Characteristics Of The Carotid Atherosclerotic Plaque

A major cause for the occurrence of stroke or TIA is atherosclerosis. Currently, the degree of the carotid artery stenosis is an important factor to select patients for a carotid endarterectomy (CEA). New imaging techniques such as MDCTA and MRI have made it possible to look in detail at the atherosclerotic plaque. This allows us to see which components (for example hemorrhage, calcifications, lipid core) are present in the atherosclerotic plaque. The exact plaque composition could help to determine which people have a higher risk of getting a recurrent stroke and could have an important impact on the choice of treatment. The PARISK study aims to answer the question which plaque characteristics – assessed with ultrasound, MDCTA and MRI – are associated with an increased risk of recurrent stroke. At this moment, final follow-up measurements are performed to answer this question. For now, we tried to get a better understanding of what happens in an atherosclerotic plaque and the role of blood clotting in atherosclerosis. Moreover, we looked at which imaging techniques and which plaque characteristics can be valuable in future clinical practice. A few examples of the topics discussed in this thesis: 1. Von Willebrand Factor (VWF) and ADAMTS13 are involved in blood clotting and previous research has shown that these blood biomarkers are also associated with an increased risk of cardiovascular disease. Atherosclerosis may play a role in this association. We investigated whether we could prove this hypothesis, unfortunately the precise mechanism of the relationship between VWF and ADAMTS13 and the risk of cardiovascular disease remains unknown. 2. In the PARISK study various imaging techniques to image the carotid artery are used. We have found a link between the presence of hemorrhage in the atherosclerotic plaque on MRI and plaque ulceration on MDCTA. In addition, we found that MRI plaque imaging techniques presently cannot be recommended to estimate volume of plaque calcifications in individual patients, and that giving a contrast medium in ultrasound can have additional value to assess plaque ulcerations

Effects of macronutrient intake in obesity:A meta-analysis of low-carbohydrate and low-fat diets on markers of the metabolic syndrome

The metabolic syndrome (MetS) comprises cardiometabolic risk factors frequently found in individuals with obesity. Guidelines to prevent or reverse MetS suggest limiting fat intake, however, lowering carbohydrate intake has gained attention too. The aim for this review was to determine to what extent either weight loss, reduction in caloric intake, or changes in macronutrient intake contribute to improvement in markers of MetS in persons with obesity without cardiometabolic disease. A meta-analysis was performed across a spectrum of studies applying low-carbohydrate (LC) and low-fat (LF) diets. PubMed searches yielded 17 articles describing 12 separate intervention studies assessing changes in MetS markers of persons with obesity assigned to LC (<40% energy from carbohydrates) or LF (<30% energy from fat) diets. Both diets could lead to weight loss and improve markers of MetS. Meta-regression revealed that weight loss most efficaciously reduced fasting glucose levels independent of macronutrient intake at the end of the study. Actual carbohydrate intake and actual fat intake at the end of the study, but not the percent changes in intake of these macronutrients, improved diastolic blood pressure and circulating triglyceride levels, without an effect of weight loss. The homeostatic model assessment of insulin resistance improved with both diets, whereas high-density lipoprotein cholesterol only improved in the LC diet, both irrespective of aforementioned factors. Remarkably, changes in caloric intake did not play a primary role in altering MetS markers. Taken together, these data suggest that, beyond the general effects of the LC and LF diet categories to improve MetS markers, there are also specific roles for weight loss, LC and HF intake, but not reduced caloric intake, that improve markers of MetS irrespective of diet categorization. On the basis of the results from this meta-analysis, guidelines to prevent MetS may need to be re-evaluated

Are (pre)adolescents differentially susceptible to experimentally manipulated peer acceptance and rejection? A vignette-based experiment

The differential susceptibility model proposes that some children are more susceptible to both positive and negative peer relationships than others. However, experimental evidence supporting such a proposition is relatively scarce. The current experiment aimed to help address this gap, investigating whether Chinese (pre)adolescents who have higher levels of general sensitivity to the environment (i.e., higher levels of sensory processing sensitivity [SPS]) would be more strongly affected by peer acceptance and rejection. (Pre)adolescents aged 8.75–15.17 (N = 1,207, Mage = 11.19 years, 59.7% boys) randomly received four hypothetical vignettes describing either peer acceptance or peer rejection. Before and after this manipulation, they reported on their positive and negative mood. We assessed (pre)adolescents’ SPS using (pre)adolescent self-reports, as well as caregiver reports for a subset of (pre)adolescents (n = 480). Results supported differential susceptibility to peer rejection and acceptance for self-reported SPS, but not caregiver-reported SPS. (Pre)adolescents with higher levels of self-reported SPS not only had stronger increases in positive mood upon peer acceptance (susceptible “for better”; β =.09, p =.001) but also stronger increases in negative mood upon peer rejection (susceptible “for worse”; β =.09, p =.023). These findings illustrate the short-term dynamics that may underlie differences in children’s long-term susceptibility to acceptance or rejection by peers

Hostile interpretation as a transdiagnostic factor for cooccurring anxiety in boys with aggressive behavior problems

Many children with aggressive behavior problems also suffer from anxiety. This cooccurrence may perhaps be explained by transdiagnostic factors. Identifying these factors seems crucial, as they may be important targets to treat these cooccurring problems effectively. This two-study paper investigates whether hostile interpretation of others’ intentions is a transdiagnostic factor for cooccurring aggression and anxiety problems, examining two samples of boys in middle childhood. We assessed boys’ aggression and anxiety using teacher-report in Study 1 (N = 84, Mage = 10.10), and parent-report in Study 2 (N = 115, Mage = 10.55). In both studies, we assessed hostile interpretation using vignettes describing ambiguous provocations by peers. Both studies revealed a strong association between aggression and anxiety problems, underscoring the necessity to examine factors that can explain this cooccurrence. However, in neither study was this association reduced when we added hostile interpretation to the model, suggesting that hostile interpretation did not function as a transdiagnostic factor in our samples. One possible explanation for these findings is that hostile interpretation predicts both aggression and anxiety problems, but in different children. We, therefore, encourage scholars to conduct more research to explain the high comorbidity of aggression and anxiety problems in children. Future research should also examine hostile interpretation as predictor or transdiagnostic factor for aggression and anxiety problems in more diverse population, including girls and other age groups

Carotid artery lumen segmentation in 3D free-hand ultrasound images using surface graph cuts

We present a new approach for automated segmentation of the carotid lumen bifurcation from 3D free-hand ultrasound using a 3D surface graph cut method. The method requires only the manual selection of single seed points in the internal, external, and common carotid arteries. Subsequently, the centerline between these points is automatically traced, and the optimal lumen surface is found around the centerline using graph cuts. To refine the result, the latter process was iterated. The method was tested on twelve carotid arteries from six subjects including three patients with a moderate carotid artery stenosis. Our method successfully segmented the lumen in all cases. We obtained an average dice overlap with respect to a manual segmentation of 84% for healthy volunteers. For the patient data, we obtained a dice overlap of 66.7%

“May cause drowsiness – I might get a rash or something?”: Qualitative research on the comprehensibility of drug label instructions and the role of health literacy

Drug labels instructions are physically attached to each package dispensed to patients and consist of dosage instructions (e.g., ‘Take two capsules twice daily’), auxiliary warnings (e.g., ‘Do not drink alcoholic beverages’) and advices (e.g., ‘Take with food or milk’). They are often misinterpreted which may lead to incorrect drug use. The wordings of instructions are a cause of such misinterpretation, especially for people with limited health literacy. In a qualitative study, we explored pharmacy visitors’ interpretations of drug label instructions and their opinions on potential improvements. Semi-structured interviews were conducted with 39 pharmacy visitors with limited and adequate health literacy. They received seven drug label instructions and explained them in their own words and demonstrated how much and how often they would take the drugs on a timetable. Although pharmacy visitors were able to explain dosage instructions, they often made mistakes in demonstrating them, especially those with limited health literacy. Medical jargon (e.g., ‘drowsiness’) and difficult words (e.g., ‘maximum’) lead to misinterpretations, especially among pharmacy visitors with limited health literacy. When optimizing drug label instructions, a trade-off must be made between the comprehensibility and the nuance of instructions

Treating children's aggressive behavior problems using cognitive behavior therapy with virtual reality: A multicenter randomized controlled trial

This multicenter randomized controlled trial investigated whether interactive virtual reality enhanced effectiveness of Cognitive Behavioral Therapy (CBT) to reduce children's aggressive behavior problems. Boys with aggressive behavior problems (N = 115; Mage = 10.58, SD = 1.48; 95.7% born in Netherlands) were randomized into three groups: CBT with virtual reality, CBT with roleplays, or care-as-usual. Bayesian analyses showed that CBT with virtual reality more likely reduced aggressive behavior compared to care-as-usual for six of seven outcomes (ds 0.19–0.95), and compared to CBT with roleplays for four outcomes (ds 0.14–0.68). Moreover, compared to roleplays, virtual reality more likely enhanced children's emotional engagement, practice immersion, and treatment appreciation. Thus, virtual reality may be a promising tool to enhance CBT effectiveness for children with aggressive behavior problems