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RATIONALE: Limited data are available on effectiveness and costs of nutritional rehabilitation for patients with COPD in community care. METHODS: In a 2-year RCT, 199 COPD patients (FEV(1)%pred. 60% [SD 16%]) and impaired exercise capacity were randomized to the interdisciplinary community-based COPD management program (INTERCOM) or usual care (UC). A prescheduled subgroup analysis was performed on 39 of 199 patients who were muscle wasted and received UC or nutritional therapy in combination with exercise training. Body composition, muscle strength, and exercise capacity were assessed at baseline and 4, 12, and 24 months. RESULTS: Between group differences after 4 months in favor of the intervention group: fat free mass index (FFMI 0.9 kg/m(2) [SE = 0.2, P < .001]), body mass index (BMI 1.0 kg/m(2) [SE = 0.4, P = .009]), maximum inspiratory mouth pressure (Pimax 1.4 kPa [SE = 0.5, P = .011]), quadriceps average power (QAP 13.1 Watt [SE=5.8, P = .036]), 6-minute walking distance (6MWD 27 m, [SE = 11.5, P = .028]), cycle endurance time (CET 525 seconds [SE=195, P = .013]), and peak exercise capacity (Wmax 12 Watt [SE = 5, P = .036]). Between group difference over 24 months in favor of the intervention group: Pimax 1.7 kPa (SE = 0.53, P = .004), QAP 19 Watt (SE = 6, P = .005), 6MWD 57 (SE = 19, P = .006), and CET 485 seconds (SE = 159, P = .006). After 4 months total costs were Euro 1501 higher in the intervention group than in the UC group (P < .05), but not significantly different after 24 months. Hospital admission costs were significantly lower in the intervention group -euro 4724 (95% CI -7704, -1734). CONCLUSION: This study in muscle-wasted COPD patients with moderate airflow obstruction shows a prolonged positive response to nutritional support integrated in a community-based rehabilitation program. [ABSTRACT FROM AUTHOR]

Abstract: The polycystic ovary syndrome (PCOS) affects 5–10% of all premenopausal women. It is diagnosed by a combination of oligo-amenorrhea and hyperandrogenism (NIH criteria) or by the presence of two out of three of: oligo-amenorrhea, hyperandrogenism, polycystic ovaries on ultrasound (Rotterdam criteria). PCOS is associated with obesity, insulin resistance and dyslipidemia. Different patterns of dyslipidemia can be present, both in lean and obese PCOS. Low HDL-cholesterol, with or without elevated TG, is the most prominent lipid abnormality. In addition, smaller HDL and LDL particles and elevated postprandial TG responses are reported. Hyperandrogenism, anovulation and insulin resistance affect multiple steps in lipid metabolism in PCOS, as will be discussed. Surrogate markers for atherosclerosis are consistently abnormal in PCOS, while studies on clinical CVD endpoints are limited and non-conclusive. The (pharmaco-) therapy of dyslipidemia in PCOS will be discussed. In addition, the effects of other PCOS related (pharmaco-) therapies, primarily aimed at hyperandrogenism, anovulation or insulin resistance, on lipid metabolism will be addressed. [Copyright &y& Elsevier]

Frailty in newly-diagnosed multiple myeloma (NDMM) patients is associated with treatment-related toxicity, which negatively affects health-related quality of life (HRQoL). Currently, data on changes in HRQoL of frail and intermediate-fit MM patients during active treatment and post-treatment follow-up are absent. The HOVON123 study (NTR4244) was a phase II trial in which NDMM patients ≥ 75 years were treated with nine dose-adjusted cycles of Melphalan-Prednisone-Bortezomib (MPV). Two HRQoL instruments (EORTC QLQ-C30 and -MY20) were obtained before start of treatment, after 3 and 9 months of treatment and 6 and 12 months after treatment for patients who did not yet start second-line treatment. HRQoL changes and/or differences in frail and intermediate-fit patients (IMWG frailty score) were reported only when both statistically significant (p < 0.005) and clinically relevant (>MID). 137 frail and 71 intermediate-fit patients were included in the analysis. Compliance was high and comparable in both groups. At baseline, frail patients reported lower global health status, lower physical functioning scores and more fatigue and pain compared to intermediate-fit patients. Both groups improved in global health status and future perspective; polyneuropathy complaints worsened over time. Frail patients improved over time in physical functioning, fatigue and pain. Improvement in global health status occurred earlier than in intermediate-fit patients. HRQoL improved during anti-myeloma treatment in both intermediate-fit and frail MM patients. In frail patients, improvement occurred faster and, in more domains, which was retained during follow-up. This implies that physicians should not withhold safe and effective therapies from frail patients in fear of HRQoL deterioration. • HRQoL differs between intermediate-fit & frail patients before start of MM therapy. • HRQoL improves in both intermediate-fit & frail patients during initial MM therapy. • Frail patients show faster & larger improvements in HRQoL during first treatment. • Improvements in HRQoL persist during post-treatment follow-up. • Physicians should not refrain from treating frail patients in fear of HRQoL loss. [ABSTRACT FROM AUTHOR]

In this work, the hydrodynamics inside packed beds of particles with different shapes are investigated: spherical, cylindrical, and cubical particles. The cylindrical and cubical geometries contain sharp ridges, which give rise to complicated pore geometries. In this study, Pore Network Modeling (PNM) validated with the Particle-Resolved Computational Fluid Dynamics (PR-CFD) simulations of packed beds with these non-spherical particles will be reported. The results show that the PNM predicts the same average flow behavior and pore pressure variations as PR-CFD. However, the PNM prediction of the pressure values is less accurate at the pore level compared to the PR-CFD for the cubical particles. • Packed beds of non-spherical particles are modeled with Particle Resolved-CFD. • Pore Network Modeling (PNM) calibrated via PR-CFD simulations. • PNM aligns with PR-CFD in average flow field and overall pressure prediction. • PNM predicts pore pressure well for spheres, cylinders. • Study shows PNM's potential and limitations in packing of complex geometries. [ABSTRACT FROM AUTHOR]

Randomised clinical trials (RCTs) are considered the basis of evidence-based medicine. It is recognised more and more that application of RCT results in daily practice of clinical decision-making is limited because the RCT world does not correspond with the clinical real world. Recent strategies aiming at substitution of RCT databases by improved population-based registries (PBRs) or by improved electronic health record (EHR) systems to provide significant data for clinical science are discussed. A novel approach exemplified by the HemoBase haemato-oncology project is presented. In this approach, a PBR is combined with an advanced EHR , providing high-quality data for observational studies and support of best practice development. This PBR + EHR approach opens a perspective on randomised registry trials. [ABSTRACT FROM AUTHOR]

Abstract: The efficacy of azacitidine has been demonstrated in acute myeloid leukemia (AML) patients with 20–30% bone marrow (BM) blasts, but limited data is available on patients with ≥30% blasts. We analyzed 55 newly diagnosed AML patients, treated with azacitidine. The overall response rate was 42%. Median overall survival (OS) was 12.3 months. We confirmed poor-risk cytogenetics, therapy-related AML, performance score ≥2, and white blood cell count ≥15×109/L as independent adverse predictors for OS. The BM blast percentage, however, had no impact on OS (P =0.55). In conclusion, administration of azacitidine is effective in AML patients with 20–30% and >30% BM blasts. [Copyright &y& Elsevier]