BackgroundDesigning RCTs in surgery requires consideration of existing evidence, stakeholders' views and emerging interventions, to ensure that research questions are relevant to patients, surgeons and the health service. When there is uncertainty about RCT design, feasibility work is recommended. This study aimed to assess how feasibility work could inform the design of a future pilot study and RCT (Bluebelle, HTA ‐ 12/200/04).MethodsThis was a prospective survey of dressings used to cover abdominal wounds. Surgical trainees from 25 hospitals were invited to participate. Information on patient risk factors, operation type and type of wound dressings used was recorded for elective and unplanned abdominal procedures over a 2‐week interval. The types of dressing used were summarized, and associations with operation type and patient risk factors explored.ResultsTwenty hospitals participated, providing data from 727 patients (1794 wounds). Wounds were predominantly covered with basic dressings (1203 of 1769, 68·0 per cent) and tissue adhesive was used in 27·4 per cent (485 of 1769); dressing type was missing for 25 wounds. Just 3·6 per cent of wounds (63 of 1769) did not have a dressing applied at the end of the procedure. There was no evidence of an association between type of dressing used and patient risk factors, type of operation, or elective and unscheduled surgery.ConclusionBased on the findings from this large study of current practice, the pilot study design has evolved. The inclusion criteria have expanded to encompass patients undergoing unscheduled surgery, and tissue adhesive as a dressing will be evaluated as an additional intervention group. Collaborative methods are recommended to inform the design of RCTs in surgery, helping to ensure they are relevant to current practice.
Middle ear mucosa is a modified respiratory epithelium and five genes for secreted mucins (MUCs 2, 3, 4, 5AC, 5B and 8) are expressed in the airways. In this study we have compared the composition predicted by the gene sequences of these mucins with that of mucins isolated from middle ear effusions. Three groups of mucins, (1) thick and (2) thin from anatomically normal children and (3) effusions from children with a cleft palate were studied. Amino acid analysis was performed on glycopeptide fragments corresponding to the characteristic tandem repeat domains of cloned mucin genes. There were marked differences both between the three mucin pools and from the tandem repeat sequences of the five cloned genes expressed in the airways. Serine, threonine and proline contributed 44%, 29% and 36% from groups (1) (2) and (3)respectively, in the ratios (2.4 : 2.9 : 1) (5 : 1 : 1) and (3.5 : 1 : 1.5).The serine to threonine ratio in thick effusions is similar to that found in MUC 4; however, the high proportion of serine in mucin from groups (2) and (3) is novel. Therefore, more than one mucin gene product is secreted by the human middle ear mucosa and further mucin genes expressed by the middle ear are yet to be cloned.
A function of nasal turbinates is the removal of particles bythe action of the cilia moving a mucous blanket. The rheologicalproperties of the mucous secretion are critical to this functionand dependent on several factors, in particular the integrity and type of mucin present. Recent work has shown that MUC5AC is a major secreted mucin in the respiratory tract and MUC2 is expressed at a much lower level.1,2 Alteration in the levels of expression of mucin genes could potentially alter the transport and lubricating properties of mucous. mRNA was isolated from inferior nasal turbinates and electrophoresis showed a polydisperse mRNA population. Northern blots were probed with 48bp digoxigenin labelled antisense oligonucleotides to the tandem repeat sequences of MUC2 and MUC5AC. The MUC2 probe gave an intense signal with the positive control (human ileum), in contrast the negative control (rat kidney) showed no binding. Turbinate mRNA also gave a strong signal although not as intense as ileum. The MUC5AC probe bound to turbinate mRNA and ileum although to a lesser extent than MUC2. The results show that both MUC2 and MUC5AC are expressed in human nasal turbinates and interestingly the level ofMUC2 was higher than that of MUC5AC (using these probes). This reversal in mucin secretory pattern, presumablya function of hyperplasia could lead to altered mucous properties. This tissue may provide a good model to study diseases in tissues of the same embryological origin and similar histology where cell proliferative changes occur, i.e. diseases of middle ear mucosa. We thank the Hearing Research Trust for their support.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.