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Virtual Reality to Reduce Preprocedural Anxiety During Invasive Coronary Angiography:The VR InCard Trial
No full textBackground: Anxiety affects one-third of patients undergoing invasive coronary angiography (ICA). Benzodiazepines are commonly administered but have modest efficacy. Virtual reality (VR) therapy is promising in reducing anxiety around various procedures. Objectives: This study aimed to evaluate the effect of VR on preprocedural anxiety in patients undergoing ICA. Methods: This randomized controlled trial included adults undergoing ICA for chronic coronary syndrome, coronary vasomotor function testing, or non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with a numeric rating scale (NRS) anxiety score of 4 or more. The control group received usual care with benzodiazepines if needed. The intervention group additionally received 2 VR therapysessions of approximately 20 and 10 minutes before ICA. The primary outcome was preprocedural NRS anxiety. Secondary outcomes included NRS anxiety at other timepoints, physiological stress parameters, and patient- and provider-reported outcome measures. Subgroup analyses were conducted by sex and ICA indication. Results: A total of 99 patients were included, 47 in the intervention group and 52 in the control group. No difference was observed in preprocedural anxiety. After adjusting for baseline anxiety, the intervention group showed a significant reduction in preprocedural NRS anxiety (mean difference: 0.9; 95% CI: 0.2-1.6; P = 0.010). No significant differences were observed in secondary outcomes. Patients undergoing ICA for NSTE-ACS experienced the greatest effect. Conclusions: VR therapy did not reduce preprocedural anxiety in patients undergoing ICA. After adjusting for baseline anxiety, VR therapy significantly reduced preprocedural anxiety, with the most pronounced effect in patients undergoing ICA for NSTE-ACS. VR therapy presents a viable nonpharmacological complement to traditional treatments for procedure-related anxiety
The role of hydrogen bond formation in the extracting efficiency of NADES formulations
No full textThe simplicity and versatility of natural deep eutectic solvents (NADES), together with a wide range of potential applications, make them great candidates to fight the lack of sustainability and circularity in large-scale industrial chemistry. Among the most prominent applications of NADES, extraction of phenolic compounds (PC) from natural sources remains one of the most attractive ones, due to the high commercial value of both, solvent and solute. In the present study, an in-depth analysis of the underlying mechanisms of extraction in NADES-PC systems is performed via quantification of the spin-spin interactions using 2D NMR experiments. The structure of the hydrogen bond donor, acceptor-to-donor molecular ratio, or number and distribution of the hydroxyl groups are determined as key components governing the solubility of PC in NADES. Moreover, our results reveal how studying the solvent hydrogen bond network formation between the NADES acceptor and donors can be easily translatable into understanding the solvation patterns and predicting the solubility efficiency of PC at low concentrations, below the level of direct detection
Optimising mastectomy with a focus on skin and nipple-sparing approaches:a multidisciplinary point of view
No full textMastectomy is indicated in approximately 15–30 % of breast cancer patients. Mastectomy drives the demand for breast reconstruction which is associated with an increased risk of surgical complications and in some reports poor local control. Postmastectomy irradiation is increasingly used in the context of breast reconstruction, which raises the risk of acute and late complications. Therefore, the purpose of this multidisciplinary narrative review is to provide insights into improving oncological and quality-of-life outcomes for patients undergoing mastectomy especially in combination with reconstruction
Geographical distribution of eight neuromuscular disorders in the Netherlands based on a nationwide registry
No full textNeuromuscular disorders are a very heterogeneous group of diseases and comprise a large number of patients. Epidemiological key figures on incidence, prevalence and mortality serve as basic information for individualised and public health care and researchers. Geographical mapping of the specific disorders is expected to provide valuable insights into clustering of the conditions, which points to possible environmental and genetical determinants. So far, mostly geographical maps of motor neuron diseases have been reported. By using record information from the Dutch nationwide Computer Registry of All Myopathies and Polyneuropathies (CRAMP) we aimed to generate geographical maps for eight disorders predominantly diagnosed in adults. We investigated the geographical distribution of newly diagnosed patients in the Netherlands from 2004 to 2011. The variables used were diagnosis, date of diagnosis, and the first two digits of the postal code for geographical location from CRAMP. The number of incident cases was divided by the total number of people populating the postal code area. Nationwide incidence maps were constructed for myotonic dystrophy, progressive (spinal) muscular atrophy, chronic inflammatory demyelinating polyneuropathy, facioscapulohumeral muscular dystrophy, inclusion body myositis, hereditary motor and sensory neuropathy, Pompe disease and oculopharyngeal muscular dystrophy. Considerable regional variation between disorders was observed, particularly for myotonic dystrophy and facioscapulohumeral muscular dystrophy. We provided the first neuromuscular atlas of the Netherlands with maps for eight disorders commonly seen in the neuromuscular practice. To address possible outliers due to low population numbers, Bayesian smoothing techniques should be considered in future research
Treatment and outcomes of local re-recurrence in rectal cancer:a multicentre observational cohort
No full textObjective: This study aimed to assess patient, tumour and treatment characteristics in locally re-recurrent rectal cancer (LrRRC), and relate these to long-term oncological outcomes since limited literature on this topic is available. Methods: A retrospective study of locally recurrent rectal cancer (LRRC) patients treated with curative intent between 1994 and 2022 in two tertiary centres in the Netherlands. Data on patient, tumour and treatment characteristics were collected. Oncological outcomes of patients treated with curative and palliative intent were displayed. Results: Of 852 curatively treated LRRC patients, 277 (33 %) developed LrRRC. The median survival of this LrRRC group was 23 months (95 % CI 20–26). Treatment with curative intent was offered to 92/277 (33 %) patients, resulting in surgical resection in 81/277 (29 %) patients. Complete oncological clearance (R0) was achieved in 50/81 cases (62 %). Surgical resection resulted in a median survival of 35 months (95 % CI 27–43). Palliative treatment resulted in a median survival of 16 months (95 % CI 11–21). Median progression free survival (PFS) in patients treated with curative intent was 16 months (95 % CI 12–20). Median local re-re-recurrence free survival (LrrRFS) in patients who underwent surgery was 11 months (95 % CI 8–16). Conclusion: The median OS in 277 LrRRC patients was 23 months. Aggressive treatment in selected patients resulted in a median OS of 35 months. Furthermore, locoregional control was achieved for 11 months in patients undergoing surgery. These findings underscore the need for meticulous patient selection and tailored treatment strategies to improve survival while minimising unnecessary morbidity
Effect of medical-grade honey (L-Mesitran) for cervical intraepithelial neoplasia II:protocol for a multicentre cohort pilot study (HONEY FOR CIN II study)
No full textIntroduction High-grade squamous intraepithelial lesions are caused by persistent high-risk human papillomavirus (hr-HPV) infections and are subdivided into cervical intraepithelial neoplasia (CIN) lesions: CIN II (moderate) and CIN III (severe). Current treatment options for CIN II include large loop excision of the transformation zone, imiquimod and expectant management. Each treatment option has its drawbacks, and therefore, a non-invasive treatment is desirable. Preliminary evidence shows that medical-grade honey (MGH) has antiviral activity and might be able to modulate the vaginal microbiome, reduce local inflammation or directly influence the intralesional immune response within cervical tissues. Therefore, this study aims to investigate the possible effect of MGH on hr-HPV clearance and to investigate the possible underlying mechanisms contributing to the regression of CIN II lesions. Methods and analysis This study is performed in the Zuyderland Medical Centre and Maastricht University Medical Centre+. A total of 60 eligible women with newly histologically confirmed CIN II will receive MGH (L-Mesitran Soft) for intravaginal use for 6 months. The primary objective is to investigate the effect of MGH on the hr-HPV clearance after 6 months. Secondary aims are the effect of MGH on the regression of CIN II lesions, clearance of hr-HPV at 12 and 24 months and the role of the vaginal microbiome, local immune system and intravaginal inflammatory status in response to MGH. Moreover, data on quality of life, side effects and compliance will be collected. Ethics and dissemination Ethical approval from the Medical Ethics Review Committee of the Zuyderland Medical Centre Heerlen has been obtained (NL86044.096.24 on 24 April 2024). The results will be presented to researchers and healthcare professionals through conferences, meetings and publications in international journals.</p
The economic benefits of fracture prevention
No full textINTRODUCTION: Osteoporosis-related fractures represent a significant and growing public health concern, especially in aging populations. Despite the availability of effective treatments, significant care gaps persist in both primary and secondary prevention. AREAS COVERED: This narrative review synthesizes key findings from economic evaluations examining the cost-effectiveness of pharmacological and non-pharmacological therapies, fracture liaison services (FLS), and FRAX®-based intervention thresholds. Relevant literature was reviewed, including systematic reviews, country specific studies, and emerging data on novel technologies. The evidence consistently demonstrates that fracture prevention strategies are cost-effective across diverse healthcare settings. Pharmacological monotherapy and sequential regimens have shown favorable economic profiles, while FLS programs, although resource-intensive, significantly reduce re-fracture rates and associated costs. Intervention thresholds should be derived clinically, with health economic modeling used to evaluate their cost-effectiveness so as to guide rational, risk-based treatment strategies. EXPERT OPINION: Health economic evaluations are increasingly enabling the development of osteoporosis treatment strategies, highlighting the strong cost-effectiveness potential of these interventions. However, challenges remain including heterogeneity in analytical approaches, under-representation of low- and middle-income countries, and limited incorporation of real-world (adherence) data. Maintaining methodological consistency, expanding region-specific data, and evaluating emerging technologies with robust economic frameworks are essential steps toward achieving globally equitable and cost-effective osteoporosis care
Stigma-related disclosure concerns and negative self-image have not improved over a decade in older people with HIV
No full textOBJECTIVE: Stigma impedes the HIV care continuum and contributes to problematic mental health outcomes, non-adherence and reduced quality of life. We prospectively analysed changes in HIV stigma measures over 10-years among older people with HIV (PWH). DESIGN: PWH participating in the AGEhIV Cohort Study completed the full Berger HIV Stigma Scale (HSS) between 2012-2014 (T0) and two of the HSS subscales - i.e. disclosure concerns and negative self-image (range per subscale: 3 to 12) - 10 years later (T1) as part of routine clinical care. METHODS: We assessed changes in scores over time using paired samples t-tests. We assessed sociodemographic and clinical factors associated with these changes at T1 using linear regression, and factors associated with higher or lower scores over time using linear mixed models. RESULTS: Disclosure concerns scores decreased significantly, albeit minimally, between T0 and T1; negative self-image scores remained stable. No factors were associated with changes in disclosure concerns scores. Higher disclosure scores were positively associated with living in households with 3 or more people. Women experienced significantly higher increases in negative self-image scores. Higher self-image scores were associated with being attracted to both men and women, compared to only men, and having moderate to severe depressive symptoms. Both HSS domains were negatively associated with more years since HIV diagnosis. CONCLUSION: In this cohort of predominately older, white, Dutch male PWH mostly with suppressed HIV, disclosure concerns and self-image did not improve over time. HIV stigma worsened in women and was lower for those in large households and with moderate to severe depression
Harnessing Radiomics and Explainable AI for the Classification of Usual and Nonspecific Interstitial Pneumonia
No full text: Accurate differentiation between usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) is crucial for guiding treatment in interstitial lung diseases (ILDs). This study evaluates the efficacy of clinical, radiomic, and combined models in classifying UIP and NSIP using high-resolution computed tomography (HRCT) scans. : A retrospective analysis was performed on 105 HRCT scans (UIP = 60, NSIP = 45) from Faisal Hospital and Research Center. Demographic and pulmonary function data formed the clinical model. Radiomic features, extracted using the pyRadiomics package, were refined using recursive feature elimination. A combined model was developed by integrating clinical and radiomic features to assess their complementary diagnostic value. Model performance was assessed via the area under the receiver operating characteristic curve (AUC). SHapley Additive exPlanations (SHAP) analysis, including both global feature importance and individual-level explanations, was used to interpret the model predictions. : The clinical model achieved an AUC of 0.62 with a sensitivity of 54% and a specificity of 78%. The radiomic model outperformed it with an AUC of 0.90 with a sensitivity and specificity above 85%. The combined model showed an AUC of 0.86 with a sensitivity of 88% and a specificity of 78%. SHAP analysis identified texture-based features, such as GLCM_Idmn and NGTDM_Contrast, as influential for classification. Radiomic features enhance classification accuracy for UIP and NSIP compared to clinical models. Integrating HCR into clinical workflows may reduce variability and improve diagnostic accuracy in ILD. Future studies should validate findings using larger, multicenter datasets
