Inequity in rehabilitation interventions after hip fracture: a systematic review.

OBJECTIVE: to determine the extent to which equity factors contributed to eligibility criteria of trials of rehabilitation interventions after hip fracture. We define equity factors as those that stratify healthcare opportunities and outcomes. DESIGN: systematic search of MEDLINE, Embase, CINHAL, PEDro, Open Grey, BASE and ClinicalTrials.gov for randomised controlled trials of rehabilitation interventions after hip fracture published between 1 January 2008 and 30 May 2018. Trials not published in English, secondary prevention or new models of service delivery (e.g. orthogeriatric care pathway) were excluded. Duplicate screening for eligibility, risk of bias (Cochrane Risk of Bias Tool) and data extraction (Cochrane's PROGRESS-Plus framework). RESULTS: twenty-three published, eight protocol, four registered ongoing randomised controlled trials (4,449 participants) were identified. A total of 69 equity factors contributed to eligibility criteria of the 35 trials. For more than 50% of trials, potential participants were excluded based on residency in a nursing home, cognitive impairment, mobility/functional impairment, minimum age and/or non-surgical candidacy. Where reported, this equated to the exclusion of 2,383 out of 8,736 (27.3%) potential participants based on equity factors. Residency in a nursing home and cognitive impairment were the main drivers of these exclusions. CONCLUSION: the generalisability of trial results to the underlying population of frail older adults is limited. Yet, this is the evidence base underpinning current service design. Future trials should include participants with cognitive impairment and those admitted from nursing homes. For those excluded, an evidence-informed reasoning for the exclusion should be explicitly stated. PROSPERO: CRD42018085930.

Establishment and characterization of adenoviral E1A immortalized cell lines derived from the rat suprachiasmatic nucleus.

Primary cultured cells from the presumptive anlage of the rat suprachiasmatic nucleus (SCN) were immortalized by infection with a retroviral vector encoding the adenovirus 12S E1A gene. After drug selection, the resulting neural cell lines (SCN1.4 and SCN2.2) displayed (a) extended growth potential without evidence of transformed or tumorigenic properties, (b) expression of E1A protein within all cell nuclei, and (c) heterogeneous cell types in various stages of differentiation. A large proportion of the SCN1.4 and SCN2.2 cells were characterized by gliallike morphologies, but showed limited expression of corresponding cell type-specific antigens. In addition, both lines exhibited a stable population of cells with neuronlike characteristics. When treated so as to enhance differentiation, these cells were often distinguished by fine, long processes and immunocytochemical expression of neuronal markers and peptides found within SCN neurons in situ. Observations on SCN neuropeptide immunostaining, content, release, and mRNA expression followed a concordant pattern in which somatostatin and vasopressin cells were the most and least common peptidergic phenotypes in both lines, respectively. Since these results indicate that constituents of E1A-immortalized lines derived from the primordial SCN can differentiate into cells with phenotypes resembling parental peptidergic neurons, it will be critical to explore next whether these lines also retain the distinctive function of the SCN to generate circadian rhythms. Cloning of immortalized cell types could subsequently yield useful tools for studying the development of SCN glial and peptidergic cell types and delineating their distinct roles in mammalian circadian time-keeping.

Light induces expression of fos-related proteins within gastrin-releasing peptide neurons in the rat suprachiasmatic nucleus.

The present study was conducted to determine whether the photic induction of c-fos expression in the rat suprachiasmatic nucleus (SCN) occurs within neurons containing gastrin-releasing peptide (GRP) and/or vasoactive intestinal polypeptide (VIP) because these peptidergic cells are closely associated with retinal projections to the ventrolateral subfield. Using dual immunostaining and thin sectioning techniques, the ventrolateral SCN of light-exposed rats was examined for evidence of individual neurons coexpressing nuclear immunostaining for c-fos proteins (Fos) with cytoplasmic immunoreactivity for GRP or VIP. In all animals, the photic induction of Fos expression in the SCN was mainly confined to cells segregated within the ventrolateral subfield and was evident in approximately 40% of the SCN neurons with cytoplasmic immunoreactivity for GRP. However, neurons coexpressing Fos and GRP comprised only a small fraction of the total number of cells within the ventrolateral SCN exhibiting light-induced Fos immunoreactivity. No sign of Fos expression was detected within VIP-immunoreactive perikarya in the ventrolateral SCN of light-treated rats. These results demonstrate that light induces Fos expression in a number of GRP-containing neurons within the SCN, suggesting that these peptidergic cells may process photic information mediating circadian entrainment.

Effects of tetrodotoxin on the circadian pacemaker mechanism in suprachiasmatic explants in vitro.

Using perifused explants of the rat suprachiasmatic nucleus (SCN), the effects of tetrodotoxin (TTX) on vasopressin (VP) release and its circadian profile were studied at various times throughout the circadian cycle. VP release from SCN explants was consistently attenuated during TTX treatment, with the amplitude of this effect depending on the time of administration. In addition, the effect of TTX on the circadian pattern of VP release was also time-dependent, such that treatment during the late subjective day was followed by a disruption of circadian rhythmicity in which peptide output remained at basal levels without notable variation whereas treatment at all other times caused no measurable perturbation in the circadian VP rhythm in succeeding cycles. In SCN explants experiencing this TTX-induced arrest of circadian VP output, subsequent exposure to KCl induced acute increases in VP release, suggesting that VP neurons retain the capacity to actively release peptide in spite of this effect of TTX. These results indicate that the interruption of electrical impulses at a critical phase may compromise the circadian function or output of the pacemaker in the SCN. In addition, the present observations provide further evidence that the overt expression of circadian rhythmicity is dependent on sodium-generated action potentials and that disruption of these electrical signals does not alter the precision of the SCN pacemaker, at least in instances where the phase of the VP rhythm can be determined after treatment.

Detection of Legionella pneumophila capsular-like envelope antigens by counterimmunoelectrophoresis.

The capsular-like envelope of Legionella pneumophila strains Togus 1 (serotype 2) and Philadelphia 1 (serotype 1) was isolated and purified by column chromatography on Sepharose 6B. Antibody raised in rabbits to these two antigenic materials did not cross-react in gel diffusion. Upon electrophoresis followed by gel diffusion, the majority of both envelope materials was found to migrate towards the cathode. A minor antigenic component of each envelope only migrated slightly towards the anode. Using the envelope antigens and the two anti-envelope sera in a counterimmunoelectrophoresis (CIE) assay, positive results were only obtained when the antigenic materials were placed in the cathodal well. The Togus 1 and Philadelphia 1 antigens did not cross-react in CIE. The sensitivity of the CIE assay was poor (15.6 micrograms/ml by carbohydrate content) compared to its sensitivity in other microbial systems. Although CIE may not be a useful diagnostic aid in identifying Legionella species due to its low sensitivity, it may be of value in serotyping the microorganism since we did not see cross-reactivity between the two strains when anti-envelope sera were used.