Blinded vs. unblinded peer review of manuscripts submitted to a dermatology journal: a randomized multi-rater study

BACKGROUND

Submissions to medical and scientific journals are vetted by peer review, but peer review itself has been poorly studied until recently. One concern has been that manuscript reviews in which the reviewer is unblinded (e.g. knows author identity) may be biased, with an increased likelihood that the evaluation will not be strictly on scientific merits.

OBJECTIVES

The purpose of this study was to compare the outcomes of blinded and unblinded reviews of manuscripts submitted to a single dermatology journal via a randomized multi-rater study.

MATERIALS AND METHODS

Forty manuscripts submitted to the journal Dermatologic Surgery were assessed by four reviewers, two of whom were randomly selected to be blinded and two unblinded regarding the identities of the manuscripts' authors. The primary outcome measure was the initial score assigned to each manuscript by each reviewer characterized on an ordinal scale of 1-3, with 1 = accept; 2 = revise (i.e. minor or major revisions) and 3 = reject. Subgroup analysis compared the primary outcome measure across manuscripts from U.S. corresponding authors and foreign corresponding authors. The secondary outcome measure was word count of the narrative portion (i.e. comments to editor and comments to authors) of the reviewer forms.

RESULTS

There was no significant difference between the scores given to manuscripts by unblinded reviewers and blinded reviewers, both for manuscripts from the U.S. and for foreign submissions. There was also no difference in word count between unblinded and blinded reviews.

CONCLUSIONS

It seems, at least in the case of one dermatology journal, that blinding during peer review does not appear to affect the disposition of the manuscript. To the extent that review word count is a proxy for review quality, there appears to be no quality difference associated with blinding.

A three years retrospective study on the nature and cause of ocular dermoids in cross-bred calves

αNature and cause of ocular dermoids were investigated by field studies, pedigree analysis, clinical examination and light microscopy. It was determined that ocular dermoids in cross-bred calves are genetically-transmitted defects. Calves typically were affected unilaterally or bilaterally with multiple, connected ocular growths that clinically and histologically mimicked normal haired skin. Sites most commonly involved included ventro-lateral limbus, third eyelid, medial canthus, eyelid and conjunctiva. Centro-corneal and anterior segmental dermoids were also observed. It is postulated from this study that bilateral ocular dermoids are genetically-transmitted defects in Hereford cattle. Characteristics of both autosomal recessive and polygenic inheritance were observed. However, mode of inheritance and role of environment in the pathogenesis of these peculiar and important developmental defects remain undefined. Extensive breeding trials utilizing superovulation, embryo transfer, and pre-terminal caesarean section as well as further field studies might be mandatory to confirm sex incidence, significance of associated somatic defects, role of environment in phenotypic expression, and mode of transmission of ocular dermoids in cross-bred calves.

Colles' fracture - is it a signal of osteoporosis?

Asymptomatic post-menopausal osteoporosis is common but some-times associated with pain and deformity. Symptomatic osteoporosis is usually associated with fracture. A 59 years old post-menopausal woman presented with a history of acute low-back-pain. She had menopause for 12 years. She gave history of colles' fracture at about two years back. Her mother died as consequences of femoral neck fracture. MRI of vertebral spine showed demineralization with partial collapse of D6,7,12 and L1 vertebra. Dual energy X-ray absorptiometry of vertebra showed BMD T-score of -4.5. Patient was managed with IV infusion of zoledronic acid, oral intake of vitamin D and calcium supplements and with regular non-weight-bearing exercises. Her condition improved gradually. During post-menopausal period, every women must be aware of osteoporosis and any fracture in that time must be evaluated to rule out osteoporosis.

Clinical significance, angiographic characteristics, and short-term outcomes in 30 patients with early coronary artery graft failure

BACKGROUND

Despite technical advances in coronary artery bypass grafting (CABG), early postoperative myocardial ischaemia still remains a challenging problem. The aim of this study was to determine the incidence, clinical features, angiographic characteristics, and management of early graft failure in the present CABG era.

METHODS

Between January 1997 and December 2002, 1731 patients underwent CABG at our institution. Coronary angiography was performed in patients with clinical evidence of early postoperative ischaemia (</=3 months). Thirty of these patients with graft failure constituted the population of this study.

RESULTS

Off-pump and on-pump CABG were almost evenly performed in these patients [n=16 (53%) and n=14 (47%) respectively]. Acute myocardial infarction and unstable angina were the leading indications for coronary angiography in the majority of patients [n=28 (93%)]. The most common cause of graft failure was occlusion / thrombosis [n=20 (67%)]. Percutaneous coronary intervention (PCI) was offered to the majority of patients [n=22 (73%)]. Of these patients, 14 underwent PCI to native coronary arteries, whereas eight underwent PCI to the culprit vessel. Three patients underwent reoperation, and five received medical management. Four patients (13%) died in hospital (two after redo CABG, one after unsuccessful PCI, and one patient managed medically). Two patients (7%) had nonfatal major complications (one non-ST-elevation myocardial infarction and one stroke).

CONCLUSION

Early graft failure generally presents as acute coronary syndrome. Graft occlusion/ thrombosis is the leading cause of ischaemia. Patients with graft failure can undergo PCI with a relatively low risk, but the need for redo CABG in associated with a high mortality. (Neth Heart J 2009;17:13-7.).

Increased incidence and mortality associated with skin cancers after cardiac transplant

Skin cancer incidence has been shown to be increased in the context of transplant-associated immunosuppression. There is, however, limited information specifically about the incidence of skin cancer after cardiac transplantation in the United States. A 10-year retrospective cohort study of 6271 heart transplants at 32 US transplant centers revealed increased postprocedure incidence of nonmelanoma and melanoma skin cancers, especially cutaneous squamous cell carcinoma, for which the incidence increased from 4- to 30-fold compared to the age and gender equivalent general population. Incidence of skin cancer in this study was consistent with prior single-center data regarding cardiac transplant patients. Comparison of all-cause mortality statistics for patients with basal cell carcinoma, squamous cell carcinoma and melanoma, respectively, demonstrated increased mortality associated with melanoma. Skin cancer screening and prophylaxis may be of some utility in reducing morbidity and mortality in cardiac transplant patients.

Comparative stain removal properties of four commercially available denture cleaning products: an in vitro study

OBJECTIVES

Formulations of commercially available denture cleaners vary widely. Unfortunately, comparative data to suggest which products are the most effective can become invalid as newer products are introduced or formulations are changed. The aim of this in vitro study was to measure the stain removal properties of four currently available denture cleaners.

METHODS

Stain was deposited on multi-well polystyrene saliva coated microplates using multiple chlorhexidine and tea solutions. Following drying, each stained well was exposed to a solution of denture cleaner, dried again and the amount of stain remaining measured using a microplate reader. The cleaning procedure was repeated with further multiple exposures of the wells to solutions of the denture cleaners.

RESULTS

All denture cleaners removed stain better than water used as a control. At five cleaning cycles only one of the cleaners (Superdrug Cleaning Powder) had removed 100% of the stain. At 30 cycles three of the cleaners had removed 100% of the stain.

CONCLUSIONS

All the commercial denture cleaners removed stain. Superdrug Cleaning Powder, which contains sodium percarbonate and sodium lauryl sulphate, was particularly effective.

Pre-Wisconsin stratigraphy and paleoclimates off Atlantic Canada, and its bearing on glaciation in Québec

Cores from tops of seamounts close to the continental shelf west of the Grand Banks contain sequences of alternating clays (representing glacials) and foram nanno ooze (deposited in warmer periods), back to the Pliocene. Although sedimentation in the cores is controlled primarily by glacial conditions on the Grand Banks and Laurentian Channel, glacial history further inland can be inferred. The Wisconsin sequence shows two cool interstadials and one rather warmer one, correlable with the Plum Point, Port Talbot and St. Pierre Interstadials. Clay sedimentation during Wisconsin glacial stages was minor, suggesting glaciers did not extend to the shelf edge. In the late lllinoian, there was a major influx of red sediments, indicating significant erosion of the Gulf of St. Lawrence and Laurentian Channel. Glaciation was more extensive than during the Wisconsin. Two lllinoian interstadials, with temperatures between those of the Plum Point and St. Pierre interstadials are recognised. Early lllinoian glaciation was the most severe yet recognised in the cores. Sedimentation appears to have been controlled by the advance of a Newfoundland — Labrador — E. Québec ice sheet across the Grand Banks.

Effect of single dose intravenous zoledronic acid on bone mineral density in post-menopausal osteoporosis of Bangladeshi women

The osteoporosis is a major health threat that affects every third post-menopausal women. Postmenopausal osteoporosis is complicated with vertebral, femoral or radius fracture. This prospective study on post-menopausal osteoporosis was carried out in the Pain Centre, Department of Anaesthesia, Analgesia and Intensive Care Medicine of BSMMU, Dhaka during the period of January 2008 to January 2010. The post-menopausal women with back pain were screened by spinal radiographs and dual-energy X-ray absorptiometry (DXA) of lumbar spine to determine the bone mineral density (BMD). The woman after menopause with a BMD T-score of -2.5 or less with or without evidence of vertebral fracture is considered as post-menopausal osteoporosis. A total of 55 post-menopausal osteoporotic patients were assigned to receive a single dose of IV infusion of zoledronic acid (5 mg) along with dietary calcium and vitamin-D. The spinal radiographs and dual-energy X-ray absorptiometry (DXA) were repeated in all the 55 patients at 12 months following zoledronic acid infusion. The mean BMD of lumbar spine increased significantly from pre-infusion value of 0.75695 g/cm2 to post-infusion of 0.80216 g/cm2. The T-score also increased from pre infusion value of -3.567 +/- 0.77 to -3.158 +/- 0.08 in 12 months following the infusion (P < 0.01). The increase is 5.026% higher than pre infusion values. The spinal radiographs taken before infusion of zoledronic acid, showed 14 fractures. There was no new fracture in any case during the 12 months study period. So, it can be concluded that once yearly IV infusion of zoledronic acid is associated with a significant increase in BMD and decrease in the risk of vertebral fracture.

Haemodynamic and end tidal CO2 changes state after inflation and deflation of pneumatic tourniquet on extremities

The use of a tourniquet for obtaining a bloodless field is an essential and accepted tool for extremity surgery. A prospective study was done on 30 adult patients undergoing elective limb surgery requiring tourniquet application for haemodynamic and End tidal CO2 (EtCO2) changes. After the induction of general anaesthesia a tourniquet was applied on the limb. There was gradual increase in heart rate & EtCO2 through out the whole period of tourniquet inflation. There was also significant increase of mean arterial pressure during the inflation period. At the end of surgery tourniquet was deflated. Tourniquet time was 76.83+/-16.94 minutes. After deflation of the tourniquet, heart rate & EtCO2 value increased & the values were maximum at 5 minutes. These values came down to the base line at 15 minutes. There was significant decrease of mean arterial pressure (MAP) at 5 minute; it also came to the base at 15 minute. These changes are usually benign but can be significant in patients with co-existing cardiovascular & intracranial diseases. In conclusion, we recommend the haemodynamic and End tidal CO2 monitoring as well as rapid fluid infusion along with hyperventilation for 15-30 minutes after deflation of tourniquet.

Reduced expression of the tumor suppressor PHLPP1 enhances the antiapoptotic B-cell receptor signal in chronic lymphocytic leukemia B-cells

The PI3K/Akt pathway is activated in response to various microenvironmental stimuli that regulate the survival and proliferation of chronic lymphocytic leukemia (CLL) B-cells, including triggering of the B-cell receptor (BCR). Although this pathway is frequently targeted in cancer, no significant alterations have yet been identified in CLL. We now show that the phosphatase PH domain leucin-rich repeat protein phosphatase (PHLPP1), a recently identified tumor suppressor and negative regulator of the Akt kinase, is absent or expressed at substantially reduced levels in CLL B-cells. To determine what the consequences of PHLPP1 loss on BCR signaling are, we downregulated or re-expressed PHLPP1 in lymphoma cell lines and primary CLL B-cells, respectively. Downregulation of PHLPP1 increased BCR-induced phosphorylation and activation of the Akt, GSK3 and ERK kinases, whereas re-expression had the opposite effect. Importantly, re-expression of PHLPP1 in primary CLL cells prevented upregulation of Mcl-1 and inhibited the increase in leukemic cell viability induced by sustained BCR engagement. Enforced expression of PHLPP1 also affected the response to other microenvironmental stimuli, particularly in terms of ERK phosphorylation. Collectively, these data show that CLL cells lack an important negative regulator of the Akt and ERK pathways, which could confer them a growth advantage by facilitating the propagation of crucial microenvironment-derived stimuli.

Role of immunochromatographic test for rapid diagnosis of malaria

The study was conducted to compare among the different diagnostic procedures for malaria in the department of Microbiology, Mymensingh Medical College, Mymensingh during the period from July 2005 to June 2006. In this study a total of 98 malaria patients were included as cases. Another 30 age and sex matched healthy people were included as controls. Blood sample from each of the case and control was collected and examined for malarial parasite by microscopic examination of peripheral blood film. Subsequently antigen and antibody were detected by immuno-chromatographic test (ICT). Out of 98 clinically suspected cases 59(60.20%) were positive for malarial parasite by microscopic examination of peripheral blood film, 57(58.16%) were positive by ICT for antigen and 58(59.19%) were positive by ICT for antibody. Sensitivity and specificity of ICT for antigen were 93.22% and 94.87% respectively. For antibody, sensitivity and specificity were 89.83% and 87.17% respectively. From this study, sensitivity and specificity of ICT for malaria was found quite satisfactory, so it is suggested that ICT for malaria could be an alternative to peripheral blood film for the diagnosis of malaria where parasite could not be detected in peripheral blood film.

Prevalence of haemoglobinopathies in 34 030 healthy adults in Tehran, Iran

Background:

Haemoglobinopathies are a group of inherited disorders of haemoglobin synthesis. Their frequency varies considerably with geographic location and ethnic group.

Aims:

To establish the prevalence of haemoglobinopathies in a mainly healthy Iranian population.

Methods:

All files of the haematology unit of the Boghrat laboratory over a period of 10 years (1998–2007) were analysed in relation to the age, sex, full blood count, haemoglobin electrophoresis results, high performance liquid chromatography (HPLC) findings, and iron profile of healthy subjects referred for consultation before marriage. Other tests were performed if indicated.

Results:

There were 34 030 files; 13 432 (39.5%) were for men, and 20 567 (60.4%) for women. 0.74% of subjects (255) showed a haemoglobinopathy. The distribution of variant haemoglobins in these 255 subjects was: Hb D 75.67% (193 cases), Hb S 4.7%, Hb E 3.13%, Hb O-Arab 1.96% and Hb Lepore 0.39%. A fast haemoglobin was found in 4.71% of subjects. Of the subjects tested, 13.2% (4478) had β-thalassaemia minor, 0.2% (52) β-thalassaemia intermedia and 0.1% (30) β-thalassaemia major.

Conclusions:

In comparison with other parts of world, there is a different pattern of haemoglobinopathy with a high prevalence of Hb D, which appears to be Hb D Iran.

Proteomics-based approach for identification and purification of human phosphate binding apolipoprotein from amniotic fluid

Human amniotic fluid is of both maternal and fetal origin; it protects the fetus and provides the environment for growth and development of the fetus. We used a proteomics-based approach for targeting and purifying human phosphate binding protein, a member of the DING family of proteins from amniotic fluid, using Blue Sepharose CL-6B, DEAE-Sephacel and gel filtration chromatography. The protein had earlier been reported to be serendipitously purified along with PON1 (paraoxonase 1). It was identified using electro-spray-ionization-time-of-flight mass spectrometry and was found to be human phosphate binding protein. Human phosphate binding proteins have been reported to play a role as phosphate scavengers and may have a protective function against phosphate-related disorders, such as atherosclerosis, diabetes and kidney stones.