Longer duration of gestation in term singletons is associated with better infant neurodevelopment

Background: Longer gestation at term and post-term age is associated with increased perinatal mortality. Nonetheless, recent neuroimaging studies indicated that longer gestation is also associated with better functioning of the child's brain. Aims: to assess whether longer gestation in term and post-term (in short: term) singletons is associated with better infant neurodevelopment. Study design: cross-sectional observational study. Subjects: Participants were all singleton term infants (n = 1563) aged 2–18 months of the IMP-SINDA project that collected normative data for the Infant Motor Profile (IMP) and Standardized Infant NeuroDevelopmental Assessment (SINDA). The group was representative of the Dutch population. Outcome measures: Total IMP score was the primary outcome. Secondary outcomes were atypical total IMP scores (scores &lt;15th percentile) and SINDA's neurological and developmental scores. Results: Duration of gestation had a quadratic relationship with IMP and SINDA developmental scores. IMP scores were lowest at a gestation of 38·5 weeks, SINDA developmental scores at 38·7 weeks. Next, both scores increased with increasing duration of gestation. Infants born at 41–42 weeks had significantly less often atypical IMP scores (adjusted OR [95 % CI]: 0·571 [0·341–0·957] and atypical SINDA developmental scores (adjusted OR: 0·366 [0·195–0·688]) than infants born at 39–40 weeks. Duration of gestation was not associated with SINDA's neurological score. Conclusions: In term singleton infants representative of the Dutch population longer gestation is associated with better infant neurodevelopment scores suggesting better neural network efficiency. Longer gestation in term infants is not associated with atypical neurological scores.</p

Management decisions on unruptured intracranial aneurysms before and after implementation of the PHASES score

Background: In management decisions on saccular unruptured intracranial aneurysms (UIAs) the risk of rupture is an important factor. The PHASES score, introduced in 2014, provides absolute 5-year risks of rupture based on six easily retrievable patient and aneurysm characteristics. We assessed whether management decisions on UIAs changed after implementation of the PHASES score. Patient and methods: We included all patients with UIAs who were referred to two Dutch tertiary referral centers for aneurysm care in the Netherlands (University Medical Center Utrecht (UMCU) and Leiden University Medical Center (LUMC)) between 2011 and 2017. Analyses were done on an aneurysm level. We calculated the overall proportion of UIAs with a decision to treat before and after PHASES implementation and studied the influence of age and center on post-implementation management changes. Results: We included 623 patients with 803 UIAs. The proportion of UIAs with a decision to treat was 123/360 (34.2%) before and 117/443 (26.4%) after PHASES implementation (absolute risk difference:-7.8%; 95% CI: -14.1 to-1.4). The decision to treat was made at a higher median PHASES score after implementation (7 points (IQR 5;10) pre-versus 8 points (IQR 5;10) post-implementation; p = 0.14). The reduced proportion with a treatment decision after implementation was most pronounced in patients <50 years (-22.3%; 95% CI:-39.2 to -3.4) and was restricted to treatment decisions made at the UMCU (-10.6%; 95% CI:-18.5 to-2.5). Discussion and conclusions: Management of UIAs changed following implementation of the PHASES score, but the impact of PHASES implementation on treatment decisions differed across age subgroups and centers.Paroxysmal Cerebral Disorder

Alendroninezuur effectiever dan alfacalcidol voor preventie van osteoporose bij patiënten met een reumatische ziekte die starten met glucocorticoïdtherapie

OBJECTIVE: To compare the effects of alendronate and alfacalcidol in the prevention ofglucocorticoid-related osteoporosis in patients with a rheumatic disease. DESIGN: Randomised, double-blind, double-placebo clinical trial (www. clinicaltrials.gov; number: NCT00138983). METHODS: A total of 201 patients with rheumatic disease who were starting glucocorticoid treatment at a daily dose that was equivalent to at least 7.5 mg of prednisone were randomised to alendronate (10 mg) and a placebo capsule ofalfacalcidol daily (n = 100) or alfacalcidol (1 microg) and a placebo tablet ofalendronate daily (n = 101) for 18 months. Primary outcome was change in lumbar spine bone mineral density at 18 months. The main secondary outcome was the incidence of morphometrically confirmed vertebral deformities. RESULTS: Overall, 163 patients completed the study. The bone mineral density of the lumbar spine increased by 2.1% (95% CI: 1.1-3.1) in the alendronate group and decreased by 1.9% (95% CI: -3.I--0.7) in the alfacalcidol group. At 18 months the mean difference in change in bone mineral density between the two groups was 4.0% (95% CI: 2.4-5-5). Three patients in the alendronate group had a new vertebral deformity, compared with 8 patients in the alfacalcidol group, including 5 symptomatic vertebral fractures in 3 patients; the hazard ratio was 0.4 (95% CI: 0.1-1.4). CONCLUSION: Alendronate was more effective than alfacalcidol in preventing glucocorticoid-induced bone loss during this 18-month trial in patients with rheumatic diseases who were starting glucocorticoid treatment

Risk, clinical course, and outcome of ischemic stroke in patients hospitalized with COVID-19: a multicenter cohort study

Background and Purpose: The frequency of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) varies in the current literature, and risk factors are unknown. We assessed the incidence, risk factors, and outcomes of acute ischemic stroke in hospitalized patients with COVID-19. Methods: We included patients with a laboratory-confirmed SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection admitted in 16 Dutch hospitals participating in the international CAPACITY-COVID registry between March 1 and August 1, 2020. Patients were screened for the occurrence of acute ischemic stroke. We calculated the cumulative incidence of ischemic stroke and compared risk factors, cardiovascular complications, and in-hospital mortality in patients with and without ischemic stroke. Results: We included 2147 patients with COVID-19, of whom 586 (27.3%) needed treatment at an intensive care unit. Thirty-eight patients (1.8%) had an ischemic stroke. Patients with stroke were older but did not differ in sex or cardiovascular risk factors. Median time between the onset of COVID-19 symptoms and diagnosis of stroke was 2 weeks. The incidence of ischemic stroke was higher among patients who were treated at an intensive care unit (16/586; 2.7% versus nonintensive care unit, 22/1561; 1.4%; P=0.039). Pulmonary embolism was more common in patients with (8/38; 21.1%) than in those without stroke (160/2109; 7.6%; adjusted risk ratio, 2.08 [95% CI, 1.52-2.84]). Twenty-seven patients with ischemic stroke (71.1%) died during admission or were functionally dependent at discharge. Patients with ischemic stroke were at a higher risk of in-hospital mortality (adjusted risk ratio, 1.56 [95% CI, 1.13-2.15]) than patients without stroke. Conclusions: In this multicenter cohort study, the cumulative incidence of acute ischemic stroke in hospitalized patients with COVID-19 was approximate to 2%, with a higher risk in patients treated at an intensive care unit. The majority of stroke patients had a poor outcome. The association between ischemic stroke and pulmonary embolism warrants further investigation.Paroxysmal Cerebral Disorder

Female risk factors for subarachnoid hemorrhage A systematic review

Technology assessment of reproductive medicin

[Cultural interests of doctors, accountants and lawyers; art, culture and interface with the profession]

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Nederlandse gedragscode wetenschappelijke integriteit

Op initiatief van KNAW, NFU, NWO, TO2-federatie, Vereniging Hogescholen en de VSNU heeft de commissie bestaande uit Keimpe Algra (voorzitter), Lex Bouter, Ton Hol en Jan van Kreveld, een nieuwe Nederlandse gedragscode wetenschappelijke integriteit opgesteld

‘No-reflow’ after acute myocardial infarction: direct visualisation of microvascular obstruction by gadolinium-enhanced CMR

Cardiovascular magnetic resonance is considered the standard imaging modality in clinical trials to monitor patients after acute myocardial infarction. However, limited data are available with respect to infarct size, presence and extent of microvascular injury (MVO) and changes over time, in relation to cardiac function in optimally treated patients. In the current study we prospectively investigate the change of infarct size over time, and the incidence and significance of MVO in a uniform, optimally treated patient group after AMI. (Neth Heart J 2008;16:179-81.

Test-retest and inter- and intrareliability of the quality of the upper-extremity skills test in preschool-age children with cerebral palsy

OBJECTIVE: To investigate the test-retest, inter-, and intraobserver reliability of the Quality of Upper Extremity Skills Test (QUEST) in young children with cerebral palsy (CP). DESIGN: For test-retest reliability, a test-retest design was used; for the intra- and interobserver reliability, the videotaped test was scored on 2 occasions by 1 observer and by various observers. SETTING: Groups of preschool-age children in 2 general rehabilitation centers. PARTICIPANTS: Twenty-one children with CP (12 boys, 9 girls) aged 2 to 4.5 years (mean, 39 mo). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Spearman correlation coefficient. RESULTS: The data indicated that test-retest reliability was strong (rho range, .85-.94). Intraobserver agreement (rho range, .63-.95) and agreement between various observers (rho range, .72-.90) were moderate to strong. CONCLUSIONS: Test-retest and inter- and intraobserver reliability of the QUEST in preschool-age children with CP is good