Search

Background: Suicidality could be associated with specific combinations of biological, social and psychologicalfactors. Therefore, depressive episodes with suicidal ideation could be different from depressive episodeswithout suicidal ideation in terms of latent variable structures.Methods: In this study we compared latent variable structures between suicidal and non-suicidal depressedpatients using confirmatory factor analysis (CFA), following a measurement invariance test procedure. Patients(N = 919) suffering from major depressive disorder were selected from the Netherlands Study of Depression andAnxiety (NESDA) and split into a group that showed no symptoms of suicidal ideation (non-SI; N = 691) and asuicidal ideation (SI) group that had one or more symptoms of suicidal ideation (N = 228). Depression andanxiety symptoms were measured using the short form of the Mood and Anxiety Symptoms Questionnaire(MASQ-D30).Results: CFA implied a difference in latent variable structures between the non-SI sample (CFI 0.957; RMSEA0.041) and the SI sample (CFI 0.900; RMSEA 0.056). Subsequent multiple-group CFA showed violations ofmeasurement invariance. The General distress and Anhedonic depression subscales were best indicated byhopelessness and lack of optimism in the SI sample and by dissatisfaction and not feeling lively in the non-SIsample. Overall, the SI sample had higher scores and lower inter-item correlations on the Anhedonic depressionitems.Limitations: We have included very mild cases of suicidal ideation in our SI sample.Conclusions: On a latent variable level, depression with suicidal ideation differs from depression without suicidalideation. Results encourage further research into the symptom structure of depression among suicidal patients

Clinical cardiology diagnosis relies on the assessment of a set of specified parameters. Computer modeling is a powerful tool that can provide a realistic interpretation of the variations of these parameters through computational quantification. Here we present an overview of different aspects of diagnosis that are based on evaluation of either systolic or diastolic cardiac abnormalities. Emphasis is on the quantitative hemodynamic assessment and modeling. For myocardial ischemia and stunning, multi-scale modeling from single fiber to the global ventricular level is demonstrated. The classic force-velocity-length relations are found to be applicable even for modern quantitative cardiac assessment. The reduced systolic shortening and delayed diastolic relaxation associated with stunning and ischemia can be reproduced even at the single muscle fiber level. In addition, ejection fraction (EF) which has been viewed as an important index in assessing the state of the heart, is found to be inadequate for the diagnosis and assessment of heart failure (HF) in differentiation of HF patients with reduced EF (HFrEF) or with preserved EF (HFpEF). Parameters that relate to structural changes whether at fiber or the global levels are found to be most appropriate to quantify the cardiac function, hence for its quantitative diagnosis. Parameters that govern heart-arterial system interaction when the LV is single-loaded with pressure-overloaded LV hypertrophy or double-loaded as in LVH with aortic valve stenosis are also quantified. It is shown that a computational modeling approach can be invaluable in delineating parameters that are critical for quantitative cardiology diagnosis.

BACKGROUND: Quantification of ventricular performance requires a comprehensive metric which is manageable for patient care and clinical trials. Ejection fraction (EF) has been embraced as an attractive candidate. However, being a dimensionless ratio, EF has serious limitations. METHODS: We aim to identify what information is not recognized when limiting the volume-related analysis by exclusively relying on EF. This investigation applies the volume domain concept, relating end-systolic volume (ESV) to end-diastolic volume (EDV). This approach allows graphical identification of the information not covered by EF. Implications for atria, left ventricle (LV) and right ventricle (RV) are investigated in healthy individuals, and cardiac patient groups using various imaging modalities. RESULTS: The Pythagorean theorem indicates that the hypotenuse which relates any {EDV, ESV} combination to EF corresponds with the information not covered by the single metric EF. The impact of the recovered EF companion (EFC) is illustrated in healthy adults (N = 410, LV 2D echocardiography), heart transplant patients (N = 101, LV CT), individuals with heart failure (N = 197, biplane angiocardiography), for the RV with corrected Fallot (N = 124, MRI), diameters for left atrium (N = 49, MRI) and area for right atrium (N = 51, MRI). For any limited EF range we find a spectrum of EFC values, showing that the two metrics contain (partly) independent information, and emphasizing that the sole use of EF only partially conveys the full information available. CONCLUSIONS: The EFC is a neglected companion, containing information which is additive to EF. Analysis based on ESV and EDV is preferred over the use of EF. ispartof: INTERNATIONAL JOURNAL OF CARDIOLOGY vol:270 pages:237-243 ispartof: location:Netherlands status: published

Highlights • Mesorectal-only RT for early rectal cancer requires dedicated planning guidelines. • A multi-centre study was conducted to identify planning objectives. • Robust optimisation objectives for organs at risk are presented., Background and purpose Organ preservation strategies are increasingly being explored for early rectal cancer. This requires revision of target volumes according to disease stage, as well as new guidelines for treatment planning. We conducted an international, multicentre dose planning study to develop robust planning objectives for modern radiotherapy of a novel mesorectal-only target volume, as implemented in the STAR-TReC trial (NCT02945566). Materials and methods The published literature was used to establish relevant dose levels for organ at risk (OAR) plan optimisation. Ten representative patients with early rectal cancer were identified. Treatment scans had mesorectal target volumes as well as bowel cavity, bladder and femoral heads outlined, and were circulated amongst the three participating institutions. Each institution produced plans for short course (SCRT, 5 × 5 Gy) and long course (LCRT, 25 × 2 Gy) treatment, using volumetric modulated arc therapy on different dose planning systems. Optimisation objectives for OARs were established by determining dose metric objectives achievable for ≥90% of plans. Results Sixty plans, all fulfilling target coverage criteria, were produced. The planning results and literature review suggested optimisation objectives for SCRT: V10Gy

BACKGROUND: Osteoarthritis is the most common form of arthritis worldwide and is a major cause of pain and disability in elderly people. The health economic burden of osteoarthritis is increasing commensurate with obesity prevalence and longevity. Osteoarthritis has a strong genetic component but the success of previous genetic studies has been restricted due to insufficient sample sizes and phenotype heterogeneity. METHODS: We undertook a large genome-wide association study (GWAS) in 7410 unrelated and retrospectively and prospectively selected patients with severe osteoarthritis in the arcOGEN study, 80% of whom had undergone total joint replacement, and 11,009 unrelated controls from the UK. We replicated the most promising signals in an independent set of up to 7473 cases and 42,938 controls, from studies in Iceland, Estonia, the Netherlands, and the UK. All patients and controls were of European descent. FINDINGS: We identified five genome-wide significant loci (binomial test p≤5·0×10(-8)) for association with osteoarthritis and three loci just below this threshold. The strongest association was on chromosome 3 with rs6976 (odds ratio 1·12 [95% CI 1·08-1·16]; p=7·24×10(-11)), which is in perfect linkage disequilibrium with rs11177. This SNP encodes a missense polymorphism within the nucleostemin-encoding gene GNL3. Levels of nucleostemin were raised in chondrocytes from patients with osteoarthritis in functional studies. Other significant loci were on chromosome 9 close to ASTN2, chromosome 6 between FILIP1 and SENP6, chromosome 12 close to KLHDC5 and PTHLH, and in another region of chromosome 12 close to CHST11. One of the signals close to genome-wide significance was within the FTO gene, which is involved in regulation of bodyweight-a strong risk factor for osteoarthritis. All risk variants were common in frequency and exerted small effects. INTERPRETATION: Our findings provide insight into the genetics of arthritis and identify new pathways that might be amenable to future therapeutic intervention. FUNDING: arcOGEN was funded by a special purpose grant from Arthritis Research UK.

Background and purpose During cervical cancer treatment, target volumes change position and shape due to organ motion and tumour regression. An MRI-accelerator will provide information on these changes by online magnetic resonance imaging (MRI) guidance throughout each treatment fraction. The purpose of this intensity-modulated radiation therapy (IMRT) planning study is to assess the benefit of online MRI guidance in healthy tissue sparing. Materials and methods Weekly MRI scans of 11 cervical cancer patients were used. We created four IMRT plans per patient, based on these weekly MRI scans, to simulate an online-IMRT approach. We applied a primary and nodal planning target volume (PTV) margin of 4mm. As reference, we created an IMRT plan based on the pre-treatment MRI scan (pre-IMRT) using a primary and nodal PTV margin of 15 and 10mm. The weekly defined bladder, rectum, bowel, and sigmoid contours were evaluated on the online-IMRT and pre-IMRT dose distributions at six dose levels (V10 Gy , V20 Gy , V30 Gy , V40 Gy , V42.8 Gy , and V45 Gy ). Results Online-IMRT compared to pre-IMRT significantly reduced the volume of healthy tissue irradiated to all dose levels, except V10 Gy . Conclusions Online MRI guidance reduces healthy tissue involvement in patients with cervical cancer.

Objective: The authors examined whether personality characteristics such as mastery, self-efficacy, and neuroticism predict the likelihood of recovery of depression among elderly in the community. It was hypothesized that these personality characteristics do predict recovery but that their effect is overwhelmed by the effect of deteriorations in physical health, cognitive decline, and loss of social resources. The second research question investigated whether these personality characteristics moderate the negative impact of the other prognostic factors on the chance of recovery. Methods: A prospective (nine-year) follow-up study of 206 depressed elderly (55ĝ€"85 years at baseline) participants of the Longitudinal Aging Study Amsterdam. Data on chance of recovery were analyzed using Cox proportional regression analyses. Results: Both in the univariate and in the multivariate model, the personality characteristics, especially neuroticism, predicted recovery of depression. The effect of neuroticism was similar to that of physical health and stronger than the impact of cognitive decline or social resources. No support was found for personality as a moderator of the negative impact of age-related stressors. Conclusions: Personality characteristics, i.e., neuroticism and physical health-related variables are separate but equally important domains for the chance of recovery of depression in later life. © 2007 American Association for Geriatric Psychiatry.

This systematic review summarises evidence of the effectiveness of naltrexone (NTX) and the added value of psychosocial treatment in the maintenance treatment of opioid and alcohol dependence. Studies were selected through a literature search conducted in March 2004. Seven opioid and seventeen alcohol studies were identified. When possible, meta-(regression) analyses were performed. There is lack of evidence about the effectiveness of NTX in the maintenance treatment of opioid dependence. There is evidence for the effectiveness and applicability of NTX in the management of alcohol dependence. The opioid studies combined NTX with a variety of psychosocial interventions, which plagued the evaluation of their value. Concomitant psychosocial interventions used in the alcohol studies were mainly cognitive behavioural, which seems to be more effective than NTX combined with supportive therapy. Available data do not allow firm conclusions regarding the added effect of psychosocial interventions. However, the data suggest that a combination of naltrexone with cognitive behavioural relapse prevention therapy is beneficial in alcohol dependent patients.

Hanneke J.M. Kerkhof ⁎, Rik J. Lories , Ingrid Meulenbelt , Ingileif Jonsdottir , Ana M. Valdes , Pascal Arp , Thorvaldur Ingvarsson , Mila Jhamai , Helgi Jonsson , Lisette Stolk , Gudmar Thorleifsson , Guangju Zhai , Feng Zhang , Yanyan Zhu , Ruud van der Breggen , Andrew Carr , Michael Doherty , Sally Doherty , David T. Felson , Antonio Gonzalez , Bjarni V. Halldorsson , Deborah J. Hart , Valdimar B. Hauksson , Albert Hofman , John P.A. Ioannidis , Margreet Kloppenburg , Nancy E. Lane , John Loughlin , Frank P. Luyten , Michael C. Nevitt , Neeta Parimi , Huibert A.P. Pols , Tom van de Putte , Fernando Rivadeneira , Eline P. Slagboom , Unnur Styrkarsdottir , Aspasia Tsezou , Joseph Zmuda , Tim D. Spector , Kari Stefansson , Andre G. Uitterlinden , Joyce B.J. van Meurs a,d

INTEGRATED 1.5 T MRI AND ACCELERATOR: PROOF OF CONCEPT FOR REAL-TIME MRI GUIDED RADIOTHERAPY B. Raaymakers1, J. Lagendijk1, J. Overweg2, J. Kok3, A. Raaijmakers1, E. Kerkhof1, R. van der Put3, I. Meijsing1, S. Crijns1, F. Benedosso3, M. van Vulpen1, N. de Graaff3, J. Allen4, K. Brown4 1 UMC UTRECHT, Department of Radiotherapy, Utrecht, Netherlands 2 PHILIPS, Hamburg, Germany 3 UMC UTRECHT, Utrecht, Netherlands 4 ELEKTA UK LIMITED, Crawley, West Sussex, United Kingdom