Lateralization in C-11-Metomidate PET and outcome of adrenalectomy in primary aldosteronism

Introduction Subtype classification method is essential when considering adrenalectomy as a possible treatment for primary aldosteronism. We aimed to retrospectively evaluate surgical outcomes of primary aldosteronism in patients who had undergone C-11-metomidate positron emission tomography (C-11-MTO-PET) for subtype classification. Methods Postoperative clinical and biochemical cure and histopathological diagnosis from biobank samples were retrospectively evaluated in 44 patients who had all undergone preoperative C-11-MTO-PET with or without adrenal venous sampling (AVS). We compared those operated based on C-11-MTO-PET alone and those with concordant or discordant lateralization in C-11-MTO-PET and AVS studies according to postoperative immunohistochemical findings and biochemical and clinical cure. Results Adrenalectomy side was based on C-11-MTO-PET alone in 14 cases and on AVS in 30 cases of whom 42 achieved complete and two partial biochemical cures. Among those who underwent AVS and were operated according to it, the two lateralization methods were concordant in 22 cases and discordant in 8 cases. Similar immunohistochemical profiles and cure rates were seen after C-11-MTO-PET alone or AVS-based operations. Respectively, those with concordant or discordant C-11-MTO-PET and AVS lateralization did not differ in surgical outcome. Together, we found errors of lateralization diagnostics with C-11-MTO-PET in 18% and with AVS in 3% among those eligible for adrenal surgery. Conclusions Outcomes of adrenalectomy based on clinically significant lateralization in C-11-MTO-PET alone correspond to those based on C-11-MTO-PET with concordant AVS lateralization. However, our results suggest that diagnosis of unilateral PA should be performed with caution with C-11-MTO-PET in case of discordant lateralization studies.Peer reviewe

Analysis of the mechanical impedance of bone-anchored hearing aids

Some patients who need hearing aids are unable to use an apparatus which transmits the sound via the external ear canal and have to use a bone conduction hearing aid. The bone vibration transducer of this aid is applied to the skin over the mastoid process and the sound is transmitted via the soft tissue and bone to the cochlea. The pressure needed to apply the transducer often gives the patient discomfort and the damping effect of the soft tissue gives poor quality of the sound transmitted. Advances in the ability to permanently implant foreign material in the body and perform permanent skin penetration has made it possible to develop a bone-anchored hearing aid. Fourteen patients have been equipped with such hearing aids. To be able to give these patients the best hearing aid, a new transducer has to be constructed to match the new situation. The impedance of the bone-anchored titaniumscrew/skull has been studied and the resistance and reactance of the mechanical impedance have been measured. The influence of a damping soft tissue layer over the bone has been analyzed. The difference between the impedance of the skull and the impedance of the soft tissue + skull was in the order of 10 to 25 dB depending on the frequency

Lateralization in 11C-Metomidate PET and outcome of adrenalectomy in primary aldosteronism

IntroductionSubtype classification method is essential when considering adrenalectomy as a possible treatment for primary aldosteronism. We aimed to retrospectively evaluate surgical outcomes of primary aldosteronism in patients who had undergone 11C-metomidate positron emission tomography (11C-MTO-PET) for subtype classification.MethodsPostoperative clinical and biochemical cure and histopathological diagnosis from biobank samples were retrospectively evaluated in 44 patients who had all undergone preoperative 11C-MTO-PET with or without adrenal venous sampling (AVS). We compared those operated based on 11C-MTO-PET alone and those with concordant or discordant lateralization in 11C-MTO-PET and AVS studies according to postoperative immunohistochemical findings and biochemical and clinical cure.ResultsAdrenalectomy side was based on 11C-MTO-PET alone in 14 cases and on AVS in 30 cases of whom 42 achieved complete and two partial biochemical cures. Among those who underwent AVS and were operated according to it, the two lateralization methods were concordant in 22 cases and discordant in 8 cases. Similar immunohistochemical profiles and cure rates were seen after 11C-MTO-PET alone or AVS-based operations. Respectively, those with concordant or discordant 11C-MTO-PET and AVS lateralization did not differ in surgical outcome. Together, we found errors of lateralization diagnostics with 11C-MTO-PET in 18% and with AVS in 3% among those eligible for adrenal surgery.ConclusionsOutcomes of adrenalectomy based on clinically significant lateralization in 11C-MTO-PET alone correspond to those based on 11C-MTO-PET with concordant AVS lateralization. However, our results suggest that diagnosis of unilateral PA should be performed with caution with 11C-MTO-PET in case of discordant lateralization studies.</p

Simplified routines in prescribing physical activity can increase the amount of prescriptions by doctors, more than economic incentives only: an observational intervention study

<p>Abstract</p> <p>Background</p> <p>Physical inactivity is one well-known risk factor related to disease. Physical activity on prescription (PAP) has been shown in some studies to be a successful intervention for increasing physical activity among patients with a sedentary lifestyle. The method involves motivational counselling that can be time-consuming for the prescribing doctor and might be a reason why physical activity on prescription is not used more frequently. This study might show a way to make the method of prescribing physical activity more user-friendly. The purpose is to determine whether a change in procedures increases the use of physical activity on prescription, and thus the aim of this study is to describe the methodology used.</p> <p>Results</p> <p>The observational intervention study included an intervention group consisting of one Primary Health Care (PHC) clinic and a control group consisting of six PHC clinics serving 149,400 inhabitants in the County of Blekinge, Sweden.</p> <p>An economic incentive was introduced in both groups when prescribing physical activity on prescription. In the intervention group, a change was made to the process of prescribing physical activity, together with information and guidance to the personnel working at the clinics. Physical therapists were used in the process of carrying out the prescription, conducting the motivational interview and counselling the patient. This methodology was used to minimise the workload of the physician. The chi-2 test was used for studying differences between the two groups. PAP prescribed by doctors increased eightfold in the intervention group compared to the control group. The greatest increase of PAP was seen among physicians in the intervention group as compared to all other professionals in the control group. The economic incentive gave a significant but smaller increase of PAP by doctors.</p> <p>Conclusion</p> <p>By simplifying and developing PAP, this study has shown a concrete way to increase the implementation of physical activity on prescription in general practice, as opposed to what can be gained by an economic bonus system alone. This study indicates that a bonus system may not be enough to implement an evidence-based method.</p

Adrenal androgens versus cortisol for primary aldosteronism subtype determination in adrenal venous sampling

Objective: We examined if measurement of adrenal androgens adds to subtype diagnostics of primary aldosteronism (PA) under cosyntropin-stimulated adrenal venous sampling (AVS).Design: A prospective pre-specified secondary endpoint analysis of 49 patients with confirmed PA, of whom 29 underwent unilateral adrenalectomy with long-term follow-up.Methods: Concentrations of androstenedione, dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulphate (DHEAS) were measured during AVS in addition to aldosterone and cortisol. Subjects with lateralisation index (LI) of ≥4 were treated with unilateral adrenalectomy, and the immunohistochemical subtype was determined with CYP11B2 and CYP11B1 stains. The performance of adrenal androgens was evaluated by receiver operating characteristics (ROC) curve analyses in adrenalectomy and medical therapy groups.Results: During AVS, the correlations between cortisol and androstenedione, DHEA and DHEAS for LI and selectivity index (SI) were highly significant. The right and left side SIs for androstenedione and DHEA were higher (p Conclusions: Under cosyntropin-stimulated AVS, the measurement of androstenedione and DHEA did not improve the cannulation selectivity. The performance of cortisol and adrenal androgens are confirmatory but not superior to cortisol-based results in lateralisation diagnostics of PA.</p

Proficiency Testing of Metagenomics-Based Detection of Food-Borne Pathogens Using a Complex Artificial Sequencing Dataset

Metagenomics-based high-throughput sequencing (HTS) enables comprehensive detection of all species comprised in a sample with a single assay and is becoming a standard method for outbreak investigation. However, unlike real-time PCR or serological assays, HTS datasets generated for pathogen detection do not easily provide yes/no answers. Rather, results of the taxonomic read assignment need to be assessed by trained personnel to gain information thereof. Proficiency tests are important instruments of validation, harmonization, and standardization. Within the European Union funded project COMPARE [COllaborative Management Platform for detection and Analyses of (Re-) emerging and foodborne outbreaks in Europe], we conducted a proficiency test to scrutinize the ability to assess diagnostic metagenomics data. An artificial dataset resembling shotgun sequencing of RNA from a sample of contaminated trout was provided to 12 participants with the request to provide a table with per-read taxonomic assignments at species level and a report with a summary and assessment of their findings, considering different categories like pathogen, background, or contaminations. Analysis of the read assignment tables showed that the software used reliably classified the reads taxonomically overall. However, usage of incomplete reference databases or inappropriate data pre-processing caused difficulties. From the combination of the participants\u2019 reports with their read assignments, we conclude that, although most species were detected, a number of important taxa were not or not correctly categorized. This implies that knowledge of and awareness for potentially dangerous species and contaminations need to be improved, hence, capacity building for the interpretation of diagnostic metagenomics datasets is necessary

Response to letter on use of functional imaging by 11C-metomidate PET for primary aldosteronism subtyping

Non peer reviewe

The effectiveness of "Exercise on Prescription" in stimulating physical activity among women in ethnic minority groups in the Netherlands: protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Lack of physical activity is an important risk factor for overweight, diabetes, cardiovascular disease and other chronic conditions. In the Netherlands, ethnic minority groups are generally less physically active and rate their own health poorer compared to ethnic Dutch. This applies in particular to women. For this reason women from ethnic minority groups are an important target group for interventions to promote physical activity.</p> <p>In the Netherlands, an exercise referral program ("Exercise on Prescription") seems successful in reaching women from ethnic minority groups, in particular because of referral by the general practitioner and because the program fits well with the needs of these women. However, the effect of the intervention on the level of physical activity and related health outcomes has not been formally evaluated within this population. This paper describes the study design for the evaluation of the effect of "Exercise on Prescription" on level of physical activity and related health outcomes.</p> <p>Methods</p> <p>The randomized controlled trial will include 360 inactive women from ethnic minority groups, with the majority having a non-Western background, aged between 18 and 65 years old, with regular visits to their general practitioner. Participants will be recruited at healthcare centres within a deprived neighbourhood in the city of The Hague, the Netherlands.</p> <p>An intervention group of 180 women will participate in an exercise program with weekly exercise sessions during 20 weeks. The control group (n = 180) will be offered care as usual. Measurements will take place at baseline, and after 6 and 12 months. Main outcome measure is minutes of self reported physical activity per week. Secondary outcomes are the mediating motivational factors regarding physical activity, subjective and objective health outcomes (including wellbeing, perceived health, fitness and body size) and use of (primary) health care. Attendance and attrition during the program will be determined.</p> <p>Conclusion</p> <p>This trial will provide information on the effectiveness of an exercise referral scheme on the short and long term among women from ethnic minority groups, mainly non-Western, in the Netherlands. The results of this study will contribute to the evidence base for interventions in ethnic minority populations.</p> <p>Trial registration</p> <p>Dutch Trial register: NTR1294</p

Comparison of two self-reported measures of physical work demands in hospital personnel: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Low back pain (LBP) is a frequent health complaint among health care personnel. Several work tasks and working postures are associated with an increased risk of LBP. The aim of this study was to compare two self-reported measures of physical demands and their association with LBP (the daily number of patient handling tasks and Hollmann's physical load index).</p> <p>Methods</p> <p>A questionnaire was distributed to 535 hospital employees in a psychiatric and an orthopedic ward in a Danish hospital. Of these 411 (77%) filled in and returned the questionnaire. Only the 373 respondents who had non-missing values on both measures of physical demands were included in the analyses. The distribution of physical demands in different job groups and wards are presented, variance analysis models are employed, and logistic regression analysis is used to analyze the association between measures of physical demands and LBP.</p> <p>Results</p> <p>In combination, hospital ward and job category explained 56.6% and 23.3% of the variance in the self-reported physical demands measured as the daily number of patient handling tasks and as the score on the physical load index, respectively. When comparing the 6% with the highest exposure the prevalence odds ratio (POR) for LBP was 5.38 (95% CI 2.03–14.29) in the group performing more than 10 patient handling tasks per day and 2.29 (95% CI 0.93–5.66) in the group with the highest score on the physical load index.</p> <p>Conclusion</p> <p>In specialized hospital wards the daily number of patient handling tasks seems to be a more feasible measure of exposure when assessing the risk of LBP compared to more advanced measures of physical load on the lower lumbar spine.</p