Association between epicardial adipose tissue and cardiac dysfunction in subjects with severe obesity

Aim: Epicardial adipose tissue (EAT) plays a role in obesity-related heart failure with preserved ejection fraction. However, the association of EAT thickness with the development of cardiac dysfunction in subjects with severe obesity without known cardiovascular disease is unclear. The aim of this study was to determine the association between EAT thickness and cardiac dysfunction and describe the potential value of EAT as an early marker of cardiac dysfunction. Methods and results: Subjects with body mass index ≥35 kg/m2 aged 35 to 65 years, who were referred for bariatric surgery, without suspicion of or known cardiac disease, were enrolled. Conventional transthoracic echocardiography and strain analyses were performed. A total of 186 subjects were divided into tertiles based on EAT thickness, of whom 62 were in EAT-1 (EAT &lt;3.8 mm), 63 in EAT-2 (EAT 3.8–5.4 mm), and 61 in EAT-3 (EAT &gt;5.4 mm). Parameters of systolic and diastolic function were comparable between tertiles. Patients in EAT-3 had the lowest global longitudinal strain (GLS) and left atrial contractile strain (LASct). Linear regression showed that a one-unit increase in EAT thickness (mm) was independently associated with a decrease in GLS (%) (β coefficient −0.404, p = 0.002), and a decrease in LASct (%) (β coefficient −0.544, p = 0.027). Furthermore, EAT-3 independently predicted cardiac dysfunction as defined by a GLS &lt;18% (odds ratio 2.8, p = 0.013) and LASct &lt;14% (odds ratio 2.5, p = 0.045). Conclusions: Increased EAT thickness in subjects with obesity without known cardiac disease was independently associated with subclinical cardiac dysfunction. Our findings suggest that EAT might play a role in the early stages of cardiac dysfunction in obesity before this may progress to overt clinical disease.</p

Adolescent alcohol intoxication in the dutch hospital Departments of Pediatrics

Objective This study was conducted to investigate the number and characteristics of adolescent alcohol intoxication cases in hospital Departments of Pediatrics. The study also analyzes drinking patterns and intoxication characteristics. Method: Data were collected using the Dutch Pediatric Surveillance System, in which about 92% of general pediatricians and 83% of academic pediatricians participate. In 2007, questionnaires were collected every month within 56 hospitals. A total of 297 adolescent alcohol intoxications were reported, of which 231 cases were analyzed. Results: Hospital-admitted adolescents in this study are 12-18 years old, with an average age of 15.3 years. Intoxicated adolescents appear to be a representative sample of the Dutch population on all background variables (gender, educational level, family structure). Conclusions: This study shows the serious nature of adolescent intoxication and may indicate that more strict governmental alcohol control policies are required

70-Gene Signature and Tumor-Stroma Ratio Select Different Groups of Patients with Breast Cancer at Risk for Recurrence

Background: Strategies for breast cancer care are improving. However, there is a clinical need for a better selection of patients who are at risk for recurrence and benefit from treatment with chemotherapy. The 70-gene signature (70-GS) guides chemotherapy decision making based on the mRNA microarray assessment but is expensive. The tumor-stroma ratio (TSR) is a morphological and cheap biomarker based on the amount of stroma in the primary tumor. In the present study the association between the 70-GS and TSR was investigated.Materials and methods: Frozen tumor tissue sections of 102 ER+/Her2- patients were send to Agendia for 70-GS analysis in an earlier study. The results of the 70-GS were available, and hematoxylin and eosin stained sections of the 102 tumors were scored for TSR. Concordance between the TSR and the 70-GS was analyzed. No data of patient outcome is available.Results: Of the patients in the 70-GS high risk category (n=46), 23 patients (50%) were classified into the stroma-high group according to previously established thresholds. 55% (n=31) of the low-risk 70-GS patients, had a stroma-low profile. The overall concordance between the 70-GS and TSR was 53% and no association was observed (Chi-square: p=0.917). Patients with a 70-GS high-risk test result had a significantly higher tumor grade and stroma-high patients were significantly older and had larger tumors.Conclusion: In conclusion, no association between the 70-GS and TSR was found. This suggests that both methods select different groups of patients at risk for recurrence, and may have additional prognostic value.Surgical oncolog

Pain assessment in impaired cognition: observer agreement in a long-term care setting in patients with dementia

Geriatrics in primary carePublic Health and primary car

Pain Assessment in Impaired Cognition (PAIC): Content validity of the Dutch version of a new and universal tool to measure pain in dementia

Objectives: Detection and measurement of pain in persons with dementia by using observational pain measurement tools is essential. However, the evidence for the psychometric properties of existing observational tools remains limited. Therefore, a new meta-tool has been developed: Pain Assessment in Impaired Cognition (PAIC), as a collaborative EU action. The aim is to describe the translation procedure and content validity of the Dutch version of the PAIC. Methods: Translation of the PAIC into Dutch followed the forward-backward approach of the Guidelines for Establishing Cultural Equivalence of Instruments. A questionnaire survey was administered to clinical nursing home experts (20 physicians and 20 nurses) to determine whether the PAIC items are indicative of pain and whether items are specific for pain or for other disorders (anxiety disorder, delirium, dementia, or depression). To quantify content validity, mean scores per item were calculated. Results: Eleven items were indicative of pain, for example, “frowning,” “freezing,” and “groaning.” Fifteen items were considered to be pain-specific, for example, “frowning,” “curling up,” and “complaining.” There were discrepancies between the notion of pain characteristics according to nurses and physicians, especially in the facial expressions domain. Discussion: Within the body movement domain, PAIC items correspond well with the clinical experience of the physicians and nurses. However, items in the facial expressions and vocalizations domains need further study with respect to item reduction. Also, differences were revealed in the notion of pain characteristics between physicians and nurses, suggesting the need for more interdisciplinary education on pain in dementia

Electrocardiographic abnormalities in childhood cancer survivors treated with cardiotoxic therapy: a systematic review

PURPOSE: The purpose of this study is to assess the available literature on the prevalence and risk factors of electrocardiographic (ECG) abnormalities after cardiotoxic treatment in childhood cancer survivors (CCS). METHODS: A literature search was performed within MEDLINE, EMBASE, and CENTRAL (1966-11/2020) and reference lists of relevant studies. Studies were eligible for inclusion if they reported ECG abnormalities ≥2 years after cancer diagnosis in ≥50 CCS treated with anthracyclines, RT involving the heart region and/or mitoxantrone. Information about population, treatment, outcome, and risk factors were extracted and risk of bias was assessed. RESULTS: Of 934 identified publications, 10 studies were included. Outcome definitions, treatment regimens, follow-up period, and risk of bias varied. These ECG abnormalities and prevalences were reported: major (5%-23%) and minor (12%) abnormalities according to the Minnesota Code, rhythm abnormalities (0%-12%), conduction abnormalities (0.3%-7.1%), depolarization abnormalities (0%), and repolarization abnormalities (0%-65%). The reported risk factors of ECG abnormalities (two studies) are male sex, anthracyclines, RT involving the heart region, and hypertension, although results were not univocal between studies and abnormalities. CONCLUSIONS: Multiple ECG abnormalities have been described in CCS ≥2 years from diagnosis, some of which can have important implications. Future research is needed to evaluate the exact long-term incidence and risk factors, and to investigate their clinical relevance and relation with cardiac dysfunction or future cardiac events. This could improve cardiac surveillance for CCS