Incidence and Predictors of Maternal Cardiovascular Mortality and Severe Morbidity in the Netherlands: A Prospective Cohort Study

Objective: To assess incidence and possible risk factors of severe maternal morbidity and mortality from cardiovascular disease in the Netherlands. Design: A prospective population based cohort study. Setting: All 98 maternity units in the Netherlands. Population: All women delivering in the Netherlands between August 2004 and August 2006 (n = 371,021) Methods: Cases of severe maternal morbidity and mortality from cardiovascular disease were prospectively collected during a two-year period in the Netherlands. Women with cardiovascular complications during pregnancy or postpartum who were admitted to the ward, intensive care or coronary care unit were included. Cardiovascular morbidity was defined as cardiomyopathy, valvular disease, ischaemic heart disease, arrhythmias or aortic dissection. All women delivering in the same period served as a reference cohort. Main outcome measures: Incidence, case fatality rates and possible risk factors. Results: Incidence of severe maternal morbidity due to cardiovascular disease was 2.3 per 10,000 deliveries (84/358,874). Maternal mortality rate from cardiovascular disease was 3.0 per 100,000 deliveries (11/358,874). Case fatality rate in women with severe maternal morbidity due to cardiovascular disease was 13% (11/84). Case fatality rate was highes

[Multiparametric MRI for prostate cancer screening],[Multiparametric MRI for prostate cancer screening]

Contains fulltext : 79762.pdf (publisher's version ) (Closed access)Two recent studies on prostate cancer screening gave conflicting results about the effects of screening on prostate cancer mortality. The current screening method of PSA determination in combination with transrectal ultrasonic biopsy leads to a large number of false positive results and overtreatment. A screening test is needed that reduces the number of unnecessary prostate biopsies and which discriminates between more and less aggressive forms of prostate cancer. Multiparametric MRI has a high specificity for prostate cancer detection and provides information about prostate cancer aggressiveness. PSA in combination with multiparametric MRI performed at 1.5 Tesla appears to be a fairly accurate screening test. Due to its high costs and limited availability, multiparametric MRI is not suitable as a primary screening test. However, it could serve as a subsequent screening test if the PSA has increased above threshold values. Using multiparametric MRI as a follow-up test during screening would provide more accurate biopsies, prevent unnecessary prostate biopsies and improve the characterization of prostate cancer

Cardiac Arrest in Pregnancy: Increasing Use of Perimortem Caesarean Section Due to Emergency Skills Training? EDITORIAL COMMENT

Obstetric

Magnetic resonance imaging guided prostate biopsy in men with repeat negative biopsies and increased prostate specific antigen.

PURPOSE: Undetected cancer in repeat transrectal ultrasound guided prostate biopsies in patients with increased prostate specific antigen greater than 4 ng/ml is a considerable concern. We investigated the tumor detection rate of tumor suspicious regions on multimodal 3 Tesla magnetic resonance imaging and subsequent magnetic resonance imaging guided biopsy in 68 men with repeat negative transrectal ultrasound guided prostate biopsies. We compared results to those in a matched transrectal ultrasound guided prostate biopsy population. Also, we determined the clinical significance of detected tumors. MATERIALS AND METHODS: A total of 71 consecutive patients with prostate specific antigen greater than 4 ng/ml and 2 or greater negative transrectal ultrasound guided prostate biopsy sessions underwent multimodal 3 Tesla magnetic resonance imaging. In 68 patients this was followed by magnetic resonance imaging guided biopsy directed toward tumor suspicious regions. A matched multisession transrectal ultrasound guided prostate biopsy population from our institutional database was used for comparison. The clinical significance of detected tumors was established using accepted criteria, including prostate specific antigen, Gleason grade, stage and tumor volume. RESULTS: The tumor detection rate of multimodal 3 Tesla magnetic resonance imaging guided biopsy was 59% (40 of 68 cases) using a median of 4 cores. The tumor detection rate was significantly higher than that of transrectal ultrasound guided prostate biopsy in all patient subgroups (p <0.01) except in those with prostate specific antigen greater than 20 ng/ml, prostate volume greater than 65 cc and prostate specific antigen density greater than 0.5 ng/ml/cc, in which similar rates were achieved. Of the 40 patients with identified tumors 37 (93%) were considered highly likely to harbor clinically significant disease. CONCLUSIONS: Multimodal magnetic resonance imaging is an effective technique to localize prostate cancer. Magnetic resonance imaging guided biopsy of tumor suspicious regions is an accurate method to detect clinically significant prostate cancer in men with repeat negative biopsies and increased prostate specific antigen

Feasibility of 3T dynamic contrast-enhanced magnetic resonance-guided biopsy in localizing local recurrence of prostate cancer after external beam radiation therapy.

Contains fulltext : 88584.pdf (publisher's version ) (Closed access)OBJECTIVES: The objective of this study was to assess the feasibility of the combination of magnetic resonance (MR)-guided biopsy (MRGB) and diagnostic 3T MR imaging in the localization of local recurrence of prostate cancer (PCa) after external beam radiation therapy (EBRT). MATERIALS AND METHODS: Twenty-four consecutive men with biochemical failure suspected of local recurrence after initial EBRT were enrolled prospectively in this study. All patients underwent a diagnostic 3T MR examination of the prostate. T2-weighted and dynamic contrast-enhanced MR images (DCE-MRI) were acquired. Two radiologists evaluated the MR images in consensus for tumor suspicious regions (TSRs) for local recurrence. Subsequently, these TSRs were biopsied under MR-guidance and histopathologically evaluated for the presence of recurrent PCa. Descriptive statistical analysis was applied. RESULTS: Tissue sampling was successful in all patients and all TSRs. The positive predictive value on a per patient basis was 75% (15/20) and on a per TSR basis 68% (26/38). The median number of biopsies taken per patient was 3, and the duration of an MRGB session was 31 minutes. No intervention-related complications occurred. CONCLUSIONS: The combination of MRGB and diagnostic MR imaging of the prostate was a feasible technique to localize PCa recurrence after EBRT using a low number of cores in a clinically acceptable time.1 maart 201

Prostate cancer: multiparametric MR imaging for detection, localization, and staging

Contains fulltext : 96236.pdf (publisher's version ) (Closed access)This review presents the current state of the art regarding multiparametric magnetic resonance (MR) imaging of prostate cancer. Technical requirements and clinical indications for the use of multiparametric MR imaging in detection, localization, characterization, staging, biopsy guidance, and active surveillance of prostate cancer are discussed. Although reported accuracies of the separate and combined multiparametric MR imaging techniques vary for diverse clinical prostate cancer indications, multiparametric MR imaging of the prostate has shown promising results and may be of additional value in prostate cancer localization and local staging. Consensus on which technical approaches (field strengths, sequences, use of an endorectal coil) and combination of multiparametric MR imaging techniques should be used for specific clinical indications remains a challenge. Because guidelines are currently lacking, suggestions for a general minimal protocol for multiparametric MR imaging of the prostate based on the literature and the authors' experience are presented. Computer programs that allow evaluation of the various components of a multiparametric MR imaging examination in one view should be developed. In this way, an integrated interpretation of anatomic and functional MR imaging techniques in a multiparametric MR imaging examination is possible. Education and experience of specialist radiologists are essential for correct interpretation of multiparametric prostate MR imaging findings. Supportive techniques, such as computer-aided diagnosis are needed to obtain a fast, cost-effective, easy, and more reproducible prostate cancer diagnosis out of more and more complex multiparametric MR imaging data

Loyalty Rebates as an Exclusionary Practice in the European Competition Law.

1 LOYALTY REBATES AS AN EXCLUSIONARY PRACTISE IN THE EUROPEAN COMPETITION LAW ABSTRACT This master thesis treats loyalty rebates in the light of European competition law when applied by dominant undertakings and analyses its consequences. It describes when such practise might be considered by European Union authorities as an abuse of a dominant position as it has negative impact on the competitors by inducing customer's loyalty to the dominant undertaking. It depicts its position in the European competition law system and compares it to other practises that influence the market in a similar way. Also, it classifies different types of loyalty and other types of rebates and explains how such rebates can force a customer to acquire increasing portions of his demand from the dominant undertaking and how they can damage its competitors. The thesis also offers a critical view on a very strict treatment of this practise by European institutions in the past and it arguments by several positive effects that loyalty and other types of rebates may have. Simultaneously it takes into consideration the newest decision of the Court of Justice of the European Union in the Intel case from September 2017 which will hopefully affect EU institutions' approach to this practise as it broke well-established per se interdiction of..

Predictive Performance of Cardiovascular Disease Risk Prediction Algorithms in People Living With HIV

Immunogenetics and cellular immunology of bacterial infectious disease

Progression of liver fibrosis following acute hepatitis C virus infection in HIV-positive MSM

Molecular basis of virus replication, viral pathogenesis and antiviral strategie