 4, and 8 µg/ml respectively), using a modified model of mouse peritonitis. This optimized model appeared to be straightforward and reproducible, and was able to detect low differences in bacterial killing between antibiotics and also between different S. aureus strains. Bactericidal activities in peritoneal fluid for vancomycin, teicoplanin, cloxacillin, and cefotaxime decreased from -2.98, -2.36, -3.22, and -3.57 log10 cfu/ml, respectively, in infection by strain A (MICs for vancomycin and cloxacillin of 1 and 0.38 µg/ml, respectively) to -1.22, -0.65, -1.04, and +0.24 in peritonitis due to strain D (MICs for vancomycin and cloxacillin of 8 and 1,024 µg/ml). Our data confirm the superiority of β-lactams against methicillin-susceptible S. aureus and show that bactericidal activity of glycopeptides decreases significantly with slight increases in MICs; this finding suggests a reduced efficacy of glycopeptides in the treatment of serious glycopeptide-intermediate S. aureus infections

Planning and reporting of quality-of-life outcomes in cancer trials.

BACKGROUND: Information about the impact of cancer treatments on patients' quality of life (QoL) is of paramount importance to patients and treating oncologists. Cancer trials that do not specify QoL as an outcome or fail to report collected QoL data, omit crucial information for decision making. To estimate the magnitude of these problems, we investigated how frequently QoL outcomes were specified in protocols of cancer trials and subsequently reported. DESIGN: Retrospective cohort study of RCT protocols approved by six research ethics committees in Switzerland, Germany, and Canada between 2000 and 2003. We compared protocols to corresponding publications, which were identified through literature searches and investigator surveys. RESULTS: Of the 173 cancer trials, 90 (52%) specified QoL outcomes in their protocol, 2 (1%) as primary and 88 (51%) as secondary outcome. Of the 173 trials, 35 (20%) reported QoL outcomes in a corresponding publication (4 modified from the protocol), 18 (10%) were published but failed to report QoL outcomes in the primary or a secondary publication, and 37 (21%) were not published at all. Of the 83 (48%) trials that did not specify QoL outcomes in their protocol, none subsequently reported QoL outcomes. Failure to report pre-specified QoL outcomes was not associated with industry sponsorship (versus non-industry), sample size, and multicentre (versus single centre) status but possibly with trial discontinuation. CONCLUSIONS: About half of cancer trials specified QoL outcomes in their protocols. However, only 20% reported any QoL data in associated publications. Highly relevant information for decision making is often unavailable to patients, oncologists, and health policymakers.

Hepatitis víricas. Implicaciones y consideraciones en la práctica odontológica

Las hepatitis víricas, especialmente las causadas por los virus B y C representan para el odontólogo y su equipo de trabajo un riesgo ocupacional debido a la posible transmisión de partículas virales a través de la sangre u otros fluidos orgánicos. Esta entidad se define como un proceso inflamatorio del hígado, con la consecuente alteración de su función y puede ser causada por alguno de los siguientes virus hepatotrópicos: A, B, C, D, E y G. El objetivo de este artículo de revisión de la literatura es describir las principales manifestaciones de las hepatitis víricas, su evolución, tratamiento, además de presentar las principales consideraciones e implicaciones a tener en cuenta por el odontólogo a la hora de tratar este tipo de pacientes.

Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis.

PURPOSE: We aimed to study the relationship between two morphological parameters recently described on MRI images in relation to lumbar spinal stenosis (LSS): the first is the sedimentation sign (SedS) and the second is the morphological grading of lumbar stenosis. MATERIALS AND METHODS: MRIs from a total of 137 patients were studied. From those, 110 were issued from a prospective database of symptomatic LSS patients, of whom 73 were treated surgically and 37 conservatively based on symptom severity. A third group consisting of 27 subjects complaining of low back pain (LBP) served as control. Severity of stenosis was judged at disc level using the four A to D grade morphological classification. The presence of a SedS was judged at pedicle level, above or below the site of maximal stenosis. RESULTS: A positive SedS was observed in 58, 69 and 76 % of patients demonstrating B, C and D morphology, respectively, but in none with grade A morphology. The SedS was positive in 67 and 35 % of the surgically and conservatively treated patients, respectively, and in 8 % of the LBP group. C and D morphological grades were present in 97 and 35 % of patients in the surgically and conservatively treated group, respectively, and in 18 % of the LBP group. Presence of a positive SedS carried an increased risk of being submitted to surgery in the symptomatic LSS group (OR 3.5). This risk was even higher in the LSS patients demonstrating grade C or D morphology (OR 65). DISCUSSION AND CONCLUSION: One-third of surgically treated LSS patients do not present a SedS. This sign appears to be a lesser predictor of treatment modality in our setting of symptomatic LSS patients compared to the severity of stenosis judged by the morphological grade.

Instalaciones oleícolas y vinícolas estudiadas en el marco del Proyecto Ager Tarraconensis (PAT)

Dentro del Proyecto Ager Tarraconensis, se han estudiado en el Camp de Tarragona 19 yacimientos con indicios de instalaciones de producción de aceite o vino, que se centran especialmente entre los siglos I a.C. y II d.C. También se han estudiado 22 yacimientos con indicios de alfarería, en siete de los cuales se conoce la producción de ánforas vinarias. El hallazgo de diversas marcas de alfarero dónde identificamos el nombre de M. Clodius Martialis apunta hacia una rica familia de la elite de Tarraco, con la que se han relacionado cuatro yacimientos y quizás un quinto. Entre la época de Augusto y el siglo III, el vino se confirma como el producto principal de una agricultura desarrollada dentro del sistema de la villa, enfocada al mercado de ultramar. El aceite se debió producir para el consumo local. Esta región no volvió a potenciar la producción de vino a nivel de gran negocio de ámbito internacional hasta el siglo XVIII, con el cual se establece una comparación.

Premature Discontinuation of Randomized Trials in Critical and Emergency Care: A Retrospective Cohort Study.

OBJECTIVES: Randomized clinical trials that enroll patients in critical or emergency care (acute care) setting are challenging because of narrow time windows for recruitment and the inability of many patients to provide informed consent. To assess the extent that recruitment challenges lead to randomized clinical trial discontinuation, we compared the discontinuation of acute care and nonacute care randomized clinical trials. DESIGN: Retrospective cohort of 894 randomized clinical trials approved by six institutional review boards in Switzerland, Germany, and Canada between 2000 and 2003. SETTING: Randomized clinical trials involving patients in an acute or nonacute care setting. SUBJECTS AND INTERVENTIONS: We recorded trial characteristics, self-reported trial discontinuation, and self-reported reasons for discontinuation from protocols, corresponding publications, institutional review board files, and a survey of investigators. MEASUREMENTS AND MAIN RESULTS: Of 894 randomized clinical trials, 64 (7%) were acute care randomized clinical trials (29 critical care and 35 emergency care). Compared with the 830 nonacute care randomized clinical trials, acute care randomized clinical trials were more frequently discontinued (28 of 64, 44% vs 221 of 830, 27%; p = 0.004). Slow recruitment was the most frequent reason for discontinuation, both in acute care (13 of 64, 20%) and in nonacute care randomized clinical trials (7 of 64, 11%). Logistic regression analyses suggested the acute care setting as an independent risk factor for randomized clinical trial discontinuation specifically as a result of slow recruitment (odds ratio, 4.00; 95% CI, 1.72-9.31) after adjusting for other established risk factors, including nonindustry sponsorship and small sample size. CONCLUSIONS: Acute care randomized clinical trials are more vulnerable to premature discontinuation than nonacute care randomized clinical trials and have an approximately four-fold higher risk of discontinuation due to slow recruitment. These results highlight the need for strategies to reliably prevent and resolve slow patient recruitment in randomized clinical trials conducted in the critical and emergency care setting.

Preparación y propiedades de una arcilla montmorillonita pilareada con polihidroxicationes de aluminio

Montmorillonite clay from Brazil was pillared with aluminium polyhydroxications. The influence of Al/Mont ratio and calcination temperature in the properties of the prepared materials was studied. Results showed that the pillarization process increases the basal spaces of the natural clay from 9,7 to 18,5Å and the superficial area from 41 to ~230m2/g. The calcination process at different temperatures showed that the pillared material was stable until 600oC but the adequate temperature for calcination was 450oC. Materials prepared with different Al/Mont ratios showed the maximum Al incorporation for ratios >10meq Al/g and a good distribution for rations >15meq Al/g.

Materiales laminares pilareados: preparación y propiedades

The structure of several types of layered materials will be described. These include clays, layered double hydroxides, group IV metal phosphates and other layered materials. The preparation of the pillared materials and pillaring agents will be presented along with a description of the properties and applications of the products.

Estudos da eletrodeposição de metais em regime de subtensão

This work reviews recent studies of underpotential deposition (UPD) of several metals on Pt and Au substrates performed in the Grupo de Materiais Eletroquímicos e Métodos Eletroanalíticos (IQSC -- USP, São Carlos). The UPD Cu, Cd and Pb on Pt were analysed in terms of their influence in the oxygen evolution reaction. Partial blockage of surface active sites, promoted by Pb ad-atoms, resulted in a change from water to hydrogen peroxide as the final product. The Ag UPD on Pt and Au substrates was also discussed in this work. A detailed model of charge calculation for Ag monolayer was developed and confirmed by the rotating ring-disk data. The partial charge transfer in UPD studies was analysed in the Cd/Pt and Cd/Au systems and a value of 0.5 was found for the adsorption electrovalence of Cd ad-ions. The Sn/Pt UPD systems were studied from the point of view of the valences of metallic ions in solution. The deposition from Sn(IV) generates a full monolayer with a maximum occupation of approximately 40% of the surface active sites (340 µC cm-2) plus 105 µC cm-2 of Hads (half monolayer). Changing the metallic ion for Sn(II), it was possible to deposit a full monolayer (210 µC cm-2) without any detectable Hads. Finally, the effect of anions was discussed in the Zn/Pt and Zn/Au systems. Here, the hydrogen evolution reaction (her) and the hydrogen adsorption/desorption were used in order to investigate the maximum coverage of the surface with Zn ad-atoms. The full monolayer, characterised by the complete absence of Hads, was achieved only in 0.5 M HF solutions.