Appraising the methodological quality of cadaveric studies: validation of the <scp>QUACS</scp> scale

Wilke, Jan; Krause, Felix; Niederer, Daniel; Engeroff, Tobias; Nürnberger, F.; Vogt, Lutz; Banzer, Winfried

doi:10.1111/joa.12292

Cited by 128 publications

(112 citation statements)

References 50 publications

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“…Therefore, data obtained from preclinical models must be interpreted with outmost care when, for instance, approaching clinical situations in feasibility studies. However, there are data available to estimate the physical parameters in a given tissue based on experiments with cadaveric samples . Based on current clinical experience with the waterjet technology, a pressure range of E60 to E80 seems reasonable to reach but not penetrate the sphincter muscle.…”

Section: Discussionmentioning

confidence: 99%

A novel waterjet technology for transurethral cystoscopic injection of viable cells in the urethral sphincter complex

Jäger

Linzenbold

Fech

et al. 2019

Neurourology and Urodynamics

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Aims: In a recent preclinical study, we noticed that injection of cells in the urethral sphincter by needle through a cystoscope under visual control frequently yielded in misplacement or loss of cells. We, therefore, investigated if a needle-free waterjet device delivers viable cells under defined settings, including injection volume and pressure, fluid velocity and transportation media, precisely through the urothelium and connective tissue close to the sphincter muscle without full penetration of the sphincter apparatus. Methods: Mesenchymal stromal cells (MSCs) were prepared for needle-free waterjet injections. Upon injections into liquids cell viability and yield were investigated by trypan blue dye exclusion. Upon injection into cadaveric urethral tissue samples, cells were isolated from the urethrae and expanded to prove that this novel method delivered viable cells into the tissue. MSC injections by William's needle served as controls. Results: Waterjet injections of MSCs into isotonic cell culture medium resulted in equal or better yields of viable cells when compared with needle injections.Upon injection in urethral tissue samples, the waterjet technology facilitated fast and precise injections of viable cells through urothelial, mucosal and submucosal layers to reach the sphincter muscle. By controlling the injection pressure, loss of cells due to insufficient thrust or unintended full penetration was avoided.Conclusions: Needle-free waterjet injections deliver cells in the urethra faster and more precisely when compared with needle injections without compromising their viability. This is the first proof-of-concept study providing evidence that a waterjet transports viable cells precisely into the targeted tissue. K E Y W O R D S cell injection, cell therapy, medical technology, stress urinary incontinence, waterjet ---This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Abbreviations: E, effect = pump setting, reflects a given pressure in an open system; IPCM, improved pressure control mode; LSM, laser scanning microscope; MSC, mesenchymal stromal cells; SUI, stress urinary incontinence; UPaCS, upgraded pump and controller system (based on ERBEJET 2).

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Section: Discussionmentioning

confidence: 99%

A novel waterjet technology for transurethral cystoscopic injection of viable cells in the urethral sphincter complex

Jäger

Linzenbold

Fech

et al. 2019

Neurourology and Urodynamics

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“…It has been shown to be a reliable and valid tool to appraise the quality of observational cadaveric studies, and has been described elsewhere in detail (Wilke et al. ). Methodological quality of in vivo experimental studies was evaluated with the PEDro scale (Sherrington et al.…”

Section: Methodsmentioning

confidence: 99%

Intermuscular force transmission along myofascial chains: a systematic review

et al. 2016

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The present review aims to provide a systematic overview on tensile transmission along myofascial chains based on anatomical dissection studies and in vivo experiments. Evidence for the existence of myofascial chains is growing, and the capability of force transmission via myofascial chains has been hypothesized. However, there is still a lack of evidence concerning the functional significance and capability for force transfer. A systematic literature research was conducted using MEDLINE (Pubmed), ScienceDirect and Google Scholar. Studied myofascial chains encompassed the superficial backline (SBL), the back functional line (BFL) and the front functional line (FFL). Peer-reviewed human dissection studies as well as in vivo experiments reporting intermuscular tension transfer between the constituents of a myofascial chain were included. To assess methodic quality, two independent investigators rated studies by means of validated assessment tools (QUACS and PEDro Scale). The literature research identified 1022 articles. Nine studies (moderate to excellent methodological quality) were included. Concerning the SBL and the BFL, there is moderate evidence for force transfer at all three transitions (based on six studies), and one of two transitions (three studies). One study yields moderate evidence for a slight, but not significant force transfer at one transition in the FFL. The findings of the present study indicate that tension can be transferred between some of the examined adjacent structures. Force transfer might have an impact in overuse conditions as well as on sports performance. However, different methods of force application and measurement hinder the comparability of results. Considering anatomical variations in the degree of continuity and histological differences of the linking structures is crucial for interpretation. Future studies should focus on the in vivo function of myofascial continuity during isolated active or passive tissue tensioning.

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“…However, the lack of information regarding the development of their appraisal tool and the assessment of its validity and feasibility are significant limitations. Wilke et al developed the QUality Appraisal for Cadaveric Studies (QUACS) scale to assess the quality of observational cadaveric studies (Wilke et al, 2015). Although this tool was also developed using an expert consensus process and assessed for reliability, validity, and feasibility, it employs a scale system and is only applicable to observational cadaveric studies.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the QUACS scale considers elements that are not directly related to methodological quality and risk of bias, and includes several items regarding the overall quality of an article such as "clinical implication of the results are discussed" and "limitation of the results are addressed." Considering the strengths and weaknesses of the tools available in anatomical research and observational studies (Sanderson et al, 2007;Smith et al, 2008;von Elm et al, 2008;Wilke et al, 2015), the AQUA Tool was designed to be applicable across different types of anatomical studies (gross, microscopic, surface, surgical, radiological, developmental, electrophysiological, etc.) since they might be pooled together into a single analysis.…”

Section: Discussionmentioning

confidence: 99%

Development of the Anatomical Quality Assessment (AQUA) Tool for the quality assessment of anatomical studies included in meta‐analyses and systematic reviews

Henry¹,

Tomaszewski²,

et al. 2016

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Critical appraisal of anatomical studies is essential before the evidence from them undergoes meta-epidemiological synthesis. However, no instrument for appraising anatomical studies with inherent applicability to different study designs is available. We aim to develop a generic yet comprehensive tool for assessing the quality of anatomical studies using a formal consensus method. The study steering committee formulated an initial conceptual design and generated items for a preliminary tool on the basis of a literature review and expert opinion. A Delphi procedure was then adopted to assess the validity of the preliminary tool. Feedback from the Delphi panelists was used to improve it. The Delphi procedure involved 12 experts in anatomical research. It comprised two rounds, after which unanimous consensus was reached about the items to be included. The preliminary tool consisted of 20 items, which were phrased as signaling questions and organized into five domains: 1. Aim and subject characteristics, 2. Study design, 3. Characterization of methods, 4. Descriptive anatomy, and 5. Results reporting. Each domain was set to end with a risk of bias question. Following round 1, some of the items underwent major revision, although agreement was reached regarding inclusion of all the domains and signaling questions in the preliminary tool. The tool was revised only for minor language inaccuracies after round 2. The AQUA Tool was designed to assess the quality and reliability of anatomical studies. It is currently undergoing a validation process. Clin. Anat. 30:6-13,

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Appraising the methodological quality of cadaveric studies: validation of the QUACS scale

Cited by 128 publications

References 50 publications

A novel waterjet technology for transurethral cystoscopic injection of viable cells in the urethral sphincter complex

A novel waterjet technology for transurethral cystoscopic injection of viable cells in the urethral sphincter complex

Intermuscular force transmission along myofascial chains: a systematic review

Development of the Anatomical Quality Assessment (AQUA) Tool for the quality assessment of anatomical studies included in meta‐analyses and systematic reviews

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