Mediamusic (E-Journal)
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Survival of molar teeth in need of complex endodontic treatment:Influence of the endodontic treatment and quality of the restoration
No full textObjectives: The objective of this retrospective practice-based study was to evaluate the survival of molar teeth and endodontic success after complex endodontic treatment up to 89 months.Methods: Endodontically (Endodontic Treatment Classification (ETC) scores II and III) treated first and second molars treated between January 2011-October 2017 within a referral setting were included. Open apices, combined surgical treatment, ETC score I, patients 2 were excluded. Cumulative survival estimates and Cox regression analysis were performed for tooth survival and endodontic healing according to the Glossary of Endodontic Terms. Restoration quality was assessed using the FDI criteria. Alpha was set at 0.05.Results: 279 endodontically treated molars in 245 patients were included for survival analysis and 268 molars for endodontic success. After 89 months, the cumulative survival was 91.7 % [95 % CI: 86.8 %?94.9 %]. Absence of adjacent teeth and deviance in root canal morphology significantly decreased the probability of tooth survival. Cumulative endododontic healing rates after 48 and 89 months were 82.2 % [95 %CI: 75.7 %?87.1 %] and 51.1 [95 % CI: 20.2 %?75.5 %] respectively. Deviance in root canal morphology and inadequate coronal seal significantly decreased the probability of endodontic healing. Indirect restorations obtained higher esthetic and biological FDI scores, however no difference between direct and indirect restorations was found concerning the functional FDI score. Conclusions: After 89 months, cumulative survival of molars in need of complex endodontic treatment was 91.7 % [95 % CI: 86.8 %?94.9 %]. Clinical significance: Within daily clinical practice, the dilemma of performing a complex endodontic (re)treatment or to explore other treatment options for molar teeth in need of reintervention is still urgent. Tooth survival of molar teeth with complex endodontic (re)treatment seems satisfactory up to 89 months.</p
Pulmonary hypertension in extremely preterm infants:a call to standardize echocardiographic screening and follow-up policy
No full textPulmonary hypertension (PH) is a frequent complication in extremely preterm born infants that seriously affects outcome. We aimed to describe the prevalence of PH in extremely preterm infants and the policy on screening and follow-up in the ten Dutch intensive care units (NICUs). We performed a retrospective cohort study at the University Medical Centre Groningen on infants with gestational age <30 weeks and/or birthweight <1000 g, born between 2012 and 2013. Additionally, we carried out a survey among the Dutch NICUs covering questions on the awareness of PH, the perceived prevalence, and policy regarding screening and following PH in extremely preterm infants. Prevalence of early-onset PH in our study was 26% and 5% for late-onset PH. PH was associated with poor survival and early-onset PH was associated with subsequent development of bronchopulmonary dysplasia (BPD). All the NICUs completed the questionnaire and we found that no standardized policy existed regarding screening and following PH in extremely preterm infants.Conclusion: Despite the frequent occurrence of PH and its clinically important consequences, (inter-)national standardized guidelines regarding screening and following of PH in extremely preterm infants are lacking. Standardizing screening and follow-up will enable early identification of infants with late-onset PH and allow for earlier treatment. Additionally, greater clarity is required regarding the prevalence of early PH as are new preventive treatment strategies to combat BPD.What is known?center dot Pulmonary hypertension (PH) substantially impairs the survival of extremely preterm infants.center dot PH is associated with bronchopulmonary dysplasia (BPD): Early-onset PH predicts the development of BPD. Late-onset PH is prevalent in infants with severe BPD.What is new?center dot Pulmonary hypertension (PH) is prevalent in preterm infants. Its consequences for morbidity and mortality justify a standardized policy aimed at early detection to improve prevention and treatment.center dot No structured policy exists in the Netherlands regarding screening/follow-up for PH in extremely preterm infants.</p
Mass and half-life measurements of neutron-deficient isotopes with A~100 and developments for the FRS Ion Catcher and CISE
No full textThe goal of this thesis was to develop new methods to study the nuclear structure for A~100 neutron-deficient isotopes by means of half-life and mass measurements. The thesis is divided into three main sub-projects. First, the initial developments of the CISE setup for chemical isobaric separation of ions. Second, the developments in the gas-handling system of the Cryogenic Stopping Cell (CSC) of the FRS-IC setup. Third, half-life and mass measurements of medium-heavy and heavy nuclei by using MR-TOF-MS technique at the FRS-IC setup
Inhaled long-acting muscarinic antagonists in asthma - A narrative review
No full textLong-acting muscarinic antagonists (LAMAs) have a recognised role in the management of chronic obstructive pulmonary disease. In asthma, muscarinic antagonists (both short- and long-acting) were historically considered less effective than β2-agonists; only relatively recently have studies been conducted to evaluate the efficacy of LAMAs, as add-on to either inhaled corticosteroid (ICS) monotherapy or ICS/long-acting β2-agonist (LABA) combinations. These studies led to the approval of the first LAMA, tiotropium, as an add-on therapy in patients with poorly controlled asthma. Subsequently, a number of single-inhaler ICS/LABA/LAMA triple therapies have been approved or are in clinical development for the management of asthma. There is now substantial evidence of the efficacy and safety of LAMAs in asthma that is uncontrolled despite treatment with an ICS/LABA combination. This regimen is recommended by GINA as an optimisation step for patients with severe asthma before any biologic or systemic corticosteroid treatment is initiated. This narrative review summarises the potential mechanisms of action of LAMAs in asthma, together with the initial clinical evidence supporting this use. We also discuss the studies that led to the approval of tiotropium for asthma and the data evaluating the efficacy and safety of the various triple therapies, before considering other potential uses for triple therapy.</p
Non-Denominational Spiritual Care Givers and the Development of their Spirituality
No full textIn the Netherlands, a growing number of spiritual care givers are working without being endorsed by any church or worldview organization. Since 2015, these non-denominational spiritual care givers can undergo an assessment of their “spiritual competence” on top of their Master’s degree in Spiritual Care, which leads to a mandate in this area. This enables them to obtain full membership of the professional Association of Spiritual Caregivers in the Netherlands (Vereniging van Geestelijk VerZorgers, VGVZ), from which they previously were excluded. The VGVZ seeks to secure the quality and professionalism of spiritual care, and full membership is a condition typically required by clients or employers. The VGVZ’s Professional Standard outlines the membership criteria and states that a spiritual care giver needs to have both a certain expertise, derived from a Master’s degree, and authorization, derived from an endorsement or mandate that ought to safeguard their spiritual competence and authentic, lived spirituality. However, as this study illustrates, the terminology used in the Professional Standard is rather unclear. Reference is made to “spiritual”, “worldview” and “hermeneutic” competencies, which are all situated in the domain of substantive, process-orientated and personal capabilities. This article critically examines the notion of spiritual competence as a leading concept in the acceptance and assessment of non-denominational spiritual care givers. By doing so, it offers a novel systematic analysis of the field and sets the agenda for future research
Hypothermic Machine Perfusion in Liver Transplantation - A Randomized Trial
No full textBACKGROUNDTransplantation of livers obtained from donors after circulatory death is associated with an increased risk of nonanastomotic biliary strictures. Hypothermic oxygenated machine perfusion of livers may reduce the incidence of biliary complications, but data from prospective, controlled studies are limited.METHODSIn this multicenter, controlled trial, we randomly assigned patients who were undergoing transplantation of a liver obtained from a donor after circulatory death to receive that liver either after hypothermic oxygenated machine perfusion (machine-perfusion group) or after conventional static cold storage alone (control group). The primary end point was the incidence of nonanastomotic biliary strictures within 6 months after transplantation. Secondary end points included other graft-related and general complications.RESULTSA total of 160 patients were enrolled, of whom 78 received a machine-perfused liver and 78 received a liver after static cold storage only (4 patients did not receive a liver in this trial). Nonanastomotic biliary strictures occurred in 6% of the patients in the machine-perfusion group and in 18% of those in the control group (risk ratio, 0.36; 95% confidence interval [CI], 0.14 to 0.94; P=0.03). Postreperfusion syndrome occurred in 12% of the recipients of a machine-perfused liver and in 27% of those in the control group (risk ratio, 0.43; 95% CI, 0.20 to 0.91). Early allograft dysfunction occurred in 26% of the machine-perfused livers, as compared with 40% of control livers (risk ratio, 0.61; 95% CI, 0.39 to 0.96). The cumulative number of treatments for nonanastomotic biliary strictures was lower by a factor of almost 4 after machine perfusion, as compared with control. The incidence of adverse events was similar in the two groups.CONCLUSIONSHypothermic oxygenated machine perfusion led to a lower risk of nonanastomotic biliary strictures following the transplantation of livers obtained from donors after circulatory death than conventional static cold storage.</p
Intertidal mussel reefs change the composition and size distribution of diatoms in the biofilm
No full textMigrating diatoms are microscopic ecosystem engineering organisms that have functional consequences on the seascape scale by significantly contributing to the microphytobenthos biofilm. The microphytobenthos biofilm is a thin photosynthesising layer that covers the sediment on intertidal flats. It fuels the food web, increases sediment stability, and enhances the deposition of particles, providing ecosystem services to coastal communities. Here we tested the effect of another ecosystem engineering habitat, intertidal blue mussel reefs, on the composition and properties of migrating diatom communities. Small-scale reefs constructed in the intertidal mimicked and reinforced the natural pattern in diatom community composition and function that we documented in the field. The field experiment adding small reefs to the intertidal ran from 30 April to 10 June 2015 and the field samples were collected around a natural blue mussel bed on the same tidal flat on 7 October 2015 (N 53.489 degrees, E 6.230 degrees). Both the constructed small-scale reefs and the natural reef changed the community composition of diatoms in the biofilm by promoting higher numbers of smaller-sized cells and species. Small diatoms have higher growth and gross photosynthesis rates, indicating that this explains the higher production and chlorophyll-a concentration of the biofilm measured on natural intertidal shellfish reefs. Our results showed that shellfish reefs have a large impact on biofilm functioning. However, biofilms are also fuel for the shellfish, indicating that the two very different ecosystem engineers may facilitate coexistence on tidal flats through a positive feedback loop.</p
P62-positive aggregates are homogenously distributed in the myocardium and associated with the type of mutation in genetic cardiomyopathy
No full textGenetic cardiomyopathy is caused by mutations in various genes. The accumulation of potentially proteotoxic mutant protein aggregates due to insufficient autophagy is a possible mechanism of disease development. The objective of this study was to investigate the distribution in the myocardium of such aggregates in relation to specific pathogenic genetic mutations in cardiomyopathy hearts. Hearts from 32 genetic cardiomyopathy patients, 4 non-genetic cardiomyopathy patients and 5 controls were studied. Microscopic slices from an entire midventricular heart slice were stained for p62 (sequestosome-1, marker for aggregated proteins destined for autophagy). The percentage of cardiomyocytes with p62 accumulation was higher in cardiomyopathy hearts (median 3.3%) than in healthy controls (0.3%; P <.0001). p62 accumulation was highest in the desmin (15.6%) and phospholamban (7.2%) groups. P62 accumulation was homogeneously distributed in the myocardium. Fibrosis was not associated with p62 accumulation in subgroup analysis of phospholamban hearts. In conclusion, accumulation of p62-positive protein aggregates is homogeneously distributed in the myocardium independently of fibrosis distribution and associated with desmin and phospholamban cardiomyopathy. Proteotoxic protein accumulation is a diffuse process in the myocardium while a more localized second hit, such as local strain during exercise, might determine whether this leads to regional myocyte decay.</p
Genetically-determined body mass index and the risk of atrial fibrillation progression in men and women
No full textAimsLimited causal evidence is available on the relationship between body mass index (BMI) and atrial fibrillation (AF) progression. Sex differences have been noted and may be relevant for AF progression. We investigated the association between the BMI Genetic Risk Score (GRS) and AF progression in men and women of the Groningen Genetic Atrial Fibrillation (GGAF) cohort.Methods and resultsThe GGAF cohort (n = 2207) is a composite of 5 prospective cohorts with individuals of European ancestry. AF patients with genetic information, with at least 12 months follow-up and AF progression data were included. AF progression was defined as progression from paroxysmal to persistent/permanent AF, or persistent to permanent AF. A BMI GRS was constructed of genetic variants associated with BMI. Univariate and multivariate Cox proportional hazard regression analyses were performed in the total population and in men and women, separately. During a median follow-up of 34 [interquartile range 19-48] months 630 AF patients (mean age 62 +/- 11, 36% women, BMI of 28 +/- 5) were analyzed, and men and women developed similar AF progression rates (respectively 6.5% versus 6.1%). The BMI GRS was not associated with AF progression either as a continuous variable or in tertiles in the overall population. However, the BMI GRS was associated with the tertile of the highest BMI GRS in women (n = 225), also after multivariable adjustments of clinical risk factors (Hazard ratio 2.611 (95% confidence interval 1.151-5.924) p = 0.022).ConclusionsGenetically-determined BMI is only associated with women at risk of AF progression. The results may be supporting evidence for a causal link between observed BMI and AF progression in women. We emphasize the need for further investigation of genetically determined BMI and observed BMI to optimize AF management in women with increased risk for AF progression.</p