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Realising early recognition of arthritis in times of increased telemedicine:the value of patient-reported swollen joints

Pathophysiology and treatment of rheumatic disease

The utility of bulk wood density for tree-ring research

Bulk wood density measurements are recognized for their utility in ecology, industry, and biomass estimations.. In tree-ring research, microdensitometric techniques are widely used, but their ability to determine the correct central tendency has been questioned. Though rarely used, it may be possible to use bulk wood density as a tool to check the accuracy of and even correct microdensitometric measurements. Since measuring bulk wood density in parallel with X-ray densitometry is quickly and easily done, we suspect that its omission is largely due to a lack of awareness of the procedure and/or its importance. In this study, we describe a simple protocol for measuring bulk wood density tailored for tree-ring researchers and demonstrate a few possible applications. To implement real-world examples of the applications, we used a sample of existing X-ray and Blue Intensity (BI) measurements from 127 living and dead Pinus sylvestris trees from northern Sweden to produce new measurements of bulk wood density. We can confirm that the central tendency in this sample material is offset using X-ray densitometry and that the diagnosis and correction of X-ray density is easily done using bulk wood density in linear transfer functions. However, this approach was not suitable for our BI measurements due to heavy discoloration. Nevertheless, we were able to use bulk wood density to diagnose and improve the use of deltaBI (latewood BI – earlywood BI) with regard to its overall trends and multi-centennial variability in a dendroclimatological application. Moreover, we experimented with percent of latewood width, scaled with bulk wood density, as a time- and cost-effective proxy for annual ring density. Although our reconstruction only explains about half of the variation in ring density, it is most likely superior to using fixed literature values of density in allometric equations aimed at biomass estimations. With this study, we hope to raise new awareness regarding the versatility and importance of bulk wood density for dendrochronology by demonstrating its simplicity, relevance, and applicability

Adolescent Nonsuicidal Self-Injury and Suicidality:A Latent Class Analysis and Associations with Clinical Characteristics in an At-Risk Cohort

Nonsuicidal self-injury (NSSI) is frequently encountered in adolescents, but its predictive value for suicidality or other clinical characteristics is challenging due to its heterogeneous nature. This study used latent class analysis to identify subgroups of NSSI and compared these on sociodemographic characteristics, adverse outcomes and protective factors. The study included 966 high-risk adolescents, Mage 14.9 y, SD 0.9 y, 51.8% female. Four classes emerged: (1) "Low NSSI-Low suicidality", (2) "Moderate NSSI-Low suicidality", (3) "Moderate NSSI-High suicidality", and (4) "High NSSI-High suicidality". Girls predominated in the high suicidality classes. Generally, Class 4 had the poorest outcomes: more internalizing and externalizing problems, less social support from friends and families and worst self-esteem. These findings emphasize the need for interventions tailored to specific phenotypes of adolescents engaging in NSSI

Decisional Conflict after Deciding on Potential Participation in Early Phase Clinical Cancer Trials:Dependent on Global Health Status, Satisfaction with Communication, and Timing

SIMPLE SUMMARY: Early phase clinical trials are an essential part of modern drug development and thus the advance of anti-cancer therapies for patients. However, deciding whether to participate in such trials can be complex and patients have reported decisional conflict (i.e., unresolved decisional needs). The aim of our study was to untangle several factors that contribute to decisional conflict in patients with advanced cancer who have recently been asked to decide whether to participate in early phase clinical trials. We found that patients experienced less decisional conflict if they had a better global health status, higher satisfaction, and made their decision sooner. Other factors, such as the decision to (not) participate, did not prove to be the best indicators for decisional conflict. With these insights, we can start to build hypotheses on how to improve the decision-making process for patients with end-stage cancer, which can ultimately improve their quality of life. ABSTRACT: When standard treatment options are not available anymore, patients with advanced cancer may participate in early phase clinical trials. Improving this complex decision-making process may improve their quality of life. Therefore, this prospective multicenter study with questionnaires untangles several contributing factors to decisional conflict (which reflects the quality of decision-making) in patients with advanced cancer who recently decided upon early phase clinical trial participation (phase I or I/II). We hypothesized that health-related quality of life, health literacy, sense of hope, satisfaction with the consultation, timing of the decision, and the decision explain decisional conflict. Mean decisional conflict in 116 patients was 30.0 (SD = 16.9). Multivariate regression analysis showed that less decisional conflict was reported by patients with better global health status (β = −0.185, p = 0.018), higher satisfaction (β = −0.246, p = 0.002), and who made the decision before (β = −0.543, p < 0.001) or within a week after the consultation (β = −0.427, p < 0.001). These variables explained 37% of the variance in decisional conflict. Healthcare professionals should realize that patients with lower global health status and who need more time to decide may require additional support. Although altering such patient intrinsic characteristics is difficult, oncologists can impact the satisfaction with the consultation. Future research should verify whether effective patient-centered communication could prevent decisional conflict

Рідке мило на основі соапстоків після нейтралізації олій та жирів в нейтралізуючому розчині, що містить етанол

Development and application of statistical models for medical scientific researc

Prenatal parental tobacco smoking, gene specific DNA methylation, and newborns size: the Generation R study

Background: Deleterious effects of prenatal tobacco smoking on fetal growth and newborn weight are well-established. One of the proposed mechanisms underlying this relationship is alterations in epigenetic programming. We selected 506 newborns from a population-based prospective birth cohort in the Netherlands. Prenatal parental tobacco smoking was assessed using self-reporting questionnaires. Information on birth outcomes was obtained from medical records. The deoxyribonucleic acid (DNA) methylation of the growth genes IGF2DMR and H19 was measured in newborn umbilical cord white blood cells. Associations were assessed between parental tobacco smoking and DNA methylation using linear mixed models and adjusted for potential confounders. Results: The DNA methylation levels of IGF2DMR and H19 in the non-smoking group were median (90 % range), 54.0 % (44.6–62.0), and 30.0 % (25.5–34.0), in the first trimester only smoking group 52.2 % (44.5–61.1) and 30.8 % (27.1–34.1), and in the continued smoking group 51.6 % (43.9–61.3) and 30.2 % (23.7–34.8), respectively. Continued prenatal maternal smoking was inversely associated with IGF2DMR methylation (β = −1.03, 95 % CI −1.76; −0.30) in a dose-dependent manner (P-trend = 0.030). This association seemed to be slightly more profound among newborn girls (β = −1.38, 95 % CI −2.63; −0.14) than boys (β = −0.72, 95 % CI −1.68; 0.24). H19 methylation was also inversely associated continued smoking <5 cigarettes/day (β = −0.96, 95 % CI −1.78; −0.14). Moreover, the association between maternal smoking and newborns small for gestational age seems to be partially explained by IGF2DMR methylation (β = −0.095, 95 % CI −0.249; −0.018). Among non-smoking mothers, paternal tobacco smoking was not associated with IGF2DMR or H19 methylation. Conclusions: Maternal smoking is inversely associated with IGF2DMR methylation in newborns, which can be one of the underlying mechanisms through which smoking affects fetal growth

The Features of the Synovium in Early Rheumatoid Arthritis According to the 2010 ACR/EULAR Classification Criteria

OBJECTIVES: It has been shown in early arthritis cohorts that the 2010 ACR/EULAR criteria for rheumatoid arthritis (RA) enable an earlier diagnosis, perhaps at the cost of a somewhat more heterogeneous patient population. We describe the features of synovial inflammation in RA patients classified according to these new criteria. METHODS: At baseline, synovial tissue biopsy samples were obtained from disease-modifying antirheumatic drug (DMARD)-naïve early RA patients (clinical signs and symptoms <1 year). Synovial tissue was analyzed for cell infiltration, vascularity, and expression of adhesion molecules. Stained sections were evaluated by digital image analysis. Patients were classified according to the two different sets of classification criteria, autoantibody status, and outcome. FINDINGS: Synovial tissue of 69 RA patients according to 2010 ACR/EULAR criteria was analyzed: 56 patients who fulfilled the criteria for RA at baseline and 13 who were initially diagnosed as undifferentiated arthritis but fulfilled criteria for RA upon follow up. The synovium at baseline was infiltrated by plasma cells, macrophages, and T cells as well as other cells, and findings were comparable to those when patients were selected based on the 1987 ACR criteria for RA. There was no clear cut difference in the characteristics of the synovium between RA patients initially diagnosed as undifferentiated arthritis and those who already fulfilled classification criteria at baseline. CONCLUSION: The features of synovial inflammation are similar when the 2010 ACR/EULAR classification criteria are used compared to the 1987 ACR criteria

Biomass increment and carbon sequestration in hedgerow-grown trees

The global role of tree-based climate change mitigation is widely recognized; trees sequester large amounts of atmospheric carbon, and woody biomass has an important role in the future biobased economy. In national carbon and biomass budgets, trees growing in hedgerows and tree rows are often allocated the same biomass increment data as forest-grown trees. However, the growing conditions in these linear habitats are different from forests given that the trees receive more solar radiation, potentially benefit from fertilization residuals from adjacent fields and have more physical growing space. Tree biomass increment and carbon storage in linear woody elements should therefore be quantified and correctly accounted for. We examined four different hedgerow systems with combinations of pedunculate oak, black alder and silver birch in northern Belgium. We used X-ray CT scans of pith-to-bark cores of 73 trees to model long-term (tree life span) and short-term (last five years) trends in basal area increment and increment in aboveground stem biomass. The studied hedgerows and tree rows showed high densities (168–985 trees km-1) and basal areas (22.1–44.9 m2 km-1). In all four hedgerow systems, we found a strong and persistent increase in stem biomass and thus carbon accumulation with diameter (long-term trend). The current growth performance (short-term trend) also increased with tree diameter and was not related to hedgerow tree density or basal area, which indicates that competition for light does not (yet) limit tree growth in these ecosystems. The total stem volume was 82.0–339.7 m3 km-1 (corresponding to 18.8–100.7 Mg aboveground carbon km-1) and the stem volume increment was 3.1–14.5 m3 km-1 year-1 (aboveground carbon sequestration 0.7–4.3 Mg km-1 year-1). The high tree densities and the persistent increase in growth of trees growing in hedgerow systems resulted in substantial wood production and carbon sequestration rates at the landscape scale. Our findings show that trees growing in hedgerow systems should be included when biomass and carbon budgets are drafted. The biomass production rates of hedgerow trees we provide can help refine the IPCC Guidelines for National Greenhouse Gas Inventories

Tailored preconceptional dietary and lifestyle counselling in a tertiary outpatient clinic in the Netherlands

Background Adverse reproductive performance has been linked to unhealthy dietary intake and lifestyles. Our objectives were to investigate the prevalence of unhealthy dietary intake and lifestyles before conception and to evaluate whether tailored preconception counselling modifies these behaviours. Methods Between October 2007 and April 2009, 419 couples received tailored preconception dietary and lifestyle counselling at the outpatient clinic of Obstetrics and Gynaecology of the Erasmus University Medical Center Rotterdam, the Netherlands. A subgroup (n = 110 couples) was counselled twice with a fixed time interval of 3 months. Self-administered questionnaires were used for tailored dietary and lifestyle counselling. A cumulative score based on six Dutch dietary guidelines was displayed in the personal Preconception Dietary Risk score (PDR score). In a similar manner, the Rotterdam Reproduction Risk score (R3 score) was calculated from lifestyle factors (women: 13 items, men: 10 items). Univariate and paired tests were used. Results Most couples (93.8) were subfertile. At the second counselling, the percentage consuming the recommended intake of fruit had increased from 65 to 80 in women and from 49 to 68 in men and the percentage of women getting the recommended intake of fish increased from 39 to 52. As a consequence, the median PDR score was decreased [women: 2.6 (95 CI 2.4-2.9) to 2.4 (95 CI 2.1-2.6), men: 2.5 (95 CI 2.3-2.7) to 2.2 (95 CI 1.9-2.4), both P < 0.05]. The median R3 scores were also lower [women: 4.7 (95 CI 4.3-5.0) to 3.1 (95 CI 2.8-3.4), men: 3.0 (95 CI 2.8-3.3) to 2.0 (95 CI 1.7-2.3), both P < 0.01] due to less alcohol use (-14.6), more physical exercise and folic acid use in women, and less alcohol use in men (-19.4) (all P < 0.01). The R3 scores in women and men were decreased in all ethnicity, educational level, neighbourhood and BMI categories. However, low educated women appeared to show a larger reduction than better educated women and men with a normal BMI to show a larger decrease than overweight men. The reduction in the PDR score of women was similar in both ethnic groups. More than 85 women and men found the counselling useful and around 70 would recommend it to others. Conclusions Tailored preconception counselling about unhealthy dietary and lifestyle behaviours of subfertile couples in an outpatient tertiary clinic is feasible and seems to decrease the prevalence of harmful behaviours in the short term. These Results with subfertile couples are promising and illustrate their opportunities to contribute to reproductive performance and pregnancy outcome