Search

Objective: Current risk algorithms do not accurately predict cardiovascular disease (CVD) risk in rheumatoid arthritis (RA). An area of interest is that of single‐nucleotide polymorphisms (SNPs), of which several have been associated with CVD in the general population. We investigated whether these SNPs are associated with CVD in RA and whether SNPs could improve CVD risk prediction in RA. Methods: Sixty SNPs were genotyped in 353 patients with RA. Logistic and Cox regression analyses were performed to identify SNPs that were associated with CVD (n = 99). A prediction model with clinical variables was made. SNPs were added to investigate the additional predictive value. Both models were internally validated. External validation was done in a separate cohort (n = 297). Results: rs3184504, rs4773144, rs12190287, and rs445925 were significantly associated with new CVD. The clinical prediction model consisted of age, sex, body mass index, systolic blood pressure, high‐density lipoprotein cholesterol (HDLc), and creatinine, with an area under the curve (AUC) of 0.74 (P = 0.03). Internal validation resulted in an AUC of 0.76 (P < 0.01). A new model was made including SNPs and resulted in a model with rs17011666 and rs801426, age, total cholesterol, and HDLc, which performed slightly better with an AUC of 0.77 (P < 0.01). External validation resulted in a good fit for the clinical model, but a poor fit for the SNP model. Conclusion: Several SNPs were associated with CVD in RA. Risk prediction slightly improved after adding SNPs to the models, but the clinical relevance is debatable. However, larger studies are needed to determine more accurately the additional value of these SNPs to CVD risk prediction algorithms. [ABSTRACT FROM AUTHOR]

Objective: Patients with back pain (BP) and radiating leg pain have poorer clinical outcomes compared to patients with BP alone. We aimed to describe the 1‐year clinical course and to identify prognostic factors associated with non‐recovery in older BP patients with radiating leg pain. Design: Patients in the BACE cohort aged >55 years with a new episode of BP and radiating leg pain were included (n = 377). Data on clinical outcomes were collected until 1‐year follow‐up. Uni‐ and multivariable regression analyses were performed to investigate the association between potential prognostic factors and three non‐recovery outcomes at the 1‐year follow‐up. Results: More than half of the patients (65%) did not recover after 12 months. In multivariable analyses, poor self‐rated health (odds ratio [OR] 2.34, 95% CI: 1.20–4.56) and BP duration at baseline (OR 1.48, 1.12–1.96) were significantly associated with non‐recovery for BP as outcome; age (OR 1.04, 1.03–1.05), smoking (OR 1.14, 1.00–1.30), depressive symptomatology (OR 1.03, 1.02–1.04), kinesiophobia (OR 1.03, 1.02–1.04), poor self‐rated health (OR 2.09, 1.83–2.39), baseline disability (OR 1.16, 1.14–1.17), BP duration (OR 1.49, 1.41–1.57), leg pain (OR 1.52, 1.37–1.68), pain during rotation (OR 1.71, 1.53–1.90) and other musculoskeletal complaints (OR 1.34, 1.17–1.52) were associated with disability. No factors were associated with leg pain. Conclusions: Several prognostic factors were associated with non‐recovery in older patients with BP and radiating leg pain. Primary care clinicians should be aware of these factors in managing these patients. [ABSTRACT FROM AUTHOR]

Purpose: Healthcare providers often experience difficulties in discussing depression with adults with visual impairment (VI), obstructing timely referral. The purpose of this study was to examine predictors of routine discussions of depression with adults with VI from the perspective of different healthcare providers from different countries. Methods: Cross‐sectional survey data from Welsh (N = 122), Australian (N = 94) and Dutch (N = 100) healthcare providers, that is eye care practitioners (ECPs) and low‐vision care providers (LVCPs), were analysed. Multivariable logistic regression analysis was performed in the Welsh sample to determine predictors for discussing depression. Internal validation was conducted by using a bootstrap method, and the recalibrated model was externally validated in the Australian and Dutch sample. Results: Work experience in eye care services (OR 0.95; 95% confidence interval (CI) 0.92 to 0.99) and perceived barriers (OR 0.95; 95% CI 0.92 to 0.98) was found to predict discussing depression with patients. The area under the curve (AUC) of 0.73 reflected good discrimination of the model. The model showed a slightly better fit in the Australian sample (AUC = 0.77), but a poor fit in the Dutch sample. Conclusion: The final prediction model was not generalizable to Dutch healthcare providers. They perceived less barriers in depression management than Welsh and Australian healthcare providers. This could be explained by differences in ECPs and LVCPs roles and responsibilities, increased attention on mental health and differences in organizing health care. Differences between healthcare providers' responsibilities and support needs should be taken into account while creating a facilitating environment to discuss depression. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to develop a Service Capacity Index for Substance Use Disorders (SCI‐SUD) that would reflect the capacity of national health systems to provide treatment for alcohol and drug use disorders, in terms of the proportion of available service elements in a given country from a theoretical maximum. Methods: Data were collected through the WHO Global Survey on Progress with Sustainable Development Goals (SDG) Health Target 3.5, conducted between December 2019 and July 2020 to produce the SCI‐SUD, based on 378 variables overall. Results: The SCI‐SUD was directly derived for 145 countries. We used multiple imputation to produce comparable SCI‐SUD estimates for countries that did not submit data (40 countries) or had very high level of missingness (9 countries). The final SCI‐SUD demonstrates considerable consistency and internal stability and is strongly associated with the macro‐level economic, healthcare‐related and epidemiologic (such as prevalence rates) variables. Conclusion: The presented methodology represents a step forward in monitoring the global situation in regard to the development of treatment systems for SU disorders, however, further work is warranted to improve the external validity of the measure (e.g., in‐depth data generation in countries) and ensure its feasibility for regular reporting (e.g., reducing the number of variables). [ABSTRACT FROM AUTHOR]

Aims: In immune‐mediated inflammatory diseases (IMIDs), early symptom control is a key therapeutic goal. Methotrexate (MTX) is the first‐line treatment across IMIDs. However, MTX is underutilized and suboptimally dosed, partly due to the inability of making individualized treatment decisions through therapeutic drug monitoring (TDM). To implement TDM in clinical practice, establishing a relationship between drug concentration and disease activity is paramount. In this meta‐analysis, we investigated the relationship between concentrations of MTX polyglutamates (MTX‐PG) in erythrocytes and efficacy as well as toxicity across IMIDs. Methods: Studies analysing MTX‐PG in relation to disease activity and/or toxicity were included for inflammatory arthritis (rheumatoid [RA] and juvenile idiopathic arthritis [JIA]), inflammatory bowel disease (Crohn's and ulcerative colitis) and dermatitis (psoriasis and atopic dermatitis). Meta‐analyses were performed resulting in several summary effect measures: regression coefficient (β), correlation coefficient and mean difference (of MTX‐PG in responders vs. nonresponders) for IMIDs separately and collectively. Results: Twenty‐five studies were included. In RA and JIA, higher MTX‐PG was significantly associated with lower disease activity at 3 months (β: −0.002; 95% confidence interval [CI]: −0.004 to −0.001) and after 4 months of MTX use (β: −0.003; 95% CI: −0.005 to −0.002). Similarly, higher MTX‐PG correlated with lower disease activity in psoriasis (R: −0.82; 95% CI: −0.976 to −0.102). Higher MTX‐PG was observed in RA, JIA and psoriasis responders (mean difference: 5.2 nmol/L MTX‐PGtotal; P <.01). Conclusion: We showed that higher concentrations of erythrocyte MTX‐PG were associated with lower disease activity in RA, JIA and psoriasis. These findings are an important step towards implementation of TDM for MTX treatment across IMIDs. [ABSTRACT FROM AUTHOR]

The statistical quality of trial‐based economic evaluations is often suboptimal, while a comprehensive overview of available statistical methods is lacking. Therefore, this review summarized and critically appraised available statistical methods for trial‐based economic evaluations. A literature search was performed to identify studies on statistical methods for dealing with baseline imbalances, skewed costs and/or effects, correlated costs and effects, clustered data, longitudinal data, missing data and censoring in trial‐based economic evaluations. Data was extracted on the statistical methods described, their advantages, disadvantages, relative performance and recommendations of the study. Sixty‐eight studies were included. Of them, 27 (40%) assessed methods for baseline imbalances, 39 (57%) assessed methods for skewed costs and/or effects, 27 (40%) assessed methods for correlated costs and effects, 18 (26%) assessed methods for clustered data, 7 (10%) assessed methods for longitudinal data, 26 (38%) assessed methods for missing data and 10 (15%) assessed methods for censoring. All identified methods were narratively described. This review provides a comprehensive overview of available statistical methods for dealing with the most common statistical complexities in trial‐based economic evaluations. Herewith, it can provide valuable input for researchers when deciding which statistical methods to use in a trial‐based economic evaluation. [ABSTRACT FROM AUTHOR]

Purpose: To determine which demographic and clinical characteristics are predictive of vision‐related quality of life (VrQoL) and quality of life (QoL) in patients with macular oedema receiving intravitreal anti‐vascular endothelial growth factor (VEGF) treatment. Methods: Vision‐related quality of life (VrQoL) and quality of life (QoL) were measured in 712 patients with retinal exudative disease receiving anti‐VEGF treatment at baseline, 6 and 12 months. VrQoL was measured using an item‐response theory based 47‐question item bank (EyeQ), whereas QoL was measured using the EuroQol Five Dimensions (EQ‐5D) questionnaire. The EQ‐5D score was dichotomized into a perfect score of 1 and a suboptimal score of <1. Demographic and clinical patient characteristics were considered as possible predictors of (Vr)QoL. Prediction models for (Vr)QoL were created with linear mixed models and generalised estimating equations, using a forward selection procedure. Results: A worse VrQoL was predicted by poorer LogMAR visual acuity of the better eye, female sex, single civil status, older age, longer length of anti‐VEGF treatment at baseline and the presence of non‐ocular and ocular comorbidities. Suboptimal EQ‐5D scores were predicted by poorer LogMAR visual acuity of the better eye, female sex, single civil status, older age, the presence of non‐ocular comorbidities and a lower educational background. Conclusions: Along with visual acuity of the better eye, which is the main factor used in clinical decision making, other patient characteristics should also be considered for the risk assessment of (Vr)QoL, such as sex, age, civil status, comorbidities and length of anti‐VEGF treatment. [ABSTRACT FROM AUTHOR]

Unpredictable hypertrophic scarring (HS) occurs after approximately 35% of all surgical procedures and causes significant physical and psychological complaints. Parallel to the need to understanding the mechanisms underlying HS formation, a prognostic tool is needed. The objective was to determine whether (systemic) immunological differences exist between patients who develop HS and those who develop normotrophic scars (NS) and to assess whether those differences can be used to identify patients prone to developing HS. A prospective cohort study with NS and HS groups in which (a) cytokine release by peripheral blood mononuclear cells (PBMC) and (b) the irritation threshold (IT) after an irritant (sodium lauryl sulphate) patch test was evaluated. Univariate regression analysis of PBMC cytokine secretion showed that low MCP‐1, IL‐8, IL‐18 and IL‐23 levels have a strong correlation with HS (P <.010‐0.004; AUC = 0.790‐0.883). Notably, combinations of two or three cytokines (TNF‐a, MCP‐1 and IL‐23; AUC: 0.942, Nagelkerke R2: 0.727) showed an improved AUC indicating a better correlation with HS than single cytokine analysis. These combination models produce good prognostic results over a broad probability range (sensitivity: 93.8%, specificity 86.7%, accuracy 90,25% between probability 0.3 and 0.7). Furthermore, the HS group had a lower IT than the NS group and an accuracy of 68%. In conclusion, very fundamental immunological differences exist between individuals who develop HS and those who do not, whereas the cytokine assay forms the basis of a predictive prognostic test for HS formation, the less invasive, easily performed irritant skin patch test is more accessible for daily practice. [ABSTRACT FROM AUTHOR]

Objectives: To systematically summarise the available evidence on urinary bladder cancer (BC) mutation markers. Gene mutations are expected to provide novel biomarkers for urinary BC diagnosis. To date, evidence on urinary BC mutation markers has not proven sufficient to be adopted by clinical guidelines. In the present systematic review, diagnostic accuracy of urinary mutation analysis is separately assessed for primary BC diagnosis (BC detection) and for follow‐up of BC patients (BC surveillance). Methods: A literature search (PubMed, Embase.com and Wiley/Cochrane Library) and systematic review was performed up to 31 October 2019. As studies were too heterogeneous, no quantitative analysis could be performed. Results: In total, 25 studies were summarised by qualitative analysis. For BC detection, diagnostic accuracy differed considerably for single mutation markers (sensitivity 1–85%, specificity 84–100%), and for marker panels (sensitivity 50–94%, specificity 43–97%). Similarly, for BC surveillance, diagnostic accuracy was highly variable for single mutation markers (sensitivity 0–85%, specificity 66–100%), and for marker panels (sensitivity 51–84%, specificity 66–96%). Conclusion: Urinary mutation analysis showed to be a promising diagnostic tool for non‐invasive BC diagnosis. Nonetheless, we observed substantial differences in diagnostic accuracy of urinary BC mutation markers among publications. To translate the data summarised in the present review to future clinical practice, heterogeneity in research design, BC population, mutation analysis technique and urinary DNA should be considered. Eventual clinical implementation of urinary BC mutation markers can only be achieved by collecting more and stronger evidence. Combining different molecular assays might overcome current shortcomings of urinary mutation analysis. [ABSTRACT FROM AUTHOR]

Background: Lower protein intake in older adults is associated with loss of muscle mass and strength. The present study aimed to provide a pooled estimate of the overall prevalence of protein intake below recommended (according to different cut‐off values) among community‐dwelling older adults, both within the general older population and within specific subgroups. Methods: As part of the PRevention Of Malnutrition In Senior Subjects in the EU (PROMISS) project, a meta‐analysis was performed using data from four cohorts (from the Netherlands, UK, Canada, and USA) and four national surveys [from the Netherlands, Finland (two), and Italy]. Within those studies, data on protein and energy intake of community‐dwelling men and women aged ≥55 years were obtained by either a food frequency questionnaire, 24 h recalls administered on 2 or 3 days, or food diaries administered on 3 days. Protein intake below recommended was based on the recommended dietary allowance of 0.8 g/kg body weight (BW)/d, by using adjusted BW (aBW) instead of actual BW. Cut‐off values of 1.0 and 1.2 were applied in additional analyses. Prevalences were also examined for subgroups according to sex, age, body mass index (BMI), education level, appetite, living status, and recent weight loss. Results: The study sample comprised 8107 older persons. Mean ± standard deviation protein intake ranged from 64.3 ± 22.3 (UK) to 80.6 ± 23.7 g/d [the Netherlands (cohort)] or from 0.94 ± 0.38 (USA) to 1.17z ± 0.30 g/kg aBW/d (Italy) when related to BW. The overall pooled prevalence of protein intake below recommended was 21.5% (95% confidence interval: 14.0–30.1), 46.7% (38.3–55.3), and 70.8% (65.1–76.3) using the 0.8, 1.0, and 1.2 cut‐off value, respectively. A higher prevalence was observed among women, individuals with higher BMI, and individuals with poor appetite. The prevalence differed only marginally by age, education level, living status, and recent weight loss. Conclusions: In community‐dwelling older adults, the prevalence of protein intake below the current recommendation of 0.8 g/kg aBW/d is substantial (14–30%) and increases to 65–76% according to a cut‐off value of 1.2 g/kg aBW/d. To what extent the protein intakes are below the requirements of these older people warrants further investigation. [ABSTRACT FROM AUTHOR]

Summary Background: Primary prevention of overweight is to be preferred above secondary prevention, which has shown moderate effectiveness. Objective: To develop and internally validate a dynamic prediction model to identify young children in the general population, applicable at every age between birth and age 6, at high risk of future overweight (age 8). Methods: Data were used from the Prevention and Incidence of Asthma and Mite Allergy birth cohort, born in 1996 to 1997, in the Netherlands. Participants for whom data on the outcome overweight at age 8 and at least three body mass index SD scores (BMI SDS) at the age of ≥3 months and ≤6 years were available, were included (N = 2265). The outcome of the prediction model is overweight (yes/no) at age 8 (range 7.4‐10.5 years), defined according to the sex‐ and age‐specific BMI cut‐offs of the International Obesity Task Force. Results: After backward selection in a Generalized Estimating Equations analysis, the prediction model included the baseline predictors maternal BMI, paternal BMI, paternal education, birthweight, sex, ethnicity and indoor smoke exposure; and the longitudinal predictors BMI SDS, and the linear and quadratic terms of the growth curve describing a child's BMI SDS development over time, as well as the longitudinal predictors' interactions with age. The area under the curve of the model after internal validation was 0.845 and Nagelkerke R2 was 0.351. Conclusions: A dynamic prediction model for overweight was developed with a good predictive ability using easily obtainable predictor information. External validation is needed to confirm that the model has potential for use in practice. [ABSTRACT FROM AUTHOR]

The authors reply: Letter on: " Sarcopenia and its association with falls and fracturesin older adults: A systematic review andmeta-analysis" by Zhang et al Thank you for the comments to our recent article "Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta-analysis".[1] However, we have updated the subgroup analysis because (i) some studies reported the association between sarcopenia with more than one type of fracture, and (ii) we obtained additional data from Cawthon[2] and Schaap[3] to compute ORs. [Extracted from the article]

Previous studies have discouraged the use of the Cox proportional hazards (PH) model for traditional mediation analysis as it might provide biased results. Accelerated failure time (AFT) models have been proposed as an alternative for Cox PH models. In addition, the use of the potential outcomes framework has been proposed for mediation models with time‐to‐event outcomes. The aim of this paper is to investigate the performance of traditional mediation analysis and potential outcomes mediation analysis based on both the Cox PH and the AFT model. This is done by means of a Monte Carlo simulation study and the illustration of the methods using an empirical data set. Both the product‐of‐coefficients method of the traditional mediation analysis and the potential outcomes framework yield unbiased estimates with respect to their own underlying indirect effect value for simple mediation models with a time‐to‐event outcome and estimated based on Cox PH or AFT. [ABSTRACT FROM AUTHOR]

Summary: Background: Thiopurine‐induced leukopenia, a frequently observed and potentially life‐threatening adverse event, complicates the clinical management of IBD patients. Aim: To assess risk factors for thiopurine‐induced leukopenia in IBD. Methods: MEDLINE, EMBASE, BIOSIS and Cochrane library were searched for studies reporting at least one risk factor for thiopurine‐induced leukopenia. Pooled odds ratio (OR) was calculated for each potential risk factor using a random effects model. Studies that were not eligible for meta‐analysis were described qualitatively. Results: Seventy articles were included, 34 (11 229 patients) were included in meta‐analyses. A significantly higher thiopurine‐induced leukopenia risk was found for TPMT (OR 3.9, 95% [CI] 2.5‐6.1) and for NUDT15 R139C (OR 6.9, 95% CI 5.2‐9.1), G52A (OR 3.2, 95% CI 1.3‐7.9) and 36_37ins/delGGAGTC variant carriers (OR 5.6, 95% CI 2.8‐11.4). A potential association between high 6‐thioguanine nucleotides (6‐TGN) or 6‐methylmercaptopurine (6‐MMP) levels and leukopenia was observed, since most studies reported higher metabolite levels in leukopenic patients (6‐TGN: 204‐308 (Lennard method) and 397 (Dervieux method), 6‐MMP: 4020‐10 450 pmol/8 x 108 RBC) compared to controls (6‐TGN: 170‐212 (Lennard method) and 269 (Dervieux method), 6‐MMP: 1025‐4550 pmol/8 x 108 RBC). Conclusions: TPMT and NUDT15 variants predict thiopurine‐induced leukopenia. High 6‐TGN and 6‐MMP levels might induce leukopenia, although exact cut‐off values remain unclear. Potential preventive measures to reduce the risk of thiopurine‐induced leukopenia include pre‐treatment TPMT and NUDT15 genotyping. Routine thiopurine metabolite measurement might be efficient, yet cut‐off levels must be validated in advance. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To develop a prediction model that can accurately predict the chance of success following revision stapes surgery in patients with recurrent or persistent otosclerosis at 2- to 6-months follow-up and to validate this model internally.Study Design: A retrospective cohort study of prospectively gathered data in a tertiary referral center.Methods: The associations of 11 prognostic factors with treatment success were tested in 705 cases using multivariable logistic regression analysis with backward selection. Success was defined as a mean air-bone gap closure to 10 dB or less. The most relevant predictors were used to derive a clinical prediction rule to determine the probability of success. Internal validation by means of bootstrapping was performed. Model performance indices, including the Hosmer-Lemeshow test, the area under the receiver operating characteristics curve (AUC), and the explained variance were calculated.Results: Success was achieved in 57.7% of cases at 2- to 6-months follow-up. Certain previous surgical techniques, primary causes of failure leading up to revision stapes surgery, and positions of the prosthesis placed during revision surgery were associated with higher success percentages. The clinical prediction rule performed moderately well in the original dataset (Hosmer-Lemeshow P = .78; AUC = 0.73; explained variance = 22%), which slightly decreased following internal validation by means of bootstrapping (AUC = 0.69; explained variance = 13%).Conclusions: Our study established the importance of previous surgical technique, primary cause of failure, and type of the prosthesis placed during the revision surgery in predicting the probability of success following stapes surgery at 2- to 6-months follow-up.Level Of Evidence: 2b. Laryngoscope, 128:2390-2396, 2018. [ABSTRACT FROM AUTHOR]

Purpose To systematically assess the literature on psychosocial interventions to improve mental health (i.e. depression, anxiety, mental fatigue, loneliness, psychological stress and psychological well-being) in visually impaired adults (≥18 years). Methods The databases Medline, Embase and Psychinfo were searched for relevant studies, which were categorised into randomised controlled trials ( RCTs), non- RCTs and before and after comparisons ( BA). The Cochrane Collaboration Risk of Bias Tool was used to assess study quality. Standardised mean differences ( SMD) were calculated to quantitatively summarise the outcomes of the RCTs and non- RCTs in a meta-analysis. Meta-regression was used to explore sources of heterogeneity in the data. Results The search identified 27 papers (published between 1981 and 2015), describing the outcomes of 22 different studies (14 RCTs, four non- RCTs, and four BAs). Pooled analyses showed that interventions significantly reduced depressive symptoms ( SMD −0.30, 95% confidence interval ( CI) −0.60 to −0.01), while effects on anxiety symptoms, mental fatigue, psychological stress and psychological well-being were non-significant. Meta-regression analyses showed homogeneity in effect sizes across a range of intervention, population, and study characteristics. Only a higher age of participants was associated with less effective results on depressive symptoms ( b = 0.03, 95% CI 0.01 to 0.05), psychological stress ( b = 0.07, 95% CI 0.01 to 0.13) and psychological well-being ( b = −0.03, 95% CI −0.05 to 0.01). However, after removing a clear outlier the overall effect on depressive symptoms and the influence of age on depressive symptoms and psychological stress were no longer significant, while the influence of age on psychological well-being remained. Conclusions There is currently only limited evidence for the effectiveness of psychosocial interventions in the field of low vision. More well-designed trials are needed with specific attention for interventions tailored to the needs of elderly patients. [ABSTRACT FROM AUTHOR]

Objective: To systematically summarize the literature on the course of pain in patients with knee osteoarthritis (OA), prognostic factors that predict deterioration of pain, the course of physical functioning, and prognostic factors that predict deterioration of physical functioning in persons with knee OA.Methods: A search was conducted in PubMed, CINAHL, Embase, Psych-INFO, and SPORTDiscus up to January 2014. A meta-analysis and a qualitative data synthesis were performed.Results: Of the 58 studies included, 39 were of high quality. High heterogeneity across studies (I(2)  >90%) and within study populations (reflected by large SDs of change scores) was found. Therefore, the course of pain and physical functioning was interpreted to be indistinct. We found strong evidence for a number of prognostic factors predicting deterioration in pain (e.g., higher knee pain at baseline, bilateral knee symptoms, and depressive symptoms). We also found strong evidence for a number of prognostic factors predicting deterioration in physical functioning (e.g., worsening in radiographic OA, worsening of knee pain, lower knee extension muscle strength, lower walking speed, and higher comorbidity count).Conclusion: Because of high heterogeneity across studies and within study populations, no conclusions can be drawn with regard to the course of pain and physical functioning. These findings support current research efforts to define subgroups or phenotypes within knee OA populations. Strong evidence was found for knee characteristics, clinical factors, and psychosocial factors as prognostics of deterioration of pain and physical functioning. [ABSTRACT FROM AUTHOR]

ABSTRACT Background To evaluate the interobserver agreement and discriminating value of three-dimensional power Doppler ultrasound (3D PDUS) in patients with fibroids. Methods An observational prospective cohort study in 19 patients with fibroids. 3D PDUS was performed by one examiner and evaluated by three independent examiners in order to evaluate various vascular parameters: vascular index (VI), flow index, and vascular flow index of the fibroid, the vascular capsule and of its highest vascular area, using both manual and automatic contour modes. The intraclass correlation coefficient and discriminating values were calculated. The correlation between VI and volume was studied using Kendall's Tau test. Results In the manual contour mode, the VIs of the fibroid and of the vascular capsule had the highest interobserver agreements (intraclass correlation coefficients of 0.89 and 0.87, respectively). Both parameters seem to have good discriminating values, given the large range of these parameters between different fibroids, independent of their volume. The vascularity of the fibroid and capsule was related. VI was not related to the volume of the fibroid. Conclusions VI assessed using 3D PDUS is a reproducible parameter in the assessment of fibroid vascularization with discriminating abilities. Additional studies are needed to further evaluate its validity and clinical relevance. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:171-178, 2015; [ABSTRACT FROM AUTHOR]

Objective obesity-related microvascular dysfunction, including alterations in rhythmic changes in vascular diameter, so-called 'vasomotion', may be important in the clustering of obesity with other cardiovascular risk factors. Adipokines have been suggested to play a role in obesity-related vascular dysfunction. Alterations in vasomotion have been found using extreme body mass index ( BMI) phenotypes. Whether these alterations can be translated to the general population is unknown. The aim was to retrospectively investigate relationships between BMI, vasomotion and adipokines in a population-based cohort. Methods Adiposity, vasomotion, adiponectin and leptin were determined in 94 apparently healthy participants (age 42 years, 46 men, mean BMI 25·5 ± 3·8 kg/m2) of the Amsterdam Growth and Health Longitudinal Study ( AGHLS). Vasomotion was assessed via wavelet analysis of skin laser Doppler flowmetry ( LDF). Results BMI was associated with the neurogenic domain of the vasomotion spectrum (β −0·011, P = 0·046), adiponectin (β −0·18, P = 0·028) and leptin (β 2·22, P < 0·0001). Adiponectin was positively associated with the neurogenic domain of vasomotion (β 0·016, P = 0·019). Leptin did not show any significant relationship with vasomotion. The association between BMI and the neurogenic domain of the vasomotion spectrum was partly explained by adiponectin. Conclusions The association between adiposity and microvascular vasomotion also applies to the normal population and is partly explained by adiponectin. [ABSTRACT FROM AUTHOR]

Background This study investigated whether implementation of cell salvage of shed mediastinal and residual blood in all patients undergoing low-to-moderate-risk cardiac surgery reduces the need for allogeneic red blood cell ( RBC) transfusion compared to patients not subjected to cell salvage. Study Design and Methods This retrospective cohort study included patients undergoing low-to-moderate-risk cardiac surgery with cardiopulmonary bypass without (control; n = 531) or with cell salvage (n = 433; Autolog, Medtronic). Study endpoints, including 24-hour blood loss and RBC requirements, were evaluated using adjusted logistic regression. Results Baseline characteristics were similar between groups. The cell saver group received 568 ± 267 mL of autologous blood. Median number of allogeneic RBC transfusions was higher in the control group (2 [1-5]) compared with the cell salvage group (1 [0-3]; p < 0.001). There were no clinically relevant differences in postoperative coagulation test results between groups. The relative risk ( RR) for postoperative RBC transfusion was reduced to 0.76 (95% confidence interval [ CI], 0.70-0.83; p < 0.0001) in the cell salvage group. Moreover, patients in the cell salvage group had a lower chance for myocardial infarction ( RR, 0.26; 95% CI, 0.08-0.91; p = 0.035), whereas the cell salvage group was associated with a higher probability for intensive care discharge within 24 hours after surgery ( RR, 1.08; 95% CI, 1.02-1.14; p = 0.009). Conclusion The use of cell salvage throughout the entire procedure reduces postoperative blood loss and allogeneic RBC transfusion. These findings advocate implementation of cell salvage in all patients undergoing on-pump cardiac surgery, irrespective of anticipated surgery-related blood loss. [ABSTRACT FROM AUTHOR]

Summary Background Recent evidence indicates that a lower plasma level of 25-hydroxyvitamin D (25 OHD) is associated with a higher risk of the metabolic syndrome. It has not been studied in older people with a high prevalence of vitamin D insufficiency. Objective This study investigates the association between vitamin D status and the metabolic syndrome in community-dwelling older persons in the Netherlands. Design and patients The study is part of the Longitudinal Aging Study Amsterdam, an ongoing cohort study in a representative sample of Dutch older persons. A total of 1286 subjects (629 men and 657 women) between the ages of 65 and 88 years participated in the study. Measurements Metabolic syndrome (U.S. National Cholesterol Education Program definition) and its individual components were assessed as well as serum 25 OHD levels. Results Among the participants, the prevalence of the metabolic syndrome was 37·0%. The mean 25 OHD level was 53·3 n m; 47·8% had 25 OHD levels below 50 n m. There was a significantly increased risk of the metabolic syndrome in the subjects with serum 25 OHD levels below 50 n m, compared with that of subjects with levels over 50 n m [odds ratio (OR) = 1·54; 95% confidence interval (CI) 1·23-1·94]. After adjustment for confounders, age, sex, season, years of education, alcohol use, total activity, smoking and PTH, the OR was 1·29 (95% CI 1·00-1·68). The association between vitamin D deficiency and the metabolic syndrome was mainly determined by the components low HDL and (high) waist circumference. Conclusions Vitamin D deficiency is common in the older population in the Netherlands, and subjects with serum 25 OHD below 50 n m have a higher risk of the metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background: Foot orthoses (FOs) are prescribed as an important conservative treatment option in patients with foot problems related to rheumatoid arthritis. However, a broad variation in FOs is used, both in clinical practice and in research. To date, there is no overview on the outcomes of the treatment with different kinds of FOs in patients with rheumatoid arthritis and a specific foot problem. The objectives of the present study were to summarize the comparative effectiveness of FOs in the treatment of various foot problems in patients with rheumatoid arthritis, on the primary outcomes foot function and foot pain, and the secondary outcomes physical functioning, health related quality of life, compliance, adverse events, the costs of FOs and patient satisfaction. Methods: Studies comparing different kinds of FOs, with a presumed therapeutic effect, in the treatment of foot problems related to rheumatoid arthritis were included. A literature search was conducted in The Cochrane Central Registry for Controlled Trials (CENTRAL), PubMed, EMBASE and PEDro up to May 18th, 2018. Data was meta-analyzed, when this was not possible qualitative data analysis was performed. Results: Ten studies were identified, with a total number of 235 patients. These studies made a comparison between different materials used (soft versus semi-rigid), types of FOs (custom-made versus ready-made; total-contact versus non-total contact), or modifications applied (metatarsal bars versus domes). Also, different techniques to construct custom-made FOs were compared (standard custom-molding techniques versus more sophisticated techniques). A medium effect for (immediate) reduction of forefoot plantar pressure was found in favor of treatment with soft FOs compared to semi-rigid FOs (SMD 0.60, 95% CI 0.07–1.14; P = 0.03; 28 participants). Other comparisons between FOs resulted in non-significant effects or inconclusive evidence for one kind of FOs over the other. Conclusions: Foot orthoses made of soft materials may lead to more (immediate) forefoot plantar pressure reduction compared to foot orthoses constructed of semi-rigid materials. Definitive high quality RCTs, with adequate sample sizes and long-term follow-up, are needed to investigate the comparative (cost-) effectiveness of different kinds of foot orthoses for the treatment of foot problems related to rheumatoid arthritis. [ABSTRACT FROM AUTHOR]