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Hyperglycaemia does not modify the efficacy of endovascular therapy in the late time window (6-24 hours)
No full textIntroduction: Hyperglycemia is common in ischemic stroke. Admission glucose modifies the effect of endovascular therapy (EVT) in patients with ischemic stroke of the anterior circulation, who are treated 0 to 6 hours since onset. Whether this also applies for late-window EVT (6–24 hours since symptom onset or last known well) is unknown. In this study, we assessed whether admission glucose level and/or hyperglycemia modifies the EVT effect in patients with ischemic stroke of the anterior circulation in the late time window. Methods: We used data from the MR CLEAN LATE trial. The primary outcome measure was the modified Rankin Scale (mRS) score at 90 days. Secondary outcome measures were symptomatic intracranial hemorrhage and mortality at 90 days. Treatment effect modification of EVT by either glucose or hyperglycemia on admission was assessed by multiplicative interaction factors with logistic regression analysis and adjusted for potential confounders. Hyperglycemia was defined as glucose level >7.8 mmol/L on admission. Results: On admission, median glucose was 7.0 mmol/L (IQR 6.0–8.3 mmol/L), and 147 patients (32%) were hyperglycemic. We found no interaction of either hyperglycemia or serum glucose on admission with treatment effect on functional outcome (p = 0.76 and p = 0.79, respectively), symptomatic intracranial hemorrhage (p = 0.29 for hyperglycemia; p = 0.57 for glucose on admission), and for mortality (p = 0.52 for hyperglycemia; p = 0.69 for glucose on admission). Conclusion: We found no evidence for effect modification of EVT by admission glucose level or hyperglycemia in patients with acute ischemic stroke and large-vessel occlusion of the anterior circulation in the late treatment window.</p
The effect of prophylactic clipping on delayed bleeding after proximal colonic endoscopic mucosal resection:a multicenter, randomized controlled trial (CLIPPER)
No full textBackground Delayed bleeding is the most common complication after endoscopic mucosal resection (EMR) of large colorectal polyps. Randomized controlled trials in high volume centers have suggested that prophylactic clipping of the resection defect reduces delayed bleeding in patients with a high risk for delayed bleeding. We aimed to evaluate the role of prophylactic clipping in reducing delayed bleeding in patients undergoing EMR for large, proximal, nonpedunculated polyps in daily clinical practice. Methods We performed a randomized controlled trial in 19 Dutch hospitals in patients referred for EMR of laterally spreading and sessile polyps >= 20mm in the proximal colon. Patients were randomly assigned (1:1) into groups receiving or not receiving prophylactic clipping. The primary end point was delayed bleeding, and analyses were performed according to intention-to-treat analysis. The trial was registered at ClinicalTrials.gov (NCT03309683). Results Between May 2018 and December 2021, 356 patients with a median polyp size of 30 mm (interquartile range 25-40) in the proximal colon were randomized (177 to the prophylactic clipping group and 179 to the control group). Delayed bleeding occurred in 16 patients (9.0 %) receiving prophylactic clipping and 11 control patients (6.1 %; P = 0.30). No deaths were reported. Conclusions Prophylactic clipping did not reduce delayed bleeding in patients undergoing EMR for large laterally spreading and sessile polyps in the proximal colon in daily clinical practice
Sensory Feedback in Parkinson Disease Voice Production:A Systematic Review
No full textBACKGROUND: Understanding voice and speech impairments in Parkinson's disease (PD) is essential for developing effective interventions and ensuring efficient social communication. OBJECTIVE: This review reports findings on voice perception and production in PD with a specific focus on sensory feedback (auditory and somatosensory) of the self-voice, neural correlates of the voice, and voice quality parameters such as pitch, loudness, and emotion modulation. METHODS: A combined bibliometric analysis and a systematic review should identify key trends and knowledge gaps in the neuroimaging (functional magnetic resonance imaging (fMRI)/EEG) literature on PD self-voice processing. RESULTS: EEG studies focusing on pitch revealed significant differences in the P200 event-related potential, but no differences in the N100, between healthy controls and individuals with PD. fMRI studies showed reduced activation in the motor cortex and basal ganglia during speech production in PD, accompanied by increased activation in other brain regions, such as the auditory cortex, which was associated with pitch variability and loudness control. A decrease in right dorsal premotor cortex activation was linked to impaired voice control, particularly regarding loudness modulation. Additionally, the review identified missing research on the emotion modulation of the voice, despite its critical role in social communication. Altered sensory feedback plays a significant role in compensatory cortical responses during vocalization, underscoring the importance of sensory feedback in maintaining normal voice production in PD. CONCLUSIONS: This review identified missing research on voice loudness perception and the potential impact of emotion perception deficits regarding voice modulation in persons with PD
Potential and value of rescuing dying neurons
No full textUnwarranted death of neurons is a major cause of neurodegenerative diseases. Since mature neurons are postmitotic and do not replicate, their death usually constitutes an irreversible step in pathology. A logical strategy to prevent neurodegeneration would then be to save all neurons that are still alive, i.e. protecting the ones that are still healthy as well as trying to rescue the ones that are damaged and in the process of dying. Regarding the latter, recent experiments have indicated that the possibility of reversing the cell death process and rescuing dying cells is more significant than previously anticipated. In many situations, the elimination of the cell death trigger alone enables dying cells to spontaneously repair their damage, recover, and survive. In this review, we explore the factors, which determine the fate of neurons engaged in the cell death process. A deeper insight into cell death mechanisms and the intrinsic capacity of cells to recover could pave the way for novel therapeutic approaches to neurodegenerative diseases
Facts Over Partisanship:Evidence-Based Updating of Trust in Partisan Sources
No full textA prominent explanation for the proliferation of political misinformation and the growing belief polarization is that people engage in motivated reasoning to affirm their ideology and to protect their political identities. An alternative explanation is that people seek the truth but use partisanship as a heuristic to discern credible from dubious sources of political information. In three experiments, we test these competing explanations in a dynamic setting where participants are repeatedly exposed to messages from ingroup or outgroup partisan sources and can learn which source is reliable based on external feedback. Participants initially showed a partisan bias as they incorporated information from ingroup sources more than from outgroup sources. This pattern was stronger among partisans that displayed high affective polarization. With experience, this partisan bias declined or even changed direction, as supporters of both groups gradually incorporated information from reliable sources more than unreliable sources irrespective of the source's partisanship. Importantly, the content of the shared information (i.e., neutral vs. political), the presence of partisan sources as opposed to neutral sources and the presence of external monetary accuracy incentives did not affect the learning process indicating the presence of strong internal accuracy motives. In contrast, increased uncertainty regarding source reliability undermined the learning process. These findings demonstrate that partisans follow Bayesian learning dynamics. Although participants initially display a partisan bias in the incorporation of information, they overcome this bias in the presence of external feedback and learn to trust credible sources irrespective of partisanship
Food neophobia affects willingness to try novel alternative proteins in young adults in Spain and the Netherlands
No full textAs the global population grows and environmental concerns intensify, adopting more sustainable protein sources becomes increasingly crucial. This study examines the influence of food neophobia (FN) and food technology neophobia (FTN) on consumers' willingness to try (WTT) novel alternative proteins, specifically insect- and plant-based proteins (mealworm and mung bean protein) and whey, as a familiar control protein. In this context, it also examines the impact of protein-related health claims and compares the responses of residents in two European countries, Spain and the Netherlands. Through an online survey, the WTT of whey, mung bean and mealworm protein were measured in 200 Dutch and 202 Spanish young adults (18–40 years). Results indicated that WTT was inversely correlated with FN for plant protein and insect protein and FTN for plant and insect protein. While this relationship is significant, it only explains between 5.3 and 12.3 % of the variance. A lower WTT was reported for insects than for plant protein (mean 3.0 vs 5.0 on a 7-point Likert scale). A protein-related health claim did not affect WTT. Spanish consumers showed similar results to Dutch consumers but had lower WTT for insect protein (mean 2.7 vs 3.3). This study reveals a promising opportunity for mung bean protein as a preferred dietary protein source for young adults in the European Union, while also highlighting the challenges in accepting mealworm protein. Transitioning to alternative proteins seems to require a source-specific approach
Myo-inositol Supplementation to Prevent Pregnancy Complications in Polycystic Ovary Syndrome:A Randomized Clinical Trial
No full textIMPORTANCE: Pregnant individuals with polycystic ovary syndrome (PCOS) present with a higher risk of pregnancy complications, including gestational diabetes, preeclampsia, and preterm birth. Myo-inositol supplementation may reduce these risks. OBJECTIVE: To determine whether daily supplementation with myo-inositol during pregnancy among individuals with PCOS reduces the risk of a composite outcome of gestational diabetes, preeclampsia, and preterm birth. DESIGN, SETTING, AND PARTICIPANTS: This double-blind, placebo-controlled, randomized trial was conducted at 13 hospitals in the Netherlands. Pregnant individuals with PCOS who were between 8 and 16 weeks' gestation were enrolled between June 2019 and March 2023. Final follow-up was complete on December 27, 2023. Analyses were conducted July 2024. INTERVENTIONS: Participants were randomized on a 1:1 basis to receive sachets with either myo-inositol, 2 g, with 0.2 mg of folic acid twice daily (n = 230) or matching placebo with 0.2 mg of folic acid only (n = 234) until delivery. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of gestational diabetes, preeclampsia, or preterm birth (before 37 weeks' gestation). RESULTS: Among 464 participants, the mean (SD) age was 31.5 (3.8) years; 18 participants (3.9%) reported Asian race and 395 (86.1%) reported White race. The prevalence of biochemical hyperandrogenism was higher at baseline in the myo-inositol group than the placebo group (29.0% [53 of 180] vs 18.5% [37 of 193]). A primary outcome event occurred in 25.0% (n = 56) of participants in the myo-inositol group and 26.8% (n = 61) in the placebo group (relative risk, 0.93 [95% CI, 0.68-1.28]; P = .67). CONCLUSIONS AND RELEVANCE: Myo-inositol supplementation during pregnancy did not reduce the incidence of a composite of gestational diabetes, preeclampsia, or preterm birth in patients with PCOS. TRIAL REGISTRATION: onderzoekmetmensen.nl Identifier: NL67329.078.18
Seeing Cold, Eating Warm:Food Perception in Imaginative Storytelling and Immersive Virtual Reality Winter Contexts
No full textFood intake is a fundamental daily activity. Its relationship to external factors such as social and environmental contexts has been widely investigated in consumer studies. Virtual reality (VR) technology enables the realistic simulation of real-life conditions and, therefore, holds promise as an ecologically valid method for understanding eating intentions and behavior. This study examines whether contextual exposure to VR or text-based storytelling influences food liking and desire in alignment with the presented environment. A total of 117 participants, either online or in a laboratory setting, viewed and rated eight food items varying in calorie density while exposed to one of three conditions: a VR-simulated winter forest, a text-based storytelling winter forest, or a control group without winter cues. Accounting for individual characteristics such as eating habits and body mass index, the results showed that participants’ food perceptions —defined here as evaluative responses toward digitally presented food items—followed a similar pattern across both winter forest contexts, with a stronger desire and liking for high-calorie over low-calorie foods. However, the intensity of their perceptual responses varied significantly between conditions. Participants in the VR forest reported greater familiarity, liking, and desire for all food items, as well as a stronger sense of spatial presence, compared to those in the storytelling condition. While VR elicited heightened and more affective responses, both VR and storytelling seem to be useful interventions for assessing contextual effects on product consumption. These findings provide insights into how different modes of contextual presentation shape food perception and encourage the integration of multiple sensory modalities to further bridge the gap between virtual and real food experiences
Patterns of Post-Concussive Symptoms Following Mild Traumatic Brain Injury:Longitudinal Data in Children and Adults to Examine Sex Differences Across the Life Span
No full textOBJECTIVE: To examine sex- and age-related differences in patterns of post-concussive symptoms (PCS), across cognitive, somatic, emotional, and behavioral domains, and their recovery within the first 6 months after mild traumatic brain injury (mTBI), and their relation to participation. SETTING: Data were collected from patients visiting the emergency departments of 14 hospitals in the Netherlands. PARTICIPANTS: Two hundred 8 to 17-year-old children with mTBI and their caregivers, and 186 adults with mTBI. DESIGN: Data were collected in 2 prospective cohort studies, with assessments at 2 weeks and 6 months post-injury. Data were analyzed using Multivariate Latent Class Growth Analysis to detect latent PCS patterns (classes), multivariate logistic regressions to assess age and sex differences between classes, and Kruskal-Wallis tests to investigate class differences in participation. MAIN MEASURES: PCS were assessed with the Health and Behavior Inventory (children) and the Rivermead Post-Concussion Symptoms Questionnaire (adults). Participation (being involved in daily life situations) was assessed with the Child and Adolescent Scale of Participation (children) and the Utrecht Scale for Evaluation and Rehabilitation-Participation (adults). RESULTS: Three distinct classes with unique PCS recovery trajectories were found across samples (children/caregiver, adults). In child-reported PCS, sex differences were found, driven by higher levels of somatic and emotional PCS in females. No sex differences were found in caregiver reports or in adult reports. Age differences were found in the caregiver report for the child sample, with higher ages found in the class showing decreasing somatic symptoms over time, and in the adult sample, where younger individuals were more often in the class with recovered PCS. Classes differed in their levels of participation in all samples. DISCUSSION: Findings highlight the heterogeneity of PCS across the lifespan as well as the variation of discrepancies in sex- and age-related findings. Taking age and sex differences into account increases our understanding of recovery patterns after mTBI and allow identification of at-risk individuals and better-tailored interventions