Statins and prevention of infections: systematic review and meta-analysis of data from large randomised placebo controlled trials

Objective To evaluate whether the potential of statins to lower the risk of infections as published in observational studies is causal

Late antibody-mediated rejection after ABO-incompatible kidney transplantation during Gram-negative sepsis

BACKGROUND: The major challenge in ABO-incompatible transplantation is to minimize antibody-mediated rejection. Effective reduction of the anti-ABO blood group antibodies at the time of transplantation has made ABO-incompatible kidney transplantation a growing practice in our hospital and in centers worldwide. ABO antibodies result from contact with A- and B-like antigens in the intestines via nutrients and bacteria. We demonstrate a patient with fulminant antibody-mediated rejection late after ABO-incompatible kidney transplantation, whose anti-A antibody titers rose dramatically following Serratia marcescens sepsis. CASE PRESENTATION: A 58-year-old woman underwent an ABO-incompatible kidney transplantation for end-stage renal disease secondary to autosomal dominant polycystic kidney disease. It concerned a blood group A1 to O donation. Pre-desensitization titers were 64 for anti-blood group A IgM and 32 for anti-blood group A IgG titers. Desensitization treatment consisted of rituximab, tacrolimus, mycophenolate mofetil, corticosteroids, immunoadsorption and intravenous immunoglobulines. She was readmitted to our hospital 11 weeks after transplantation for S. marcescens urosepsis. Her anti-A IgM titer rose to >5000 and she developed a fulminant antibody-mediated rejection. We hypothesized that the (overwhelming) presence in the blood of S. marcescens stimulated anti-A antibody formation, as S. marcescens might share epitopes with blood group A antigen. Unfortunately we could not demonstrate interaction between blood group A and S. marcescens in incubation experiments. CONCLUSION: Two features of this post-transplant course are remarkably different from other reports of acute rejection in ABO-incompatible kidney transplantation: first, the late occurrence 12 weeks after kidney transplantation and second, the very high anti-A IgM titers (>5000), suggesting recent boosting of anti-A antibody formation by S. marcescens

The effects of a pre-conception lifestyle intervention in women with obesity and infertility on perceived stress, mood symptoms, sleep and quality of life

Funding: This research was supported by The Netherlands Organization for Health Research and Development (50-50110-96-518), the Dutch Heart Foundation (Grant number: 2013T085), and the European Commission (Horizon2020 project ‘DynaHealth’, 633595). The department of obstetrics and gynaecology from the UMCG receives an unrestricted educational grant from Ferring Pharmaceutical BV the Netherlands, unrelated to the present study.Peer reviewedPublisher PD

A lifestyle intervention randomized controlled trial in obese women with infertility improved body composition among those who experienced childhood adversity

Funding Information Hartstichting. Grant Number: 2013T085 ZonMw. Grant Number: 50‐50110‐96‐518 European Commission. Grant Number: 633595Peer reviewedPublisher PD

Preconception Lifestyle and Cardiovascular Health in the Offspring of Overweight and Obese Women

Funding: The LIFEstyle study was funded by ZonMw, the Dutch Organization for Health Research and Development, grant number: 50-50110-96-518. The follow-up of the LIFEstyle trial was funded by grants from the Dutch Heart Foundation (2013T085) and the European Commission (Horizon2020 project 633595 DynaHealth). None of these organizations had a role in data collection, analysis, interpretation of data, or writing the report. Acknowledgments: We thank all participants of the WOMB project, all participating hospitals and their staff and the members of the Dutch Consortium (www.studies-obsgyn.nl) for their hard work and dedication. Furthermore,we thank all members of the WOMB project who contributed to the follow-up study.Peer reviewedPublisher PD

Women, their Offspring and iMproving lifestyle for Better cardiovascular health of both (WOMB project) : A protocol of the follow-up of a multicentre randomised controlled trial

The LIFEstyle study was supported by a grant from The Netherlands Organization for Health Research and Development (50-50110-96-518). The WOMB project is funded by the Dutch Heart Foundation (2013T085) and the European Commission (Horizon2020 project ‘DynaHealth’, 633595).Peer reviewedPublisher PD

A lifestyle intervention improves sexual function of women with obesity and infertility : A 5 year follow-up of a RCT

Acknowledgments We thank all the women who participated in this study. We thank all participating hospitals and their staff for their contribution to this study, and the lifestyle coaches, research nurses, research midwives and office members of the Dutch Consortium (www.studies-obsgyn.nl) for their hard work and dedication. Furthermore, we thank all members of the WOMB-project who contributed to the follow-up study; with special thanks to our colleague PhD students, post-docs, research assistants and students.Peer reviewe

Long-term effects of a preconception lifestyle intervention on cardiometabolic health of overweight and obese women

Background: The global prevalence of obesity in women keeps increasing. The preconception period may be a window of opportunity to improve lifestyle, reduce obesity and improve cardiometabolic health. This study assessed the effect of a preconception lifestyle intervention on long-term cardiometabolic health in two randomized controlled trials (RCTs).Methods: Participants of the LIFEstyle and RADIEL preconception lifestyle intervention studies with a baseline body mass index (BMI) ≥29 kg/m2 were eligible for this follow-up study. Both studies randomized between a lifestyle intervention targeting physical activity, diet and behaviour modification or usual care. We assessed cardiometabolic health 6 years after randomization.Results: In the LIFEstyle study (n = 111) and RADIEL study (n = 39), no statistically significant differences between the intervention and control groups were found for body composition, blood pressure, arterial stiffness, fasting glucose, homeostasis model assessment of insulin resistance, HbA1c, lipids and high sensitive C-reactive protein levels 6 years after randomization. Participants of the LIFEstyle study who successfully lost ≥5% bodyweight or reached a BMI &lt;29 kg/m2 during the intervention (n = 22, [44%]) had lower weight (-8.1 kg; 99% CI [-16.6 to -0.9]), BMI (-3.3 kg/m2; [-6.5 to -0.8]), waist circumference (-8.2 cm; [-15.3 to -1.3]), fasting glucose (-0.5 mmol/L; [-1.1 to -0.0]), HbA1c (-4.1 mmol/mol; [-9.1 to -0.8]), and higher HDL-C (0.3 mmol/L; [0.1-0.5]) compared with controls.Conclusion: We found no evidence of improved cardiometabolic health 6 years after a preconception lifestyle intervention among overweight and obese women in two RCTs. Women who successfully lost weight during the intervention had better cardiometabolic health 6 years later, emphasizing the potential of successful preconception lifestyle improvement.</p

Future Scenarios of Nitrogen in Europe

The future effects of nitrogen in the environment will depend on the extent of nitrogen use and the practical application techniques of nitrogen in a similar way as in the past. Projections and scenarios are appropriate tools for extrapolating current knowledge into thefuture. However,these tools will not allow future system turnovers to be predicted. Approaches• In principle, scenarios of nitrogen use follow the approaches currently used for air pollution,climate ,or ecosystem projections. Short term projections (to 2030) are developed using a ‘baseline’ path of development,which considers abatement options that are consistent with European policy. For medium-term projections (to 2050) and long-term projections, the European Nitrogen Assessment (ENA) applies a ‘storyline’ approach similar to that used in the IPCC SRES scenarios. Beyond 2050 in particular, such story lines also take into account technological and behavioral shift s.Key findings/state of knowledge• The ENA distinguishes between driver-oriented and effect-oriented factors determining nitrogen use. Parameters that cause changes in nitrogen fixation or application are called drivers. In a driver-based approach, it is assumed that any variation of these parameters will also trigger a change in nitrogen pollution. In an effect-based approach, as the adverse effects of nitrogen become evident inthe environment, introduction of nitrogen abatement legislation requiring the application of more efficient abatement measuresis expected. This approach needs to rely on a target that is likely to be maintained in the future (e.g.human health). Nitrogen abatement legislation basedon such targets will aim to counter any growth in adverse environmental effects that occur as a result of increased nitrogen application.• For combustionand industry, technical fixes forabatement are available. Allscenarios agree in projecting a decrease in NOx emissions.Yet agricultural nitrogen use is expected to remain the leading cause of nitrogen release to the environment, as options to reduce emissions are limited. Thus, major changes will occur only if the extent of agricultural production changes, which may possibly be triggered by decreasing population numbers in Europe.The scenarios presented here project modest changes in NH 3 and N 2 O emissions, or nitrateleaching, but do not agree on the direction of these changes.•Agricultural activity (and thus nitrogen loads to the environment) may decrease strongly if the European population adopts a healthier‘low meat’ diet leading to lower nitrogenlosses related to animal husbandry. Change to a ‘healthy diet’ across the EU, which consists of 63% less meat and eggs, would reduce ammonia emissions from animal production by 48%. However, if an agricultural area previously used for animal feed production is utilized for biofuel crops, additional nitrogen fertilizer maybe required, which will partially offset reductions of nitrogen leakage to the environment. Major uncertainties/challenges• International trade in nitrogen-containing goods (agricultural as well as industrial) represents a key uncertainty and is difficult to project. Estimating the demand for such goods for Europe alone may not at all reflect European production and related environmental effects. The industrial use of nitrogen is alsovery poorly understood, but it is expected to continue to grow considerably. The respective environmental impacts of such products cannot be clearly discerned from statistical information.Recommendations• Scenarios need to be continuously updated in terms of economic, technical, and societal trends to reflect improved understanding of these factors. Using nitrogen budgets as tools could improve the consistency of scenarios.JRC.DDG.H.2-Climate change and air qualit