Summary Objective Determining the relation between acetabular coverage, especially overcoverage which may lead to pincer impingement, and development of osteoarthritis (OA) of the hip. Design From a ...prospective cohort study of 1,002 individuals with symptoms of early OA (Cohort Hip and Cohort Knee, CHECK), 720 participants were included. Standardized anteroposterior pelvic radiographs and false profile lateral radiographs were obtained at baseline and 5 years follow-up. Acetabular undercoverage (mild dysplasia) and overcoverage (pincer deformity) were measured by a centre edge angle of <25° and >40° respectively in both radiographic views. The strength of association between those parameters at baseline and development of incident OA (Kellgren and Lawrence (K&L) grade >2 or total hip replacement), or joint space narrowing within 5 years was expressed in odds ratio (OR) adjusted for K&L grade, age, body mass index (BMI), and sex using generalized estimating equations. Results At baseline, 76% of the included hips had no signs of radiographic OA (K&L = 0) whereas 24% had doubtful OA (K&L = 1). Within 5 years, 7.0% developed incident OA. Acetabular dysplasia was significantly associated with development of incident OA with ORs between 2.62 (95% confidence interval (CI) 1.44–4.77) and 5.45 (95% CI 2.40–12.34), dependent on the radiographic view. A pincer deformity was not associated with any outcome measure, except for a significantly protective effect on incident OA when a pincer deformity was present in both radiographic views OR 0.34 (95% CI 0.13–0.87). Conclusion Acetabular dysplasia was significantly associated with development of OA. However, a pincer deformity was not associated with OA, and might even have a protective effect on its development, which questions the supposed detrimental effect of pincer impingement.
Compassion has been identified as important for therapeutic relationships in clinical medicine however there have been few empirical studies looking at how compassion is expressed different contexts. ...The purpose of this study was to explore how context impacts perceptions and expressions of compassion in the intensive care unit and in palliative care.
This was an inductive qualitative study that employed sensitizing concepts from activity theory, realist inquiry, phenomenology and autoethnography. Clinicians working in intensive care units and palliative care services wrote guided field notes on their observations and experiences of how suffering and compassion were expressed in these settings. Data were analyzed using constructivist grounded theory.
Fifty-eight field notes were generated, along with transcripts from three focus groups. Clinicians conceptualized, observed, and expressed compassion in different ways within different contexts. Patterns of compassion identified were relational, dispositional, activity-focused, and situational. A pattern language of compassion in healthcare was developed based on these findings.
Recognizing compassion as shifting patterns of diverse attitudes, behaviours, and relationships raises numerous questions as to how compassion can be developed, supported and recognized in different clinical settings.
Summary Objective To investigate differences in MRI features between two etiologically distinct subtypes of knee osteoarthritis (OA): one group with metabolic syndrome and one lean group with ...frequent physical activity. Methods We included two groups of 50 subjects of the Osteoarthritis Initiative (OAI) incidence subcohort, with KL ≥ 2 in at least one knee at 48 months follow-up. Inclusion criteria for the metabolic syndrome group were a body mass index (BMI) ≥ 30 kg/m2 and two out of three of the following criteria: hypertension (RR > 130/85 mm Hg or hypertension medication), insulin resistance (high blood sugar or diabetic medication) or dyslipidemia (lipid lowering medication). Inclusion criteria for the active lean group were a BMI < 25 kg/m2 and a Physical Activity Scale for the Elderly (PASE) score ≥ 2. MRI scans were scored using MR Imaging Osteoarthritis Knee Score (MOAKS). Differences in MOAKS items between groups were tested using generalized linear models adjusted for sex and age. Results Scores for cartilage damage were significantly higher in the patella, trochlea and lateral femur in the metabolic syndrome group. Osteophyte scores were higher for all compartments in the metabolic syndrome group, though only significant for the patella, trochlea and medial tibia. Hoffa synovitis was significantly more prevalent in the active lean group while prepatellar bursa signal was more prevalent in the metabolic syndrome group. Conclusion Metabolic OA and OA related to physical activity showed differences in MRI features, depending on knee compartment. These results show that different etiological processes in knee OA can lead to differences in structural degradation.
Parents of preterm neonates wish greater involvement in pain management; little is known about factors associated with this involvement. We aim to describe perceived maternal information on infants' ...pain during hospitalization (PMIP), to study associations between PMIP and mothers' attitudes during painful procedures, and to identify individual and contextual factors associated with PMIP.
Analyses of questionnaires from the French national cohort study of preterm neonates, EPIPAGE-2. PMIP was derived from mothers' answers to questions about information perceived on both pain assessment and management.
Among 3056 eligible neonates born before 32 weeks, 1974, with available maternal reports, were included in the study. PMIP was classified as "sufficient," "little, not sufficient," or "insufficient, or none" for 22.7, 45.9, and 31.3% of neonates, respectively. Mothers reporting PMIP as "sufficient" were more frequently present and more likely comforting their child during painful procedures. Factors independently associated with "sufficient" PMIP were high maternal education, gestational age <29 weeks, daily maternal visits, perception of high team support, and implementation of the neonatal and individualized developmental care and assessment program.
Perceived maternal information on premature infants' pain reported as sufficient increased maternal involvement during painful procedures and was associated with some units' policies.
Adult granulosa cell tumor (AGCT) is a rare ovarian cancer subtype, with a peak incidence around 50–55 years. Although AGCT can occur in specific syndromes, a genetic predisposition for AGCT has not ...been identified. The aim of this study is to identify a genetic variant in families with AGCT patients, potentially contributing to tumor evolution. We identified four families, each including two women diagnosed with AGCT. Whole-genome sequencing was performed to identify overlapping germline variants or affected genes. Familial relationship was evaluated using genealogy and genomic analyses. Patient characteristics, medical (family) history, and pedigrees were collected. Findings were compared to a reference group of 33 unrelated AGCT patients. Mean age at diagnosis was 38 years (range from 17 to 60) versus 51 years in the reference group, and seven of eight patients were premenopausal. In two families, three first degree relatives were diagnosed with breast cancer. Furthermore, polycystic ovary syndrome (PCOS) and subfertility was reported in three families. Predicted deleterious variants in PIK3C2G, BMP5, and LRP2 were identified. In conclusion, AGCTs occur in families and could potentially be hereditary. In these families, the age of AGCT diagnosis is lower and cases of breast cancer, PCOS, and subfertility are present. We could not identify an overlapping genetic variant or affected locus that may explain a genetic predisposition for AGCT.
The effect of towns on plant phenology, i.e. advancement of spring development compared with a rural environment, via the urban heat island (UHI) phenomenon, has been shown for many towns in many ...countries. This work combines experimental and observational methodology to provide a better and deeper view of climatic habitat in an urban context with a view to understanding the relationship between plant development and urban climate on the intra-urban scale (by taking into account town structure). A dense network of 17 meteorological stations was set up in Rennes, France, enabling us to identify and quantify climatic changes associated with the UHI. Meanwhile, phenological observations were made during early spring (March and April) in 2005 on Platanus acerifolia and Prunus cerasus to study the relationship between climatic and phenological data. The results show that there is both a climatic gradient and a developmental gradient corresponding to the type of urbanisation in the town of Rennes. The town influences plant phenology by reducing the diurnal temperature range and by increasing the minimum temperature as one approaches the town centre. The influence of ground cover type (plants or buildings) on development is also shown. The developmental phases of preflowering and flowering are influenced to differing extents by climatic variables. The period during which climatic variables are effective before a given developmental phase varies considerably. The preflowering phases are best correlated with the mean of the minimum air temperature for the 15-day period before the observation, whereas flowering appears to be more dependent on the mean of the daily diurnal temperature range for the 8 days preceding the observation.
Cost-Effectiveness of Early Irbesartan Treatment Versus Control (Standard Antihypertensive Medications Excluding ACE Inhibitors,
Other Angiotensin-2 Receptor Antagonists, and Dihydropyridine Calcium ...Channel Blockers) or Late Irbesartan Treatment in Patients
With Type 2 Diabetes, Hypertension, and Renal Disease
Andrew J. Palmer , BSC, MBBS 1 ,
Lieven Annemans , PHD 2 3 ,
Stéphane Roze , MS 1 ,
Mark Lamotte , MD 2 ,
Pablo Lapuerta , MD 4 ,
Roland Chen , MD 4 ,
Sylvie Gabriel , MD 5 ,
Paulo Carita , PHD 5 ,
Roger A. Rodby , MD 6 ,
Dick de Zeeuw , MD, PHD 7 and
Hans-Henrik Parving , MD 8
1 CORE-Center for Outcomes Research, Binningen/Basel, Switzerland
2 HEDM, Health Economics and Disease Management, Meise, Belgium
3 Ghent University, Ghent, Belgium
4 Pharmaceutical Research Institute, Bristol-Myers Squibb, Princeton, New Jersey
5 Sanofi-Synthelabo, Bagneux, France
6 Rush University Medical Center, Chicago, Illinois
7 Department of Clinical Pharmacology, University Medical Center, Groningen, the Netherlands
8 Steno Diabetes Center, Gentofte, Denmark
Address correspondence and reprint requests to Dr. Andrew J. Palmer, CORE-Center for Outcomes Research, Buendtenmattstrasse
40, 4102 Binningen/Basel, Switzerland. E-mail: ap{at}thecenter.ch
Abstract
OBJECTIVE —The aim of this study was to determine the most cost-effective time point for initiation of irbesartan treatment in hypertensive
patients with type 2 diabetes and renal disease.
RESEARCH DESIGN AND METHODS —This study was a Markov model–simulated progression from microalbuminuria to overt nephropathy, doubling of serum creatinine,
end-stage renal disease, and death in hypertensive patients with type 2 diabetes. Two irbesartan strategies were created:
early irbesartan 300 mg daily (initiated with microalbuminuria) and late irbesartan (initiated with overt nephropathy). These
strategies were compared with control, which consisted of antihypertensive therapy with standard medications (excluding ACE
inhibitors, other angiotensin-2 receptor antagonists, and dihydropyridine calcium channel blockers) with comparable blood
pressure control, initiated at microalbuminuria. Transition probabilities were taken from the Irbesartan in Reduction of Microalbuminuria-2
study, Irbesartan in Diabetic Nephropathy Trial, and other published sources. Costs and life expectancy, discounted at 3%
yearly, were projected over 25 years for 1,000 simulated patients using a third-party payer perspective in a U.S. setting.
RESULTS —Compared with control, early and late irbesartan treatment in 1,000 patients were projected to save (mean ± SD) $11.9 ± 3.3
million and $3.3 ± 2.7 million, respectively. Early use of irbesartan added 1,550 ± 270 undiscounted life-years (discounted
960 ± 180), whereas late irbesartan added 71 ± 40 life-years (discounted 48 ± 27) in 1,000 patients. Early irbesartan treatment
was superior under a wide-range of plausible assumptions.
CONCLUSIONS —Early irbesartan treatment was projected to improve life expectancy and reduce costs in hypertensive patients with type 2
diabetes and microalbuminuria. Later use of irbesartan in overt nephropathy is also superior to standard care, but irbesartan
should be started earlier and continued long term.
DSC, doubling of serum creatinine
ESRD, end-stage renal disease
IDNT, Irbesartan in Diabetic Nephropathy Trial
IRMA-2, Irbesartan in Reduction of Microalbuminuria-2
UAE, urinary albumin excretion
Footnotes
A.J.P. and S.R. have received consulting fees and grant/research support from Bristol-Myers Squibb, Sanofi-Synthélabo, Eli
Lilly, Novo Nordisk, Merck-Santé, Amgen, Amylin, Medtronic, Coloplast, and Janssen. L.A. has received grant support from Sanofi-Synthélabo.
R.A.R. has received honoraria and consulting fees from Sanofi-Synthélabo and Bristol-Myers Squibb. D.D.Z. has received honoraria
from BMS-Sanofi. H.-H.P. is on an advisory board for Sanofi-Synthélabo; has received honoraria/consulting fees from Sanofi-Synthélabo,
Merck, BMS, and Pfizer; and has received grant support from Sanofi-Synthélabo.
U.S.-specific ESRD data have been taken from the U.S. Renal Data System. The interpretation and reporting of these data are
the responsibility of the authors and in no way should be seen as an official policy or interpretation of the U.S. government.
Additional information for this article can be found in an online appendix at
http://care.diabetesjournals.org .
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
Accepted May 5, 2004.
Received February 3, 2004.
DIABETES CARE
We report two cases of Guillain-Barré syndrome who had concomitant Zika virus viruria. This viruria persisted for longer than 15 days after symptom onset. The cases occurred on Martinique in January ...2016, at the beginning of the Zika virus outbreak. Awareness of this possible neurological complication of ZikV infection is needed.
Species diversity can vary dramatically across lineages due to differences in speciation and extinction rates. Here, we explore the effects of several plant traits on diversification, finding that ...most traits have opposing effects on diversification. For example, outcrossing may increase the efficacy of selection and adaptation but also decrease mate availability, two processes with contrasting effects on lineage persistence. Such opposing trait effects can manifest as differences in diversification rates that depend on ecological context, spatiotemporal scale, and associations with other traits. The complexity of pathways linking traits to diversification suggests that the mechanistic underpinnings behind their correlations may be difficult to interpret with any certainty, and context dependence means that the effects of specific traits on diversification are likely to differ across multiple lineages and timescales. This calls for taxonomically and context-controlled approaches to studies that correlate traits and diversification.
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Biological sciences; Evolutionary biology; Evolutionary theories; Plant biology; Plant population biology
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