The incidence of metabolic syndrome and its reversal in a cohort of schizophrenic patients followed for one year

Cross-sectional studies showed a high prevalence of metabolic syndrome in patients with schizophrenia. This study aimed to identify the incidence of metabolic syndrome and its reversal in a non-preselected cohort of chronic psychotic patients in routine practice in one year follow-up and to find variables to describe development and reversal of metabolic syndrome. This cohort study was conducted as part of a disease management program and patients were included if they had two complete assessments in a one year follow-up. We conducted two logistic regressions to find variables to describe the development of metabolic syndrome and the reversal of metabolic syndrome. At the time of the first assessment 35% (n = 92) of the 260 included patients had metabolic syndrome. Within one year 21 patients developed metabolic syndrome and 30 patients had it reversed. This was an incidence of 13% (21/168) and a reversal of 33% (30/92). Smoking, family history of cardiovascular diseases, and duration of disease >6 years was associated with a higher risk of developing metabolic syndrome as well as abdominal obesity and dyslipidemia. Patients with abdominal obesity had a smaller chance of reversing metabolic syndrome. Other variables included in the logistic regression such as receiving cardiovascular/antidiabetic drug treatment or duration of disease >6 years did not alter the risk of reversing the metabolic syndrome. Our study showed that the natural course of metabolic syndrome is dynamic. A considerable number of patients developed or reversed the metabolic syndrome in one year follow-up. (C) 2009 Elsevier Ltd. All rights reserved

A 12-month follow-up study of treating overweight schizophrenic patients with aripiprazole

Objective: To investigate the feasibility of switching overweight schizophrenic patients to aripiprazole and to assess the impact of 12 months of aripiprazole treatment on weight in routine practice. Method: This was a non-controlled cohort study in overweight schizophrenic patients. Data were collected before treatment with aripiprazole was started and at 12-month follow-up. Results: A total of 53 patients were included; of these 55% continued using aripiprazole for 12 months. Aripiprazole treatment for 12 months (P = 0.027) and stopping clozapine or olanzapine treatment (P = 0.038) predicted weight loss (>= 3 kg). Patients receiving aripiprazole monotherapy (n = 16, mean -3.0 kg) had similar weight loss than patients receiving aripiprazole in addition to another antipsychotic drug (n = 13, mean -4.4 kg). Conclusion: In routine practice once aripiprazole treatment was started, more than half of the patients remained on aripiprazole and most of them lost weight. Adding aripiprazole to clozapine gave similar weight loss as monotherapy with aripiprazole

Diagnosis of bone, joint, and joint prosthesis infections with In-111-labeled nonspecific human immunoglobulin G scintigraphy

Contains fulltext : 4730.pdf (publisher's version ) (Open Access

The human environmental balance

A future policy instrument for assessing the consequences of changes (already made) to the physical environment can be found in the instrument known as the human environmental balance. By taking all relevant aspects into account when using this instrument, present and future serious defects along with necessary areas of focus will become clear. In this way, the balance will fulfil an important evaluative and indicative function, serving as an integral conceptual framework to find out what investments to make and where they should be made. This report describes a survey, representing an initial step on the road to a balanced physical environment, charting further work along the way. It is also meant to stimulate a broad debate on how to audit this physical environment and what to study. The concept of the physical environment is defined as consisting of (stocks of) various objects in a certain (spatial) arrangement. These objects are evaluated from three perspectives: ecological, economic and social/psychological. The first two perspectives focus on long-term issues on sustainability. In the third perspective the central theme is the perception of the environment by humans themselves; here, we are concerned about short-term issues on the sub-national (local) level. The 1970-1995 draft balance also saw its first elaboration in this report.De leefomgevingsbalans is een door VROM voorgesteld toekomstig beleidsinstrument om gedane ingrepen in het fysieke milieu op hun integrale gevolgen voor de leefomgeving te beoordelen. De leefomgevingsbalans zou hiermee een belangrijke evaluerende en signalerende functie hebben: door beschouwing van alle relevante aspecten maakt de balans zichtbaar waar tekorten zijn of dreigen te ontstaan en waar extra inspanningen nodig zijn. Hiermee vormt de leefomgevingsbalans een integratief raamwerk dat richtinggevend kan zijn voor de aard en locatie van gewenste investeringen. Dit rapport is een verkenning van een mogelijk invulling van een dergelijke leefomgevingsbalans en dient uitsluitend als basis voor discussie. Het beschouwt de fysieke leefomgeving als een verzameling van (voorraden) van allerlei objecten in een bepaalde ruimtelijke configuratie. Deze objecten worden vanuit verschillende invalshoeken verschillend gewaardeerd. Hierbij is onderscheid gemaakt in een ecologisch, economisch en sociaal-psychologisch perspectief. De eerste twee perspectieven zijn vooral gericht op lange termijn-vraagstukken waarbij duurzaamheid voorop staat. Bij het laatste perspectief gaat om de individuele leefbaarheid van de burger, veelal handelend over korte termijn-vraagstukken op vooral lokaal niveau. Op deze wijze wordt het 'leefomgevingskapitaal' gepresenteerd als een drieluik van economische, ecologische en sociaal-psychologische waarden. In het rapport is ook een eerste uitwerking van dit concept voor de periode 1970-1995 gegeven

The Survival Paradox of Elderly Patients After Major Liver Resections

The objective of this study is to assess the outcome of liver resections in the elderly in a matched control analysis. From a prospective single center database of 628 patients, 132 patients were aged 60 years or over and underwent a primary major liver resection. Of these patients, 93 could be matched one-to-one with a control patient, aged less than 60 years, with the same diagnosis and the same type of liver resection. The mean age difference was 16.7 years. Patients over 60 years of age had a significantly higher American Society of Anaesthesiologists (ASA) grade. All other demographics and operative characteristics were not different. In-hospital mortality and morbidity were higher in the patients over 60 years of age (11% versus 2%, p=0.017 and 47% versus 31%, p=0.024). One-, 3-, and 5-year survival rates in the patients over 60 years of age were 81%, 58%, and 42%, respectively, compared to 90%, 59%, and 42% in the control patients (p=0.558). Unified model Cox regression analysis showed that resection margin status (hazard ratio 2.51) and ASA grade (hazard ratio 2.26), and not age, were determining factors for survival. This finding underlines the important fact that in patient selection for major liver resections, ASA grade is more important than patient age

A detailed comparison of experimental and theoretical stress-analysis of a human femur

Experimental strain-gauge and theoretical stress analysis methods are used to evaluate the mechanical behavior of the femur as a structural element under loading. It is shown that when the cortical bone material is assumed to behave linear elastic, homogeneous and transversely isotropic, excellent agreement between experimental results and theoretical predictions is obtained. Also that the bone shaft can with reasonable approximation be represented by an axisymmetric model, even when intramedullary hip joint prostheses are present. The implications of these results for the analysis of intramedullary bone-prosthesis structures are discussed