Search

The objective of the study was to gain an insight into the perceptions and experiences of patients with rheumatoid arthritis and a high cardiovascular disease risk (CVD-RA) when undergoing an exercise intervention aimed at improving their cardiorespiratory fitness. This qualitative study was part of a pilot study, which investigated the effects of an exercise intervention on cardiorespiratory fitness in patients with CVD-RA. Six patients were invited to participate in face-to-face semi-structured interviews. We invited patients who completed the exercise intervention as well as patients who withdrew from the exercise intervention. The interviews were analyzed according to the method of thematic analysis. Six patients were interviewed, of whom four patients completed and two patients discontinued the exercise intervention. The mean (SD) age was 58 (9.7) years, the median disease duration was 10 years, and five patients were female. The analyses revealed seven themes that provided insight into perceptions and experiences: (1) ability to understand reasons for actions; (2) the need to be seen; (3) reaching their maximum effort; (4) experiencing their limits; (5) wanting personalized exercise therapy; (6) happy to be physically active; (7) benefits of exercise. Patients perceived that they were able to perform a cardiopulmonary exercise test with maximum effort and achieved the prescribed intensity of the exercise intervention. They also experienced an improvement in their physical activity by incorporating physical activity in their daily live. Overarching principles that re-occurred in the themes were: the need to be viewed as a person and the importance of feeling safe.

Objective: In patients with rheumatoid arthritis (RA) with cardiovascular disease risk, it is unknown whether exercises are safe, improve cardiorespiratory fitness and reduce disease-related symptoms and cardiovascular-disease (CVD) risk factors. We aimed to investigate in RA patients with CVD risk: (1) safety of medium to high-intensity aerobic exercises, (2) potential changes of cardiorespiratory fitness and (3) disease activity and CVD risk factors in response to the exercises. Methods: Single-arm pilot-exercise intervention study including 26 consecutive patients (21 women) with > 4% 10-year risk of CVD mortality according to the Dutch Systematic Coronary Risk Evaluation. Aerobic exercises consisted of two supervised-sessions and five home-sessions per week for 12 weeks. Patients were required to exercise at intensities between 65 and 85% of their maximum heart rate. To assess safety, we recorded exercise related adverse events. Before and after the exercises, cardiorespiratory fitness was assessed with a graded maximal oxygen-uptake exercise test, while disease activity was evaluated via the Disease Activity Score-28 (DAS28) using the erythrocyte segmentation rate (ESR). Resting blood pressure, ESR and total cholesterol were assessed as CVD risk factors. Results: Twenty out of 26 patients performed the 12-week exercises without any adverse events. According to patients, withdrawals were unrelated to the exercises. Exercises increased cardiorespiratory fitness (pre: 15.91 vs. post: 18.15 ml.kg−1 min−1, p = 0.003) and decreased DAS28 (pre: 2.86 vs. post: 2.47, p = 0.04). No changes were detected in CVD risk factors. Conclusion: A 12-week exercise intervention seems to be safe and improves cardiorespiratory fitness and disease activity in patients with RA with a high risk for cardiovascular diseases.Key Points1. Rheumatoid arthritis patients with high cardiovascular disease risk were able to perform a maximum exercise test and a 12-week aerobic-based medium-to-high intensity exercise intervention.2. The exercise intervention improved cardiorespiratory fitness and disease activity in rheumatoid arthritis patients with high cardiovascular disease risk.3. Cardiorespiratory fitness levels were still low post-exercise intervention (i.e. 18.15 ml.kg−1min−1 compared to the 20.9 ml.kg−1min−1 baseline mean of the RA patients without CVD risk).

Purpose of Review: In addition to disease-modifying anti-rheumatic drug (DMARD) treatment, exercise is increasingly promoted in patients with rheumatoid arthritis (RA). Although both are known to reduce disease activity, few studies have investigated the combined effects of these interventions on disease activity. The aim of this scoping review was to provide an overview of the reported evidence on whether a combined effect—i.e., a greater reduction in disease activity outcome measures—can be detected in studies where an exercise intervention was performed in addition to the DMARD treatment in patients with RA. This scoping review followed the PRISMA guidelines. A literature search was performed for exercise intervention studies in patients with RA treated with DMARDs. Studies without a non-exercise control group were excluded. Included studies reported on (components of) DAS28 and DMARD use and were assessed for methodological quality using version 1 of the Cochrane risk-of-bias tool for randomized trials. For each study, comparisons between groups (i.e., exercise + medication vs. medication only) were reported on disease activity outcome measures. Study data related to the exercise intervention, medication use, and other relevant factors were extracted to assess what may have influenced disease activity outcomes in the included studies. Recent Findings: A total of 11 studies were included of which 10 between-group studies on DAS28 components were made. The remaining one study focused on within-group comparisons only. Median duration of the exercise intervention studies was 5 months, and the median number of participants was 55. Six out of the 10 between-group studies reported no significant differences between groups in DAS28 components between exercise + medication vs. medication only. Four studies showed significant reductions in disease activity outcomes for the exercise + medication group compared with the medication-only group. Most studies were not adequately designed methodologically in order to investigate for comparisons of DAS28 components and had a high risk of multi-domain bias. Summary: Whether the simultaneous application of exercise therapy and DMARD medication in patients with RA has a combined effect on disease outcome remains unknown, due to weak methodological quality of existing studies. Future studies should focus on the combined effects by having disease activity as the primary outcome.

Very-high resolution (VHR) satellite imagery is increasingly used to visualize the effects of armed conflicts in near-real time. Yet these data, typically commercial, are generally released selectively or for a fee, impeding scientific and humanitarian applications. Such images also tend to focus on cities or infrastructure, obscuring the effects of war in rural or sparsely populated areas such as forests. To leverage VHR imagery for improved and more holistic conflict monitoring, we call for (a) archiving VHR images for scientific and humanitarian use; (b) producing analysis-ready, conflict-wide VHR mosaics to harmonize monitoring; and (c) forming a sustainably funded public VHR satellite program. International coordination on such a satellite could also support the transformation of VHR Earth observation (EO) data into a public good. Taking these three steps promises to revolutionize conflict monitoring, much in the way that opening access to lower-resolution EO data has stimulated new discoveries about the planet's ecosystems and human impacts. Broadening and standardizing access to and analysis of archived VHR imagery may improve understandings of war, empower and refine responses, and potentially, mitigate future conflicts.

BACKGROUND To date, there is no evidence to support the optimal competition strategy for success in powerlifting competitions. The purpose of this study was to analyse Powerlifting (PL) competition data to assess the relationship between squat attempts, the success of each lift attempt, and weight increase between attempts, with winning. METHODS 10,672 individual competition entries (males: n = 6617, females: n = 4,055) were included within the analysis from 'raw' Powerlifting Australia sanctioned competitions held between 2008 and 2019. We reported Cohen's d, statistical significance, 95% confidence intervals and the univariate odds of winning an event. Factors were assessed by separate simple logistic regression and reported as an odds ratio. RESULTS Overall, first squat attempt weight for those who won was on average 7.0kg greater (P

Latella, C, Teo, W-P, Spathis, J, and van den Hoek, D. Long-term strength adaptation: A 15-year analysis of powerlifting athletes. J Strength Cond Res 34(9): 2412–2418, 2020—Strength is a fundamental component of athletic performance and development. This investigation examined the long-term strength development of powerlifting (PL) athletes. The rate of strength gain/day was assessed in 1897 PL athletes (F = 626, M = 1,271) over a 15-year period (2003–2018). Independent T-tests explored sex differences in baseline absolute (kg) and relative strength (kg·body mass−1 [bm]) recorded from the first competition, and strength gain/day (kg·d−1). Analyses based on initial strength quartiles were conducted using one-way analysis of variances with significance set at p < 0.05. Bivariate correlational analysis tested for relationships between strength gain/day and baseline strength, the number of competitions, and mean days between competitions. Males had greater absolute (M: 513.3 ± 99.8 kg, F: 289.4 ± 55.7 kg, p < 0.001) and relative (M: 5.89 ± 1.04 kg·bm−1, F: 4.27 ± 0.85 kg·bm−1, p < 0.001) strength at baseline. Overall, strength gain/day (F: 0.12 ± 0.69 kg·d−1, M: 0.15 ± 0.44 kg·d−1, p = 0.318) was similar between sexes. However, the strongest males showed a lower rate of strength improvement (0.102 kg·d−1) compared with least strong males (0.211 kg·d−1), p = 0.010. No differences were observed across quartiles for females. Correlational analyses revealed significant but weak negative relationships between strength gain/day and the mean days between competitions for females (r2 = −0.120, p = 0.003) and males (r2 = −0.190, p < 0.001). Similar relationships were observed for baseline strength (r2 = −0.073, p = 0.009) and the number of competitions (r2 = −0.111, p < 0.001) for males. The results suggest similar strength adaptation between sexes. The strongest males improve more slowly, possibly due to a ceiling effect. Collectively, the findings provide novel evidence of real-world long-term strength adaptations that may be particularly useful to understand athlete development, to aid periodized programming, and to benchmark strength over time.

Pearson, J, Spathis, JG, van den Hoek, DJ, Owen, PJ, Weakley, J, and Latella, C. Effect of competition frequency on strength performance of powerlifting athletes. J Strength Cond Res 34(5): 1213-1219, 2020-Powerlifting (PL) requires athletes to achieve the highest possible "total" weight lifted across squat, bench press, and deadlift. Athletes compete multiple times per year; however, it is not well understood how often PL athletes should compete to facilitate maximal strength performance. This study investigated the effect of competition frequency on strength (relative and absolute) in PL athletes over a 12-month period. Results across all male (n = 563, mean ± SD; age; 28 ± 10 years, body mass; 89.3 ± 19.3 kg) and female (n = 437, age; 31 ± 11 years, body mass; 70.1 ± 15.8 kg) PL athletes were collated. Total competition scores were used to calculate absolute and relative strength for each competition. Linear mixed models with random effects, and effect sizes ± 95% confidence intervals compared competition frequency and total score for (a) all, (b) male, and (c) female competition entries, respectively. The association between total score at each competition was assessed with Pearson's correlation coefficient for the same independent variables. Results demonstrate greater absolute strength at competition 2 for all athletes (5.1%: p = 0.043: d = 0.16) and males (2.9%: p = 0.049: d = 0.15). For females, absolute strength was greater at competition 5 compared to 1 (12.0%: p = 0.001: d = 0.65) and 2 (9.6%: p = 0.007: d = 0.50). Weak positive correlations for relative strength and number of times competed for males were evident between competitions 1 to 4 (r = 0.070-0.085, p = 0.003-0.043). For females, 3 competitions weakly correlated with absolute strength (r = 0.106, p = 0.016). PL athletes who compete multiple times per year are more likely to achieve higher totals; however, there is an upper limit to the number of competitions (4 per year) that seem to allow a performance increase.

Latella, C, van den Hoek, D, and Teo, WP. Differences in strength performance between novice and elite athletes: Evidence from powerlifters. J Strength Cond Res 33(7S): S103-S112, 2019-Strength forms an integral part of many sports. In particular, powerlifting success is determined solely by maximal strength, providing a unique opportunity to investigate the differences and potential factors influencing novice and elite competitors. We evaluated performance from 2,137 competitors between local (LOC), national (NAT), and international (INT) competitions. Results were analyzed by using the total (TOT) competition score within weight classes and age categories. Cohen's d effect sizes and 95% confidence intervals were used to detect differences within categories between LOC, NAT, and INT competitions. The coefficient of variation (CV) was used to determine the absolute variability. A moderate to large increase in performance was observed for all weight classes between LOC and NAT (men; d = 0.76, women; d = 1.09). No meaningful differences were observed between LOC and NAT, and NAT and INT when compared using age. No meaningful differences were observed between NAT to INT competitions when compared using weight classes. The CV was not different across competition level (CV = 17.4-22.9%) categories. Several internal (athlete) and external (environmental) factors are likely to explain these findings. Therefore, factors such as training experience, performance variability, body composition, anthropometric characteristics, and competition pressure that may influence strength performance should also be considered in both training phases and during competition. Collectively, the results offer novel information regarding the difference in strength performance between novice, subelite, and elite strength athletes. Strength and conditioning professionals should consider these factors when working with various athletes where maximal strength is an important determinant of success.

This study compared the sensitivity of peak running speed (PRS) measured during a submaximal run test (SRT) with a countermovement jump (CMJ) test to provide an alternate method of measuring neuromuscular fatigue (NMF). The study involved 20 semi-professional academy soccer players who performed a SRT and CMJ test, 24-hours pre-match, 24-, 48-, 72- and 96-hours post-match. Moderate decreases (effect-size (ES) +/- 90% confidence intervals) were observed 24-hours post-match for CMJ(H); ES -0.70 +/- 0.19, CMJ(PV); ES -0.92 +/- 0.27 and PRS; ES -0.58 +/- 0.11 with small decreases in CMJ(H); ES -0.36 +/- 0.13 and PRS; ES -0.27 +/- 0.23 still evident 48-hours post-match before returning to baseline 72-hours post-match. The results confirm PRS as an inexpensive alternate method of measuring NMF which, allows instantaneous real-time feedback on NMF. This can allow changes to be made immediately on-field within the post-match recovery phase without the need for further analysis or equipment.

Lower cardiorespiratory fitness (CRF) and physical activity (PA) associate with higher cardiovascular disease (CVD) risk, but the relationship between CRF and PA in people who have rheumatoid arthritis (RA) at an increased CVD risk (CVD-RA) is not known. The objectives of this study were to determine the levels of CRF and PA in people who have CVD-RA and to investigate the association of CRF with PA in people who have CVD-RA. A total of 24 consecutive patients (19 women) with CVD-RA ( 4% for 10-year risk of fatal CVD development as calculated using the Systematic Coronary Risk Evaluation)-were included in the study. CRF was assessed with a graded maximal exercise test determining maximal oxygen uptake (VO

Introduction: To determine whether combined exercise training with an energy-restricted diet leads to improved physical fitness and body composition when compared to energy restriction alone in free-living premenopausal women with clinically severe obesity. Methods: Sixty premenopausal women (BMI of 40.4 ± 6.7) were randomised to energy restriction only (ER) or to exercise plus energy restriction (EXER) for 12 months. Body composition and fitness were measured at baseline, 3, 6 and 12 months. Results: VO2 peak improved more for EXER compared to ER at 3 (mean difference ± SEM 2.5 ± 0.9 mL ∙ kg–1 ∙ min–1, p = 0.006) and 6 (3.1 ± 1.2 mL ∙ kg–1 ∙ min–1, p = 0.007) but not 12 months (2.3 ± 1.6 mL ∙ kg–1 ∙ min–1, p = 0.15). Muscle strength improved more for EXER compared to ER at all time points. No differences between groups for lean mass were observed at 12 months. Conclusion: Combining exercise training with an energy-restricted diet did not lead to greater aerobic power, total body mass, fat mass or limit lean body mass loss at 12 months when compared to energy restriction alone for premenopausal women with clinically severe obesity in free-living situations. Future research should aim to determine an effective lifestyle approach which can be applied in the community setting for this high-risk group.

Issue addressed: To deconstruct a personal account involving the initial decision making and ultimate consequences of driving under the influence of alcohol to educate drinkers about the realities of short- and long-term impacts associated with drink-driving. Methods: This qualitative study uses collaborative methods and draws on an autoethnographic (n = 1) account to identify multiple challenges and outcomes arising from a singular drink-driving incident. Results: Findings document how the split-second decision to drink and drive can give rise to unforeseen, ongoing and complex problems associated with injuries and pain management, the legal system, personal and professional costs, social isolation and shame. Conclusions: Many believe that driving ability is only affected if an individual is drunk, and that the ramifications of low-range drinking (blood alcohol concentration greater than 0.05 and less than 0.07) and driving are minimal and avoidable. This personal account emphasises the stark realities associated with such na€ive perceptions, particularly among young males, and augments efforts to dissuade drivers from drinking. So what? The experiential insights within this narrative account have the potential to help inform peer education programs and contribute to reductions in youth road trauma and associated injuries.

Objective Obesity is associated with a decline in health-related quality of life (HRQOL), while weight loss and exercise training have a positive influence. The aim of this systematic review was to compare the effects of energy restriction (ER) alone intervention to diet and exercise intervention on HRQOL. Methods MEDLINE, CINAHL and PsycINFO databases were searched for randomised controlled trials examining HRQOL through lifestyle interventions which examined ER and energy restriction plus exercise in obese adults. Results Nine hundred and fifty-two papers were assessed for inclusion in this review with nine being deemed suitable. This review indicates that four studies provide evidence to support the role of exercise in addition to ER to improve HRQOL in adults with obesity. The findings of this review are limited due to the limited number of studies as well as substantial heterogeneity in ER, exercise prescription variables and outcome measures utilised within studies. Conclusions A definitive conclusion regarding the capacity of exercise to facilitate greater improvement in HRQOL than diet alone, or, to formulate an exercise prescription for obese adults to address HRQOL is not feasible based on the existing evidence. Future studies should utilise comparable HRQOL assessment tools along with ensuring full reporting of results.

Summary Introduction Achieving continence in children with neurogenic sphincteric incompetence is a challenge. Awareness of the long-term outcome in this young patient population is important. In the past 25 years, the study institution has built experience in bladder outlet procedures such as bladder neck sling and bladder neck reconstructions. Objective The objective of this study was to evaluate the long-term outcome on continence and re-intervention rate of bladder outlet procedures in children with neurogenic urinary incontinence at the study institution. Design All children who underwent a bladder neck procedure between 1992 and 2017 at the study institution were retrospectively reviewed. Continence at the end of follow-up was the primary endpoint, defined as ‘dry’ when there was an interval of a minimum of 4 h without urinary leakage. Non-parametric tests were used for statistical analysis. Results During this 25-year period, a total of 60 children underwent a bladder outlet procedure, either a bladder neck sling (n = 43) or a bladder neck reconstruction (n = 17). The median age at surgery was 11.6 years (interquartile range [IQR] 7.8–13.9). Concomitant surgery consisted of bladder augmentation in 80% and continent catheterizable urinary channel in 97% of children. Dry rate within 1 year was 38%. After a median follow-up of 10.4 years (IQR 6.5–15.5), 77% of all children were dry. Twenty-five children (42%) needed one or more re-interventions, including redo of the bladder outlet procedure, other type of outlet procedure, bulking agents, bladder augmentation, and bladder neck closure. Discussion This study confirms that achieving continence is a challenge. The inconsistent use of the definition of urinary continence creates confusion in the literature and makes comparison of outcome with other studies difficult. Openness of (long-term) results in achieving urinary continence is important and helpful for future patients. Conclusion On the long term, the majority of children with neurogenic urinary incontinence were dry after a bladder outlet procedure, but a considerable number of patients had a re-intervention. The initial outcome on continence was slightly disappointing. Reporting long-term results is essential and helpful for patient counseling. Summary Table . Gender and continence outcome presented in number (%). Total n = 60 BNS n = 43 BNR n = 17 Difference between BNS and BNR Gender Female 35 (58%) 31 (72%) 4 (23.5%) Male 25 (42%) 12 (28%) 13 (77.5%) P a Continence outcome Dry rate 23 (38%) 15 (35%) 8 (47%) P = 0.382 a Dry rate > 1 yr follow-up 46 (77%) 33 (77%) 13 (77%) P = 0.982 a BNS, bladder neck sling; BNR, bladder neck reconstruction. a Chi-squared test.

Powerlifting (PL) is characterised by the ability to generate maximal force. However, an understanding of the factors affecting strength in PL athletes is poorly understood. Therefore, competition data were analysed from 1368 individuals during 2017. Relative strength was compared for the squat (SQ), bench press (BP) and deadlift (DL) between age groups (Sub-junior [SJ], Junior [JU], Open [OP], and Masters’ I-IV [M1-M4]), weight classes (females; 47 kg, 52 kg, 57 kg, 63 kg, 72 kg, 84 kg and + 84 kg and males; 59 kg, 66 kg, 74 kg, 83 kg, 93 kg, 105 kg, 120 kg, + 120 kg) and between sexes. The results showed that relative strength was greater for males across all lifts (P < 0.001). Relative strength tended to decrease with increasing body mass for males (SQ, BP and DL: P < 0.001, R2 = 0.9306–0.9763) and females (SQ, BP and DL: P < 0.001, R2 = 0.9485–0.9802), and with increasing age for males (SQ, BP and DL: P < 0.001, R2 = 0.4742–0.6729), and females (SQ: P < 0.001, BP: P = 0.002 and DL: P = 0.001, R2 = 0.0844–0.3705), respectively. The findings offer important information regarding factors that affect strength performance in athletes. Coaches should consider the factors influencing strength when developing resistance training programmes or in longer term athletic development for powerlifters and other strength based sports.

Dit is een retrospectieve studie naar blaashalschirurgie die is uitgevoerd in ons ziekenhuis om inzicht te krijgen in korte- en langetermijnresultaten op continentie bij kinderen met complexe incontinentieproblematiek. De dossiers van 101 kinderen zijn geanalyseerd. Bij 59 kinderen was er sprake van neurogene incontinentie door intrinsieke sfincterdeficientie en bij 42 kinderen was er sprake van extrofie c.q. epispadie. Continentie is gedefinieerd als compleet droog gedurende vier uur tussen mictie dan wel katheterisatie. In de neurogene groep was binnen een jaar na blaashalschirurgie 25% van de kinderen continent. Hierna onderging 42% van de kinderen een re-interventie van de blaashals, waarna alsnog 66% continent werd. In de niet-neurogene groep was binnen een jaar 40% van de kinderen continent en onderging 45% een re-interventie van de blaashals, waarna 90% alsnog continent werd (follow-up acht jaar). Het primaire effect van blaashalschirurgie op incontinentie is met deze strikte definitie enigszins teleurstellend. Toch werd met additionele interventies het merendeel van de patienten continent. De niet-neurogene groep had een betere uitkomst.

Background Accelerometry is the method of choice for objectively assessing physical activity in older adults. Many studies have used an accelerometer count cut point corresponding to 3 metabolic equivalents (METs) derived in young adults during treadmill walking and running with a resting metabolic rate (RMR) assumed at 3.5 mL · kg−1 · min−1 (corresponding to 1 MET). RMR is lower in older adults; therefore, their 3 MET level occurs at a lower absolute energy expenditure making the cut point derived from young adults inappropriate for this population. The few studies determining older adult specific moderate-to-vigorous intensity physical activity (MVPA) cut points had methodological limitations, such as not measuring RMR and using treadmill walking. Methods This study determined a MVPA hip-worn accelerometer cut point for older adults using measured RMR and overground walking. Following determination of RMR, 45 older adults (mean age 70.2 ± 7 years, range 60–87.6 years) undertook an outdoor, overground walking protocol with accelerometer count and energy expenditure determined at five walking speeds. Results Mean RMR was 2.8 ± 0.6 mL · kg−1 · min−1. The MVPA cut points (95% CI) determined using linear mixed models were: vertical axis 1013 (734, 1292) counts · min−1; vector magnitude 1924 (1657, 2192) counts · min−1; and walking speed 2.5 (2.2, 2.8) km · hr−1. High levels of inter-individual variability in cut points were found. Conclusions These MVPA accelerometer and speed cut points for walking, the most popular physical activity in older adults, were lower than those for younger adults. Using cut points determined in younger adults for older adult population studies is likely to underestimate time spent engaged in MVPA. In addition, prescription of walking speed based on the adult cut point is likely to result in older adults working at a higher intensity than intended.

Background: Clinical practice guidelines globally recommend lifestyle modification including diet and exercise training as first-line treatment for obesity. The clinical benefits of exercise training in adults with obesity is well-documented; however, there is no strong evidence for the effectiveness of exercise training for weight loss in class II and class III obesity. The purpose of the randomised controlled trial described in this protocol article is to examine the effect of exercise training, in addition to a very low energy diet (VLED), in clinically severe obese women for changes in body composition, physical function, quality of life, and markers of cardiometabolic risk. Methods/Design: Sixty women, aged 18–50 years with a body mass index (BMI) greater than 34.9 kg.m2 and at least one obesity-related co-morbidity, will be recruited for this 12-month study. Participants will be randomised to either exercise plus energy restriction (n = 30), or energy restriction alone (n = 30). All participants will follow an energy-restricted individualised diet incorporating a VLED component. The exercise intervention group will also receive exercise by supervised aerobic and resistance training and a home-based exercise programme totalling 300 minutes per week. Primary outcome measures include body composition and aerobic fitness. Secondary outcome measures include: physical function, cardiometabolic risk factors, quality of life, physical activity, and mental health. All outcome measures will be conducted at baseline, 3, 6 and 12 months. Discussion: Previous research demonstrates various health benefits of including exercise training as part of a healthy lifestyle at all BMI ranges. Although clinical practice guidelines recommend exercise training as part of first-line treatment for overweight and obesity, there are few studies that demonstrate the effectiveness of exercise in class II and class III obesity. The study aims to determine whether the addition of exercise training to a VLED provides more favourable improvements in body composition, physical function, quality of life, and markers of cardiometabolic risk for women with clinically severe obesity, compared to VLED alone. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12611000694910). Date registered: 4 July 2011

Introductie: Om de laparoscopische pyelumplastiek (LP) in onze kliniek te accepteren als nieuwe behandeling voor UPJ-stenose bij kinderen, moeten de resultaten ervan minstens gelijkwaardig zijn aan die van de conventionele open pyelumplastiek (OP), met een duidelijk korte opname. Het doel van deze studie is het vergelijken van onze resultaten van de LP bij kinderen vanaf 3 jaar met die van de OP en de resultaten van de LP zoals beschreven in de literatuur.

Patients with rheumatoid arthritis (RA) have a significantly increased risk of mortality compared with the general population. One of the most important predictors for mortality is somatic comorbidity. Moreover, studies have demonstrated that comorbid depression is associated with mortality. Which specific comorbidities are associated with mortality is less investigated. The purpose of this study was to investigate the association of a wide range of comorbidities with mortality in patients with RA.Longitudinal data over a 14-year period were collected from 882 patients with RA. Data were assessed with questionnaires. The mortality status was obtained from the Statistics Netherlands for the period 1996-2011 for 99% of the patients. Somatic comorbidity was assessed in 1997, 1998, 1999, and 2008 and measured by a national population-based questionnaire including 20 chronic diseases. Comorbid depression was assessed in 1997, 1998, and 1999 and measured with the Center for Epidemiologic Studies Depression Scale. Cox regression was used to study the relationship between comorbidity and mortality.At baseline, 72% of the patients were women. The mean ± SD age was 59.3 ± 14.8 years, and the median (interquartile range) disease duration was 5.0 (2.0-14.0) years. A total of 345 patients died during the study period. Comorbidities that were associated with mortality were circulatory conditions (hazard ratio [HR] 1.60 [95% confidence interval (95% CI) 1.15-2.22]), respiratory conditions (HR 1.43 [95% CI 1.09-1.89]), cancer (HR 2.00 [95% CI 1.28-3.12]), and depression (HR 1.35 [95% CI 1.06-1.72]).Comorbid circulatory conditions, respiratory conditions, cancer, and depression are associated with mortality among patients with RA. Careful monitoring of these comorbidities during the course of the disease and adequate referral may improve health outcomes and chances of surviving.

Objectives: Endothelin (ET) is a strong constrictor of smooth muscle structures. The relevance of Endothelin-A receptors in the bladder was demonstrated in several in vitro studies. The aim of this functional study was to evaluate the acute effect of the selective ET-A-antagonist LU 302146 (LU) on neurostimulation-induced bladder contractions in vivo. Methods: Eight male mini pigs were anesthesized. The bladder was exposed and a double lumen catheter was inserted to perform intravesical pressure (pves) measurements. Laminectomy was performed for sacral anterior root stimulation (SARS) of S2. Four animals received the selective ET-A-antagonist LU, three atropine and one animal was treated with vehicle. Pves was recorded before and after drug administration as well as before and during neurostimulation. At the end of each LU trial, a supplementary application of 4 mg atropine was administered followed by a final SARS. Results: In all experiments reproducible pves values were elicited during electrostimulation before administration of the test substance. The selective ET-A-antagonist reduced stimulation-induced bladder contraction by a mean of 57%. Additional administration of atropine inhibited the detrusor contraction almost completely during SARS. The vehicle had no effect on bladder contraction. Conclusions: In the presented animal model, ET-1 inhibition with the selective ET receptor-A-antagonist LU 302146 decreases stimulation-induced bladder contraction in vivo. The results suggest that the selective ET-A antagonist LU acts on the atropine-resistant component of efferent detrusor activation since additional administration of atropine almost completely abolish detrusor contraction. This observation in addition to the involvement of ET-1 in bladder smooth muscle proliferation, raises the possibility that ET-receptor antagonists might be beneficial in patients with neurogenic bladder dysfunction or in patients with functional or anatomical BOO.

Introduction An increased activity of the external urethral sphincter or pelvic floor muscles during voluntary voiding leads to dysfunctional voiding. Frequently reported symptoms are urinary incontinence, urinary tract infections and high post-void residuals. Dysfunctional voiding is a common problem in school-aged children and despite various treatment options, 10-40% of the children remain therapy-refractory. Objective The aim of this study is to evaluate the effectiveness of Onabotulinum toxin-A (BTX-A) injections in the external urethral sphincter in children with therapy-refractory dysfunctional voiding. Patients and methods Patients with therapy-refractory dysfunctional voiding who have received BTX-A injections in the external urethral sphincter from 2010 to 2013 were analysed. Children with known neuropsychiatric disorders were excluded. All children had abnormal flow patterns and increased pelvic floor tone during uroflowmetry/EMG studies. They had received at least five sessions of urotherapy and two sessions of pelvic floor physical therapy prior to treatment. A total of 100 IU of BTX-A was injected in the external urethral sphincter at the 3, 9 and 12 o'clock positions. Our main outcome measures were urinary incontinence, recurrent urinary tract infections and post-void residual. Results A total of twenty patients, of whom 16 girls, with a median age of 9 years (range 5-14) were treated with BTX-A. The median follow-up was 13 months (range 5-34). Post-void residual decreased by 75% after BTX-A, from a median of 47.5 ml (16.3-88.5 ml) to 0 ml (0.0-28.0 ml) (p = 0.001) Six patients had a post-void residual < 20 ml prior to treatment. After BTX-A sixteen patients had a post-void residual < 20 ml (Figure). No significant changes in uroflowmetry results was seen. Sixteen children are no longer daily incontinent, of whom 9 became completely dry (p = 0.0001). Eleven patients suffered from recurrent urinary tract infections prior to treatment. After BTX-A five children remained infection free, while the other six experienced only one urinary tract infection during follow-up (p = 0.003). Fourteen patients received additional urotherapy after BTX-A. Repeat injections were necessary in four patients after initial satisfactory results, with repeated good clinical responses. Two children showed no improvement after first BTX-A injection. No serious adverse events were reported. Discussion The results in this homogenous group of patients confirm the conclusions of previous studies in opting BTX-A in the external urethral sphincter to be a viable treatment option for the therapy-refractory group of patients with dysfunctional voiding. What is new, is that in most of our patients post-injection urotherapy was used to amplify the BTX-A effect. During our long-term follow-up the satisfactory results were sustained, similar to the results of the long-term follow-up presented by Vricella et al. [1]. The retrospective character and relative small sample size are limitations of this study. Conclusions This study shows safe and persistent satisfactory results during our average 13-month follow-up in 90% of our patients with therapy-refractory dysfunctional voiding. A prospective study using validated and standardized measurements will be performed to affirm our results and evaluate the exact role of post-injection urotherapy.

Diseases in childhood have an impact on growth. The influence of Langerhans cell histiocytosis (LCH) on growth has never been studied well. Recently a patient with LCH was treated with human growth hormone (GH) because of severe GH deficiency due to LCH involvement of both the hypothalamus and pituitary. This led us to review our charts from 1971 onward for evaluation of the growth patterns in patients with LCH. Here the long-term growth of 22 patients with LCH is reported, the median follow up being 7 years and 1 month. The height data were converted into standard deviation scores (SDS). At diagnosis the mean SDS of patients with isolated LCH at diagnosis was 0.04 and -0.37 in patients with disseminated LCH. Of the total group, 12 patients did not show any influence from the LCH or therapy on their growth. The remaining 10 patients reached, after a minimum of 3 years, a percentile clearly higher than that at diagnosis. However all the ten above mentioned patients, either isolated or disseminated LCH, had a lesion in the facial side of the skull. CONCLUSION. GH deficiency is not a common manifestation of LCH in childhood and GH provocation tests are only indicated when there is a poor or decelerating growth rate. In our patients the number of organs involved and/or the treatment modality did not influence the growth in all but one.

Reported here is the case of a 5-year old boy with a pyeloureteral junction (PUJ) obstruction and pyelonephritis caused by Actinobaculum schaalii, an Actinomyces-like organism. Pyelonephritis or any other urinary tract infection caused by Actinobaculum schaalii has not been described in children before. The patient responded well to pyeloplasty in combination with antibiotic treatment.

To describe long-term physical functioning and its association with somatic comorbidity and comorbid depression in patients with established rheumatoid arthritis (RA).Longitudinal data over a period of 11 years were collected from 882 patients with RA at study inclusion. Patient-reported outcomes were collected in 1997, 1998, 1999, 2002, and 2008. Physical functioning was measured with the Health Assessment Questionnaire and the physical component summary score of the Short Form 36 health survey. Somatic comorbidity was measured by a questionnaire including 12 chronic diseases. Comorbid depression was measured with the Center for Epidemiologic Studies Depression Scale. We distinguished 4 groups of patients based on comorbidity at baseline.Seventy-two percent of the patients at baseline were women. The mean ± SD age was 59.3 ± 14.8 years and the median disease duration was 5.0 years (interquartile range 2.0-14.0 years). For the total group of patients with RA, physical functioning improved over time. Patients with somatic comorbidity, comorbid depression, or both demonstrated worse physical functioning than patients without comorbidity at all data collection points. Both groups with comorbid depression had the lowest scores. Only patients with both somatic comorbidity and comorbid depression showed significantly less improvement in physical functioning over time.Both somatic comorbidity and comorbid depression were negatively associated with physical functioning during an 11-year followup period. Furthermore, their combination seems to be especially detrimental to physical functioning over time. These results emphasize the need to take somatic comorbidity and comorbid depression into account in the screening and treatment of patients with RA.

We devised a technique for phalloplasty in a female-to-male transsexual combining the lateral upper arm free flap with a bladder mucosa graft, to address the ideal requirements of phalloplasty in the best possible way. The surgical techniques are described. Healing of the phallus has been uneventful, but postoperative bladder spasms, meatal stenosis, and an intraurethral valve were encountered. The cosmetic result of the phalloplasty is pleasing. Sensibility is still increasing after a 14-month follow-up. Scarring of the upper arm donor site can be camouflaged easily. Although the actual phalloplasty as described in this article is a one-stage microsurgical procedure that appears to be reproducible, the construction of a phallus meeting all requirements still implies more than one stage.

Contains fulltext : 79985.pdf (Publisher’s version ) (Closed access) Chromosome analysis in two young patients with multiple congenital anomalies revealed a de novo interstitial deletion of 8q that has not been reported before. The deletions were overlapping by 8.35 Mb (8q24.21q24.23). The clinical features shared by our patients were coloboma, VSD, digital abnormalities, congenital dislocation of a hip, feeding problems, psychomotor delay and convulsions. The deletion included the region for Langer-Giedion syndrome (TRPS1 and EXT1) in the girl only. However, she is too young to present features of this syndrome, apart from dysmorphic features like a bulbous nose and notched alae nasi. Several genes are present in the commonly deleted region, including genes with unknown function, and genes for which haploinsufficiency is known to have no phenotypic effect in mice (Wnt1). A gene that might play a role in the convulsions of our patients is KCNQ3.

Guidelines for the treatment ofundescended testis (UDT) are sparse. Often an operation in the second year of life is advised. --Recent data indicate that the normal maturation process, which will ultimately lead to a normal quantity and quality of germ cells, is impaired as early as in the first half year of a newborn's life. None of the guidelines take this into account. Spontaneous descent after the fourth month following birth, of testes that have previously not descended, hardly ever occurs. --No differences have been shown in complication numbers between surgery before and after the first birthday. Orchidopexy prior to the 13th birthday reduces the risk of testicular cancer. --Therefore, based on these data, it is advised to perform orchidopexy in the second half of the first year of a newborn's life. In older boys a UDT must be treated before the 13th birthday. --In the Netherlands a lot more orchidopexies are done despite what may be expected based on prevalence numbers of UDT: testes retaining a normal volume that would most probably have descended spontaneously come puberty. --It remains important to carry out a careful physical examination and document the position of the testes soon after birth, and later on if UDT is suspected, to avoid unnecessary operations on retractile testes and acquired UDT.

It is well established within the Industry that injection of (produced) water almost always takes place under fracturing conditions. Particularly when large volumes of very contaminated water are injected-either for voidage replacement or disposal-large fractures may be induced over time. Unfortunately, not much work has been carried out to date to provide methodologies for predicting and measurement of the size of waterflood-induced fractures. This contrasts to the vast amount of work that has been done for stimulation (e.g. propped) fractures. Injection Fall-Off (IFO) test analysis offers a cheap way to infer the dimensions of induced fractures from welltests. This paper presents a new methodology for IFO test analysis of fractured waterflood wells. This methodology derives the dimensions of induced fractures, and the extent to which these are contained to the target injection layer. Furthermore, the paper focuses on the application of this methodology to a waterflood offshore Sakhalin in the Russian far East. The methodology is based on an exact solution to the fully transient elliptical fluid flow equation around a closing fracture with changing conductivity, face skin, and multiple reservoir mobility zones. It also captures the case that during closure the fracture generally shrinks from adjacent geological layers. It is demonstrated that the analyses based on the storage and linear flow regimes can be integrated into one analysis in order to reduce error bounds. The method is applied to a number of examples in a water-flood offshore Sakhalin. Here, start-up of injection wells was accompanied by regular IFO testing in order to monitor fracture growth over time. The interpreted fracture dimensions were compared with predicted dimensions using a recently developed in-house waterflood fracture simulator. The fracture lengths as interpreted from IFO test analysis appeared to be systematically lower than the predicted ones, and a number of explanations for this difference are presented in the paper.

Een phimosis is niet hetzelfde als een niet-retraheerbare voorhuid. Strikt genomen dient het woord phimosis te worden gereserveerd voor de pathologische verlittekende voorhuid als gevolg van ontstekingen, balanitis xerotica obliterans of door genezen scheurtjes na geforceerd terughalen van de voorhuid over de glans penis. Het begrip fysiologische phimosis wordt veel gebruikt, maar het is beter om te praten over een niet-retraheerbare voorhuid zonder klachten. Ondanks het feit dat de helft van de wereldbevolking geboren is met een voorhuid is er bijzonder weinig over bekend.

Een preputium dat niet is terug te schuiven is niet altijd vernauwd en min of meer fysiologisch. Zonder behandeling zal tot 98% van de jongens met een niet terugschuifbare voorhuid voor het 10e levensjaar wel in staat zijn de voorhuid terug te schuiven. Soms berust het niet volledig terugschuifbaar zijn op (fysiologische) verklevingen tussen preputium en glans penis. Enige smegmaretentie wordt vaak gezien bij kinderen. Soms leidt dit tot een ontsteking van de glans, soms worden duidelijke wit doorschemerende smegmaophopingen gezien die kunnen imponeren als atheroomcysten. Over het algemeen ontlasten deze ophopingen spontaan zonder klachten.

Een urinekweek is nog altijd de gouden standaard ter detectie of ter uitsluiting van een urineweginfectie. De diagnose urineweginfectie wordt gesteld als er sprake is van een significante bacteriurie ( >105kolonievormende bacterien), verkregen uit vers geloosde urine, bij voorkeur midstream urine. Daarnaast moet er een monocultuur zijn, dat wil zeggen slechts 1 bacteriesoort.

Het proces van zindelijk worden verloopt in een aantal fasen. Bij de pasgeborene is er sprake van een reflexmatige mictie. Bij vulling van de blaas worden rek- en strekreceptoren geprikkeld die via reflexbanen langs het sacrale ruggemerg een blaascontractie bewerkstelligen. Als het kind ouder wordt is het in staat de plas op te houden door de bekkenbodemspier aan te spannen.

Heart failure is a life-threatening complication of fulminant meningococcal septic shock (MSS). Depression of left ventricular function, in particular, is thought to be due to circulating meningococcal endotoxin. Myocardial failure leads to ventricular dilation expressed by an increased left-ventricle end-diastolic diameter (LVED). With ultrasonography, LVED can be accurately measured as well as the shortening fraction (SF). In an evaluative study we investigated the accuracy of the SF and compared it to the accuracy of the Glasgow meningococcal septicemia prognostic score (GMSPS) in the prediction of mortality in children with fulminant MSS. In 27 children admitted in a 4-year period with a presumptive clinical diagnosis of fulminant MSS, hypotension persisted for more than 1 h despite volume loading and inotropic therapy. Seven of these children died (26%); all had an SF or =10 (the sensitivity of both scores was 100%). Positive predictive values of the SF and GMSPS were 41% and 58% respectively. CONCLUSIONS: SF can be used in addition to other severity scores in clinical decision-making and contribute to the selection of children with the worst prospects for inclusion in experimental treatment studies

A significant increase in the incidence of caseous lesions in the lymph nodes of slaughter pigs prompted a large-scale investigation in five slaughterhouses in The Netherlands. In total, 158,763 pigs from 2,899 groups underwent gross examination. At least one pig with caseous lesions in the submaxillary and/or mesenteric lymph nodes was observed in each of 154 of the 2,899 groups examined (5%). In total, 856 pigs (0.5%) were affected. As many as five pigs in each of 141 of the 154 positive groups (91.5%) had lymph node lesions. Greater numbers of pigs with affected lymph nodes were found in 13 groups (8.5%). Four pigs had lesions in the kidneys, liver, or spleen. Acid-fast bacteria were detected by microscopic examination of 121 of 292 Ziehl-Neelsen-stained smears of caseous lesions (41%). In a follow-up study, Mycobacterium avium complex (MAC) bacteria were isolated from 219 of 402 affected lymph nodes (54.2%). Ninety-one of the isolated strains were analyzed by restriction fragment length polymorphism (RFLP) typing with insertion sequence IS 1245 as a probe. All but 1 of these 91 strains contained IS 1245 DNA, indicating that pigs in The Netherlands carried almost exclusively M. avium bacteria and no other bacteria of MAC. Only one pig isolate exhibited the bird-type RFLP pattern. MAC isolates from 191 human patients in The Netherlands in 1996 were also typed by RFLP analysis. Computer-assisted analysis showed that the RFLP patterns of 61% of the human isolates and 59% of the porcine isolates were at least 75% similar to the RFLP patterns of the other group of strains. This indicates that pigs may be an important vehicle for M. avium infections in humans or that pigs and humans share common sources of infection.