109 research outputs found
MRI-based classification of neuropsychiatric systemic lupus erythematosus patients with self-supervised contrastive learning
No full textSex hormones and sex hormone-targeting therapies in systemic sclerosis: A systematic literature review
No full textBackground: The pathophysiology of systemic sclerosis (SSc) is complex and elusive, however, considering the strong female preponderance and different clinical characteristics between men and women, a contribution of sex hormones has been proposed.Objectives: We undertook this systematic literature review to investigate: (1) the role played by male and female sex hormones in the pathogenesis of SSc; (2) how sex hormone levels change in SSc patients and how hormonal variations modify the progression of SSc; (3) the effect of therapies targeting sex hormones on the disease course.Methods: A literature search was performed in Pubmed, Embase, Web of Science, and Cochrane library databases. Given the heterogeneity in study design, different quality assessment tools were applied where appropriate.Results: We retrieved 300 articles and 30 were included in the review. The available evidence points to a fibrogenic, but also a vasodilatory, role of estrogens in SSc. With the limitation of small sample sizes, women with SSc tend to have lower levels of androgens and non-significantly higher levels of estradiol compared to healthy controls, while in men we found increased levels of estradiol and discordant results for androgens. After menopause the skin score seems to decrease and prevalence of pulmonary artery hypertension seems to rise, which might be prevented by the use of hormone replacement therapy. No recent high-quality trial evaluated the efficacy of hormone-targeting therapies in SSc.Conclusions: Few translational studies of varying quality evaluated the role of sex hormones in SSc showing possible profibrotic and vasodilatatory effects of estrogens, but more research is needed to elucidate the extent of this contribution. Insights on the influence of sex hormones, along with the availability of new compounds acting on estrogen pathways, might provide ideas for additional studies on the application of sex hormone-targeting therapies in SSc. (C) 2019 Elsevier Inc. All rights reserved
Lung function is associated with minimal EQ-5D changes over time in patients with systemic sclerosis
No full textIn systemic sclerosis (SSc) therapeutic efforts are often directed to prevent progressive respiratory impairment, but it is unclear to what extent changes in pulmonary function tests (PFTs) are associated with health-related quality of life (HRQoL). The aim of our study is to evaluate how modifications in PFTs contribute to longitudinal variations in HRQoL, assessed through the multidimensional questionnaire EQ-5D, in patients with SSc. We included SSc patients with forced vital capacity (FVC%), diffusing capacity of the lungs for carbon monoxide (DLCO%) and EQ-5D assessed in at least two visits. The EQ-5D consists of two parts, a utility score ranging from - 0.59 to 1, and a 0-100 Visual Analogue Scale (VAS). Higher values represent better health. The association between changes in FVC% and DLCO%, and evolution of EQ-5D over time, was investigated using generalized estimating equations. Three hundred seventy-eight patients were included, accounting for a total of 1619 measurements. The models showed that improvement in FVC% is significantly associated with increase in both utility score (beta = 0.001; 95% CI 0.000 to 0.002; p = 0.003) and VAS over time (beta = 0.188; 95% CI 0.111 to 0.264; p < 0.001). Moreover, improvement in DLCO% is longitudinally associated with increase in utility score (beta = 0.001; 95% CI 0.000 to 0.002; p = 0.038), while the results for VAS were non-significant (beta = 0.020; 95% CI -0.079 to 0.120; p = 0.690). We show that change in PFTs has a significant, although minor, impact on HRQoL as measured by EQ-5D in SSc.Pathogenesis and treatment of chronic pulmonary disease
When rheumatologists report that they agree with a guideline, does this mean that they practise the guideline in clinical practice? Results of the International Recommendation Implementation Study (IRIS)
No full textIntroduction: The European League Against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA) and the treatto- target (T2T) principles have been developed in order to improve the treatment outcome of patients with RA, and have received broad attention. It is not clear, though, whether these recommendations are indeed followed up in clinical practice. Objective: To investigate if rheumatologists that report to agree with existing guidelines indeed follow them up in clinical practice. Methods: The International Recommendation Implementation Study (IRIS) included 132 participating rheumatologists from 14 countries. Participating rheumatologists received a questionnaire measuring their awareness/commitment with the EULAR/T2T recommendations and followed a dedicated educational programme. Subsequently, they were asked to enrol 5-10 patients with new-onset RA in the online IRIS database and monitor disease activity and treatment for a period of 1-2 years. Four recommendations (3 from the EULAR recommendations and one from the T2T recommendations) were selected on the basis of testability, and analysed with regard to compliance by participating rheumatologists. Results: In total, 72 of the 132 participating rheumatologists contributed 378 patients to the database. Of these participants, 70 (98%) agreed upfront with the recommendation that diseasemodifying antirheumatic drug (DMARD) therapy should be started as soon as possible after diagnosis in every patient; 69 (96%) of the rheumatologists agreed with the recommendation that methotrexate (MTX) should be part of the first treatment strategy. When measuring the actual performance, it was found that the recommendation on early DMARD start was met in 253 (67%) of the recorded patients, and the recommendation on MTX in 225 (60%) of the recorded patients. Of the participants, 60 (83%) agreed that composite measures should be recorded regularly, but only in 134(54%) of the patients were composite scores actually recorded in ≥50% of patient visits. Conclusion: Reporting to be compliant with EULAR recommendations and T2T principles, even after dedicated education does not mean they actually comply with it in clinical practice
Redesigning communities: Realising cohousing through circular transformation
No full textThe past generation has built more than all previous generations combined. The houses got bigger, families got smaller and our lifestyle more consuming. Times however have changed so that nowadays we are faced with multiple social problems – such as aging and loneliness – and environmental problems. Living more social and reducing consumption is therefore crucial for our society nowadays, and suitable for the proposed location in the neighbourhood 'De Werven' in 'Almere Haven'. The focus on relationships, community and reducing resources led to the subject of cohousing; a residential community that shares resources, facilities and that undertakes joint activities. This type of living suits – and can even improve – social cohesion within Almere Haven and the feeling of being part of something. The original thought of ‘De Werven’ was to create small, social neighbourhoods within a larger residential neighbourhood. Implementing cohousing within this typology therefore suits the original intention. By changing the housing typologies a community is realised for different family situations suitable for all ages. For the transformation the present existing materials will be harvested and reused to establish a circular and low-energy living environment. An environment in which the individual is just as important as the community.Adapting 20C HeritageArchitecture, Urbanism and Building Sciences | Heritage & Architectur
Groupwise image registration based on a total correlation dissimilarity measure for quantitative MRI and dynamic imaging data
No full textThe most widespread technique used to register sets of medical images consists of selecting one image as fixed reference, to which all remaining images are successively registered. This pairwise scheme requires one optimization procedure per pair of images to register. Pairwise mutual information is a common dissimilarity measure applied to a large variety of datasets. Alternative methods, called groupwise registrations, have been presented to register two or more images in a single optimization procedure, without the need of a reference image. Given the success of mutual information in pairwise registration, we adapt one of its multivariate versions, called total correlation, in a groupwise context. We justify the choice of total correlation among other multivariate versions of mutual information, and provide full implementation details. The resulting total correlation measure is remarkably close to measures previously proposed by Huizinga et al. based on principal component analysis. Our experiments, performed on five quantitative imaging datasets and on a dynamic CT imaging dataset, show that total correlation yields registration results that are comparable to Huizinga’s methods. Total correlation has the advantage of being theoretically justified, while the measures of Huizinga et al. were designed empirically. Additionally, total correlation offers an alternative to pairwise mutual information on quantitative imaging datasets
sj-pdf-1-jso-10.1177_23971983221138177 – Supplemental material for Mouth opening in systemic sclerosis: its course over time, determinants and impact on mouth handicap
No full textSupplemental material, sj-pdf-1-jso-10.1177_23971983221138177 for Mouth opening in systemic sclerosis: its course over time, determinants and impact on mouth handicap by Sarah JH Khidir, Maaike Boonstra, Sytske Anne Bergstra, Gerry WM Boerrigter, Elles M Voogt-van der Harst, Maarten K Ninaber, Nina Ajmone Marsan, Tom WJ Huizinga, Annette HM van der Helm-van Mil and Jeska K de Vries-Bouwstra in Journal of Scleroderma and Related Disorders</p
- …
