Background Despite the increasing use of pre- and post-hydration protocols and low osmolar instead of high osmolar iodine containing contrast media, the incidence of contrast induced nephropathy ...(CIN) is still significant. There is evidence that contrast media cause ischemia reperfusion injury of the renal medulla. Remote ischemic preconditioning (RIPC) is a non-invasive, safe, and low cost method to reduce ischemia reperfusion injury. The aim of this study is to investigate whether RIPC, as an adjunct to standard preventive measures, reduces contrast induced acute kidney injury in patients at risk of CIN. Methods The RIPCIN study is a multicenter, single blinded, randomized controlled trial in which 76 patients at risk of CIN received standard hydration combined with RIPC or hydration with sham preconditioning. RIPC was applied by four cycles of 5 min ischemia and 5 min reperfusion of the forearm. The primary outcome measure was the change in serum creatinine from baseline to 48 to 72 hours after contrast administration. Results With regard to the primary endpoint, no significant effect of RIPC was found. CIN occurred in four patients (2 sham and 2 RIPC). A pre-defined subgroup analysis of patients with a Mehran risk score ≥11, showed a significantly reduced change in serum creatinine from baseline to 48 to 72 hours in patients allocated to the RIPC group (Δ creatinine −3.3 ± 9.8 μmol/L) compared with the sham group (Δ creatinine +17.8 ± 20.1 μmol/L). Conclusion RIPC, as an adjunct to standard preventive measures, does not improve serum creatinine levels after contrast administration in patients at risk of CIN according to the Dutch guideline. However, the present data indicate that RIPC might have beneficial effects in patients at a high or very high risk of CIN (Mehran score ≥ 11). The RIPCIN study is registered at: http://www.controlled-trials.com/ISRCTN76496973
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
International guidelines recommend supervised exercise therapy (SET) as primary treatment for all patients with intermittent claudication (IC), yet primary endovascular revascularisation (ER) might ...be more effective in patients with iliac artery obstruction.
This was a multicentre RCT including patients with IC caused by iliac artery stenosis or occlusion (NCT01385774). Patients were allocated randomly to SET or ER stratified for maximum walking distance (MWD) and concomitant SFA disease. Primary endpoints were MWD on a treadmill (3.2 km/h, 10% incline) and disease specific quality of life (VascuQol) after one year. Additional interventions during a mean follow up of 5.5 years were recorded.
Between November 2010 and May 2015, 114 patients were allocated to SET, and 126 to ER. The trial was terminated prematurely after 240 patients were included. Compliance with SET was 57/114 (50%) after six months. Ten patients allocated to ER (8%) did not receive this intervention. One year follow up was complete for 90/114 (79%) SET patients and for 104/126 (83%) ER patients. The mean MWD improved from 187 to 561 m in SET patients and from 196 to 574 m in ER patients (p = .69). VascuQol sumscore improved from 4.24 to 5.58 in SET patients, and from 4.28 to 5.88 in ER patients (p = .048). Some 33/114 (29%) SET patients had an ER within one year, and 2/114 (2%) surgical revascularisation (SR). Some 10/126 (8%) ER patients had additional ER within one year and 10/126 (8%) SR. After a mean of 5.5 years, 49% of SET patients and 27% of ER patients underwent an additional intervention for IC.
Taking into account the many limitations of the SUPER study, both a strategy of primary SET and primary ER improve MWD on a treadmill and disease specific Qol of patients with IC caused by an iliac artery obstruction. It seems reasonable to start with SET in these patients and accept a 30% failure rate, which, of course, must be discussed with the patient. Patients continue to have interventions beyond one year.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The Millennium Run Observatory: first light Overzier, R; Lemson, G; Angulo, R. E ...
Monthly Notices of the Royal Astronomical Society,
2013, Volume:
428, Issue:
1
Journal Article
Peer reviewed
Open access
Simulations of galaxy evolution aim to capture our current understanding as well as to make predictions for testing by future experiments. Simulations and observations are often compared in an ...indirect fashion: physical quantities are estimated from the observational data and compared to models. However, many applications can benefit from a more direct approach, where the observing process is also simulated, so that the models are seen fully from the observer's perspective. To facilitate this, we have developed the Millennium Run Observatory (MRObs), a theoretical virtual observatory which uses virtual telescopes to 'observe' semi-analytic galaxy formation simulations based on the suite of Millennium Run (MR) dark matter simulations. The MRObs produces data that can be processed and analysed using the standard observational software packages developed for real observations. At present, we produce images in 40 filters covering the rest-frame ultraviolet to infrared for two stellar population synthesis models, for three different models of absorption by the intergalactic medium, and in two cosmologies (Wilkinson Microwave Anisotropy Probe year 1 and 7). Galaxy distributions for a large number of mock light cones can be 'observed' using models of major ground- and space-based telescopes. The data include light cone catalogues linked to structural properties of galaxies, pre-observation model images, mock telescope images and Source Extractor products that can all be traced back to the higher level dark matter, semi-analytic galaxy and light cone catalogues available in the MR data base. Here, we describe our methods and announce a first public release of simulated observations that emulate a large number of extragalactic surveys e.g. Sloan Digital Sky Survey, Canada-France-Hawaii Telescope Legacy Survey (CFHT-LS), Great Observatories Origins Deep Survey (GOODS), GOODS/Early Release Science (ERS), Cosmic Assembly Near-Infrared Deep Extragalactic Legacy Survey (CANDELS) and Hubble Ultra Deep Field (HUDF). The MRObs browser, an online tool, further facilitates exploration of the simulated data. We demonstrate the benefits of a direct approach through a number of example applications: (1) deep galaxy number counts in the CANDELS survey; (2) observed properties of galaxy clusters; (3) structural parameters of galaxies; and (4) identification of dropout galaxies. The MRObs enhances the range of questions that can be asked of semi-analytic models, allowing observers and theorists to work towards each other with virtually complete freedom of where to meet.
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BFBNIB, FZAB, GIS, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
The aim of this study was to identify risk factors for 90 day death after elective open surgical repair (OSR) of abdominal aortic aneurysms (AAAs) in women.
This was a multicentre case control study. ...The nationwide Dutch Surgical Aneurysm Audit registry (2013–2019) was solely used to identify women who underwent elective OSR as eligible patients. Data for this study were subsequently collected from the patients’ medical files. Women with AAA were included and those who died (cases) were compared with those who survived (controls) 90 days after surgery. Inflammatory, mycotic, or symptomatic or ruptured AAA were excluded. The association between pre- and peri-operative risk factors and death was assessed by logistic regression analysis in the whole sample and after matching cases to controls of the same age at the time of repair. Mesenteric artery patency was also assessed on pre-operative computed tomography and used in the analysis.
In total, 266 patients (30 cases and 236 controls) from 21 hospitals were included. Cases were older (median interquartile range; IQR 75 years 71, 78.3 vs. 71 years 66, 77; p = .002) and more often had symptomatic peripheral arterial disease (PAD) (14/29 48% vs. 49/227 22%; p = .002). Intra-operative blood loss (median IQR 1.6 L 1.1, 3.0 vs. 1.2 L 0.7, 1.8), acute myocardial infarction (AMI) (10/30 33% vs. 8/236 3%), renal failure (17/30 57% vs. 33/236 14%), and bowel ischaemia (BI) (17/29 59% vs. 12/236 5%) were more prevalent among cases. Older age (odds ratio OR 1.11, 95% confidence interval CI 1.03–1.19) and PAD (OR 3.91, 95% CI 1.57–9.74) were associated with death. Multivariable analysis demonstrated that, after adjustment for age, AMI (OR 9.34, 95% CI 1.66–52.4) and BI (OR 35.6, 95% CI 3.41–370) were associated with death. Superior mesenteric artery stenosis of >70% had a clinically relevant association with BI (OR 5.23, 95% CI 1.43–19.13; p = .012).
Age, symptomatic PAD, AMI, and BI were risk factors for death after elective OSR in women. The association between a >70% SMA stenosis and BI may call for action in selected cases.
•Identifying risk factors for death after elective open abdominal aortic aneurysm repair in women.•Older age and symptomatic peripheral artery disease are associated with death.•Acute myocardial infarction and bowel ischaemia (BI) also increase mortality risk.•Superior mesenteric artery stenosis seems to be a clinically relevant factor for BI.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
We present the public data release of halo and galaxy catalogues extracted from the eagle suite of cosmological hydrodynamical simulations of galaxy formation. These simulations were performed with ...an enhanced version of the gadget code that includes a modified hydrodynamics solver, time-step limiter and subgrid treatments of baryonic physics, such as stellar mass loss, element-by-element radiative cooling, star formation and feedback from star formation and black hole accretion. The simulation suite includes runs performed in volumes ranging from 25 to 100 comoving megaparsecs per side, with numerical resolution chosen to marginally resolve the Jeans mass of the gas at the star formation threshold. The free parameters of the subgrid models for feedback are calibrated to the redshift z=0 galaxy stellar mass function, galaxy sizes and black hole mass–stellar mass relation. The simulations have been shown to match a wide range of observations for present-day and higher-redshift galaxies. The raw particle data have been used to link galaxies across redshifts by creating merger trees. The indexing of the tree produces a simple way to connect a galaxy at one redshift to its progenitors at higher redshift and to identify its descendants at lower redshift. In this paper we present a relational database which we are making available for general use. A large number of properties of haloes and galaxies and their merger trees are stored in the database, including stellar masses, star formation rates, metallicities, photometric measurements and mock gri images. Complex queries can be created to explore the evolution of more than 105 galaxies, examples of which are provided in the Appendix. The relatively good and broad agreement of the simulations with a wide range of observational datasets makes the database an ideal resource for the analysis of model galaxies through time, and for connecting and interpreting observational datasets.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Gold standard must be solid gold de Boode, W. P.; Vrancken, S. L.; Lemson, J. ...
Intensive care medicine,
07/2013, Volume:
39, Issue:
7
Journal Article
Peer reviewed
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We study the biasing relation between dark matter haloes or galaxies and the underlying mass distribution, using cosmological N-body simulations in which galaxies are modelled via semi-analytic ...recipes. The non-linear, stochastic biasing is quantified in terms of the mean biasing function and the scatter about it as a function of time, scale and object properties. The biasing of galaxies and haloes shows a general similarity and a characteristic shape, with no galaxies in deep voids and a steep slope in moderately underdense regions. At a comoving scale of ∼8h−1Mpc, the non-linearity in the biasing relation is typically ≲10per cent and the stochasticity is a few tens of per cent, corresponding to ∼30per cent variations in the cosmological parameter β=Ω0.6/b Biasing depends weakly on halo mass, galaxy luminosity, and scale. The observed trend with luminosity is reproduced when dust extinction is included. The time evolution is rapid, with the mean biasing larger by a factor of a few at z∼3 compared with z= 0, and with a minimum for the non-linearity and stochasticity at an intermediate redshift. Biasing today is a weak function of the cosmological model, reflecting the weak dependence on the power-spectrum shape, but the time evolution is more cosmology-dependent, reflecting the effect of the growth rate. We provide predictions for the relative biasing of galaxies of different type and colour, to be compared with upcoming large redshift surveys. Analytic models in which the number of objects is conserved underestimate the evolution of biasing, while models that explicitly account for merging provide a good description of the biasing of haloes and its evolution, suggesting that merging is a crucial element in the evolution of biasing.
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BFBNIB, FZAB, GIS, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
We evaluate nationwide perioperative outcomes of complex EVAR and assess the volume-outcome association of complex EVAR.
Endovascular treatment with fenestrated (FEVAR) or branched (BEVAR) endografts ...is progressively used for excluding complex aortic aneurysms (complex AAs). It is unclear if a volume-outcome association exists in endovascular treatment of complex AAs (complex EVAR).
All patients prospectively registered in the Dutch Surgical Aneurysm Audit who underwent complex EVAR (FEVAR or BEVAR) between January 2016 and January 2020 were included. The effect of annual hospital volume on perioperative mortality was examined using multivariable logistic regression analyses. Patients were stratified into quartiles based on annual hospital volume to determine hospital volume categories.
We included 694 patients (539 FEVAR patients, 155 BEVAR patients). Perioperative mortality following FEVAR was 4.5% and 5.2% following BEVAR. Postoperative complication rates were 30.1% and 48.7%, respectively. The first quartile hospitals performed <9 procedures/yr; second, third, and fourth quartile hospitals performed 9-12, 13-22, and ≥23 procedures/yr. The highest volume hospitals treated the significantly more complex patients. Perioperative mortality of complex EVAR was 9.1% in hospitals with a volume of < 9, and 2.5% in hospitals with a volume of ≥13 (P = 0.008). After adjustment for confounders, an annual volume of ≥13 was associated with less perioperative mortality compared to hospitals with a volume of < 9.
Data from this nationwide mandatory quality registry shows a significant effect of hospital volume on perioperative mortality following complex EVAR, with high volume complex EVAR centers demonstrating lower mortality rates.
To compare cost effectiveness of endovascular revascularisation (ER) and supervised exercise therapy (SET) as primary treatment for patients with intermittent claudication (IC) due to iliac artery ...obstruction.
Cost utility analysis from a restricted societal perspective and time horizon of 12 months. Patients were included in a multicentre randomised controlled trial (SUPER study, NCT01385774, NTR2648) which compared effectiveness of ER and SET. Health status and health related quality of life (HRQOL) were measured using the Euroqol 5 dimensions 3 levels (EQ5D-3L) and VascuQol-25-NL. Incremental costs were determined per allocated treatment and use of healthcare during follow up. Effectiveness of treatment was determined in quality adjusted life years (QALYs). The difference between treatment groups was calculated by an incremental cost utility ratio (ICER).
Some 240 patients were included, and complete follow up was available for 206 patients (ER 111 , SET 95). The mean costs for patients allocated to ER were €4 031 and €2 179 for SET, a mean difference of €1 852 (95% bias corrected and accelerated bca bootstrap confidence interval 1 185 – 2 646). The difference in QALYs during follow up was 0.09 (95% bcaCI 0.04 – 0.13) in favour of ER. The ICER per QALY was €20 805 (95% bcaCI 11 053 – 45 561). The difference in VascuQol sumscore was 0.64 (95% bcaCI 0.39 – 0.91), again in favour of ER.
ER as a primary treatment, results in slightly better health outcome and higher QALYs and HRQOL during 12 months of follow up. Although these differences are statistically significant, clinical relevance must be discussed due to the small differences and relatively high cost of ER as primary treatment.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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