Mediamusic (E-Journal)
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Efficiency of Diagnostic Testing for Helicobacter pylori Infections:A Systematic Review
No full textBACKGROUND: The most recommended treatment for a Helicobacter pylori infection is high doses of combined antibiotics. The objective of this article is to perform a systematic review of the economic evaluation studies applied to assess the efficiency of diagnostic testing for H. pylori infections, so that their main characteristics can be identified and to learn from the literature how the antimicrobial resistance (AMR) issue is incorporated into these economic evaluations.METHODS: We conducted a systematic review to compare the costs and clinical effectiveness of diagnostic strategies for H. pylori infections. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and extracted the items from the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.RESULTS: We found thirteen articles that were of good quality according to CHEERS: six studies focused on diagnostics of Helicobacter pylori infections associated with dyspepsia and four on duodenal ulcers. Testing was found to be the most cost-effective strategy in eight articles. Four studies considered AMR.CONCLUSIONS: Testing was more cost-effective than empirical treatment, except in cases of high prevalence (as with developing countries) or when patients could be stratified according to their comorbidities. The introduction of AMR into the model may change the efficiency of the testing strategy.</p
Deconstructing Instructions in the Art Academy
No full textDrawing as a manual discipline was long taught in the West according to specific ‘academic’ principles, culminating institutionally in the art academies of the 19th century. This educational process was mediated by visual images and three-dimensional objects, and relied on copying as a means to acquire manual skill along with a ‘vocabulary’ of idealized forms. During the twentieth century the roles, values and practices of art changed profoundly, and consequently methods of artistic education changed as well. As symbols of a tradition overcome, many (modernizing) art academies, many instruction books, plaster casts of sculptures, and écorchés were either discarded or consigned to storage rooms and libraries. In one such art school, Minerva Art Academy in Groningen (the Netherlands), a didactic experiment was undertaken in the spring semester of 2019. Art historian Vanessa van ‘t Hoogt and artist Henrike Scholten designed and taught an elective course that investigates and reflects critically on the art academy’s history. Using a historically informed, experimental and practice-based pedagogic approach, the 16-week course challenged 23 undergraduate art students to engage with the material and didactic heritage of the art academy. Not in a nostalgic or neo-academic fashion, but on their own terms as contemporary art students. This project report describes some aspects of the authors’ didactic approach during the course. As an investigative and sometimes performative project, it toes the line between educational action research and object-based teaching. The aim of the course was to provide art students with new tools to engage with the history of their discipline and its processes of skill acquisition in a reflective and generative way
The Association of Early Electrocardiographic Abnormalities With Brain Injury Severity and Outcome in Severe Traumatic Brain Injury
No full textThe aim of this study was to evaluate the frequency of electrocardiographic (ECG) abnormalities in the acute phase of severe traumatic brain injury (TBI) and the association with brain injury severity and outcome. In contrast to neurovascular diseases, sparse information is available on this issue. Data of adult patients with severe TBI admitted to the Intensive Care Unit (ICU) for intracranial pressure monitoring of a level-1 trauma center from 2002 till 2018 were analyzed. Patients with a cardiac history were excluded. An ECG recording was obtained within 24 h after ICU admission. Admission brain computerized tomography (CT)-scans were categorized by Marshall-criteria (diffuse vs. mass lesions) and for location of traumatic lesions. CT-characteristics and maximum Therapy Intensity Level (TILmax) were used as indicators for brain injury severity. We analyzed data of 198 patients, mean (SD) age of 40 +/- 19 years, median GCS score 3 [interquartile range (IQR) 3-6], and 105 patients (53%) had thoracic injury. In-hospital mortality was 30%, with sudden death by cardiac arrest in four patients. The incidence of ECG abnormalities was 88% comprising ventricular repolarization disorders (57%) mostly with ST-segment abnormalities, conduction disorders (45%) mostly with QTc-prolongation, and arrhythmias (38%) mostly of supraventricular origin. More cardiac arrhythmias were observed with increased grading of diffuse brain injury (p = 0.042) or in patients treated with hyperosmolar therapy (TILmax) (65%, p = 0.022). No association was found between ECG abnormalities and location of brain lesions nor with thoracic injury. Multivariate analysis with baseline outcome predictors showed that cardiac arrhythmias were not independently associated with in-hospital mortality (p = 0.097). Only hypotension (p = 0.029) and diffuse brain injury (p = 0.017) were associated with in-hospital mortality. In conclusion, a high incidence of ECG abnormalities was observed in patients with severe TBI in the acute phase after injury. No association between ECG abnormalities and location of brain lesions or presence of thoracic injury was present. Cardiac arrhythmias were indicative for brain injury severity but not independently associated with in-hospital mortality. Therefore, our findings likely suggest that ECG abnormalities should be considered as cardiac mimicry representing the secondary effect of traumatic brain injury allowing for a more rationale use of neuroprotective measures.</p
Prevalence of sarcopenic obesity and sarcopenic overweight in the general population:The lifelines cohort study
No full textBackground & aims: Sarcopenic obesity (SO) is defined by a relatively low muscle mass in combination with obesity. Sarcopenic obesity was first noted as a health risk in geriatric populations but has recently been recognized as a scientific and clinical priority that may extend beyond geriatric settings. Obesity is generally preceded by overweight, so the prevalence and health risks of sarcopenia in those with overweight (SOW) is of interest for preventive purposes. The aim of this study, therefore, was to assess the prevalence and determinants of SO and SOW in a general population.Methods: Participants (n = 119,494), aged 18-90 years were included from the Dutch Lifelines cohort study. Muscle mass was assessed by 24-h urine creatinine excretion and stratified for gender for analysis, and obesity was defined as a Body Mass Index (BMI) >= 30 kg/m(2) and overweight >= 25 kg/m(2). Multivariate logistic regression models were applied to assess the relevant determinants of SO and SOW.Results: Respectively for men and women the prevalence of SO was 0.9% and 1.4%, and prevalence of SOW 6.5% and 6.0%. In subjects with sarcopenia, BMI was >= 25 kg/m(2) in 45.5% and >= 30 kg/m(2) in 6.1%. Overall females had a higher prevalence of SOW and SO in all age groups except for SOW in males between ages 40-59. Also, age was a significant determinant of SO and SOW, with a rise in prevalence as of age 50. Of all subjects with SO and SOW, respectively 82.5% and 80.4% were below the age of 70. Compared to those with no morbidities, the odds ratio of SO and SOW among participants with >3 comorbidities was 2.71 (95% CI: 1.62-4.54) and 1.33 (95% CI: 1.07-1.65) among males and 1.14 (95% CI: 0.79-1.65) and 1.28 (95% CI: 1.06-1.54) among females, independent of other determinants. Overall, an inverse association was found between SOW and SO and physical activity and macronutrient intake.Conclusion: The results support the need for more awareness of SO beyond the field of geriatrics, in particular in subjects with comorbidities. SOW is more prevalent than SO and may provide opportunities for preventive strategies for the general population. (C) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).</p
Regional Responses in Radiation-Induced Normal Tissue Damage
No full textSimple SummarySide effects caused by the concomitant irradiation of normal tissue during radiotherapy for cancer treatment can negatively affect the patient's quality of life and limit the radiation dose that can safely be administered to the tumor. Recently, considerable developments have been achieved in radiotherapy and imaging technologies, allowing the selective sparing of the regions within organs that contribute most to the development of these side effects. This review discusses regional variation in the response to radiation in several organs, including the brain, salivary glands, cardiopulmonary system, pancreas, and bladder. Regional responses are shown to originate from general principles, such as the localization of target cells or function. We conclude that regional responses are a general phenomenon that should be studied in other organs. This will facilitate further optimization of the use of modern radiotherapy technologies.Normal tissue side effects remain a major concern in radiotherapy. The improved precision of radiation dose delivery of recent technological developments in radiotherapy has the potential to reduce the radiation dose to organ regions that contribute the most to the development of side effects. This review discusses the contribution of regional variation in radiation responses in several organs. In the brain, various regions were found to contribute to radiation-induced neurocognitive dysfunction. In the parotid gland, the region containing the major ducts was found to be critical in hyposalivation. The heart and lung were each found to exhibit regional responses while also mutually affecting each other's response to radiation. Sub-structures critical for the development of side effects were identified in the pancreas and bladder. The presence of these regional responses is based on a non-uniform distribution of target cells or sub-structures critical for organ function. These characteristics are common to most organs in the body and we therefore hypothesize that regional responses in radiation-induced normal tissue damage may be a shared occurrence. Further investigations will offer new opportunities to reduce normal tissue side effects of radiotherapy using modern and high-precision technologies.</p
Regenerative Pharmacology for COPD
No full textRegenerative pharmacology for COPDXinhui Wu investigated novel therapeutic targets for chronic obstructive pulmonary disease (COPD). COPD is one of the most common lung diseases worldwide. It is characterized by airflow obstruction in the lung that causes breathing difficulties, cough, mucus (sputum) production and wheezing. The main causes of COPD are tobacco smoke and air pollution. They key problem in COPD is defective tissue repair, causing chronic bronchitis and emphysema, which are the two most common conditions resulting from airway and/or alveolar abnormalities. However, the current treatments for COPD can only reduce the symptoms and do not reverse or slow down the progression of the disease. Ms. Wu focused her research on the mechanisms underlying cigarette smoke and air pollution-induced dysfunctional lung repair and discovered several potential regenerative drug targets beneficial to lung repair in COPD.By using novel tools, such as 3D organoids and the precision-cut-lung slices (PCLS), to model different pathological conditions, Ms. Wu identified that cigarette smoke and air pollution both cause defective lung repair, but with different mechanisms. Molecular pathways such WNT-5A/B signaling, TGF- signaling, growth factors related signaling, cell death related signaling and circadian clock signaling all appear to play fundamental roles in the defective functions of alveolar epithelial progenitors. Several pharmacological strategies, such as ROCK inhibitors; antioxidants such as NAC and MitoQ; the analogues of PGE2 and PGI2 were discovered as potential regenerative therapeutic targets in lung repair for COPD
Central sensitization, illness perception and obesity should be considered when interpreting disease activity in axial spondyloarthritis
No full textOBJECTIVES: Many patients with axial spondyloarthritis (axSpA) report persistent pain even when treated with anti-inflammatory agents. Our aim was to explore the presence of central sensitization (CS) and different types of illness perceptions in patients with axSpA, and to assess their associations with disease activity assessments.METHODS: Consecutive outpatients from the GLAS cohort were included. Besides standardized assessments, patients filled out the Central Sensitization Inventory (CSI), Illness Perception Questionnaire (IPQ-R) and Pain Catastrophizing Scale (PCS). Univariable and multivariable linear regression analyses were used to investigate the association between questionnaire scores, patient characteristics and disease activity assessments ASDASCRP, BASDAI and CRP.RESULTS: We included 182 patients with a mean symptom duration of 21.6 years. Mean ASDASCRP was 2.1, mean BASDAI 3.9, and median CRP 2.9. Mean CSI score was 37.8 (scale 0-100) and 45% of patients scored ≥40, indicating a high probability of CS. CSI score, IPQ-R domain identity (number of symptoms the patient attributes to their illness), and IPQ-R domain treatment control (perceived treatment efficacy), and obesity were significantly and independently associated with both ASDASCRP and BASDAI, explaining a substantial proportion of variation in these disease activity scores (R2=0.35 and R2=0.47, respectively). Only obesity was also independently associated with CRP.CONCLUSION: CS may be common in patients with long-term axSpA. CS, as well as specific illness perceptions and obesity were all independently associated with the widely used (partially) patient-reported disease activity assessments ASDASCRP and BASDAI. Treating physicians should take this into account in the follow-up and treatment of their patients.</p
Axial-Vector Currents and Chiral Symmetry
No full textIn this work we consider the axial-vector form factors of the nucleon in flavor-SU(2) and of the baryon octet in flavor-SU(3) Chiral Perturbation Theory. We include the Δ-isobar and the baryon decuplet as explicit degrees of freedom and focus on their consistent treatment in terms of chiral power counting. We employ the use of on-shell meson and baryon masses in the one-loop contributions to the axial-vector form factors. The convergence properties of such an approach are scrutinized. Our results are compared to the available flavor-SU(2) QCD lattice data
Definition of large bowel obstruction by primary colorectal cancer:A systematic review
No full textAim: Controversies on therapeutic strategy for large bowel obstruction by primary colorectal cancer mainly concern acute conditions, being essentially different from subacute obstruction. Clearly defining acute obstruction is important for design and interpretation of studies as well as for guidelines and daily practice. This systematic review aimed to evaluate definitions of obstruction by colorectal cancer in prospective studies.Method: A systematic search was performed in PubMed, Embase and the Cochrane Library. Eligibility criteria included randomized or prospective observational design, publication between 2000 and 2019, and the inclusion of patients with an obstruction caused by colorectal cancer. Provided definitions of obstruction were extracted with assessment of common elements.Results: A total of 16 randomized controlled trials (RCTs) and 99 prospective observational studies were included. Obstruction was specified as acute in 28 studies, complete/emergency in five, (sub)acute or similar terms in four and unspecified in 78. Five of 16 RCTs (31%) and 37 of 99 cohort studies (37%) provided a definition. The definitions included any combination of clinical symptoms, physical signs, endoscopic features and radiological imaging findings in 25 studies. The definition was only based on clinical symptoms in 11 and radiological imaging in six studies. Definitions included a radiological component in 100% of evaluable RCTs (5/5) vs. 54% of prospective observational studies (20/37, P = 0.07).Conclusion: In this systematic review, the majority of prospective studies did not define obstruction by colorectal cancer and its urgency, whereas provided definitions varied hugely. Radiological confirmation seems to be an essential component in defining acute obstruction.</p
Recovery Courses of Patients Who Return to Work by 3, 6 or 12 Months After Total Knee Arthroplasty
No full textPurpose This study compared the preoperative levels and postoperative recovery courses of physical and mental impairments, activity limitations and participation restrictions of working-age patients who return to work (RTW) by 3, 6 or 12 months after total knee arthroplasty (TKA). Methods A prospective survey study including TKA patients (aged < 65) (n = 146) who returned to work (RdTW) in the first postoperative year. Three groups were compared: those who returned by 3 (n = 35), 6 (n = 40) or 12 (n = 29) months. Surveys were completed preoperatively and at 6 weeks and 3, 6 and 12 months postoperatively. Outcomes represented domains of the International Classification of Functioning, i.e. physical impairments (pain, stiffness, vitality), mental impairments (mental health and depressive symptoms), activity limitations (physical functioning) and participation restrictions (social and work functioning). Results Preoperative knee-specific pain and physical functioning levels were better among patients who RdTW by 3 months, compared to those who returned by 12 months. Patients who RdTW by 3 months experienced significantly better recovery from physical impairments than those who returned by 6 months (on general pain) or 12 months (on general and knee-specific pain and on stiffness). Patients returning by 3 months experienced significantly better recovery from activity limitations (on knee-specific physical functioning). Conclusions To optimize return to work outcome after TKA surgery, the focus should lie on physical impairments (general and knee-specific pain, stiffness) and activity limitations (knee-specific physical functioning) during recovery.</p