Dialyse Centrum Groningen

Biological grafts are proposed as an alternative to synthetic grafts in sacrocolpopexy (SC) to reduce complications such as graft exposure and immunologic reactions. However, concerns remain long-term durability. This systematic review and meta-analysis assess recurrence rates and graft-related complications (GRC) in minimally invasive sacrocolpopexy (MISC) using biological grafts. To evaluate the recurrence and GRC following MISC with biological grafts and to compare outcomes across different materials. PubMed, Embase and Cochrane databases were searched up to August 2024. Studies with ≥ 10 patients undergoing MISC with biological grafts, reporting recurrence or GRC with ≥ 6 months follow-up, were included. Two independent reviewers assessed study quality using the Newcastle-Ottawa Scale (NOS). A random-effects meta-analysis estimated pooled recurrence and GRC with 95% confidence intervals (CI). Five studies (353 patients) met inclusion criteria. Recurrence rates ranged from 2.4% to 52.6% (pooled: 25.6% [95% CI: 8.1%-48.2%]). Graft exposure occurred in 0.8% (95% CI: 0.0%-4.2%). ADM had the lowest recurrence (2.4%) with no reported exposures, whereas Tutoplast cadaveric fascia lata showed the highest recurrence (52.6%) and exposure (5.3%). The pooled reoperation rate for recurrence was 16.8% (95% CI: 0.0%-51.7%). This systematic review identified a higher recurrence rate with biological grafts in MISC than typically reported for synthetic grafts in other literature, while exposure rates appeared to be comparable. Given study heterogeneity, further research is required to determine the optimal graft choice balancing durability and complication risk.

Patient-centered communication together with evidence-based practice is seen as the underlying pillars of shared decision making (SDM). However, the application of patient-centered communication in physiotherapy practice has not yet been studied from an observer-based point of view. The purpose was to determine to what extent physiotherapists use patient-centered communication in the first physiotherapy consultations of people with shoulder problems, and to what extent patient-centered communication is related to the level of SDM. In this secondary analysis, 100 audio-recorded initial physiotherapy consultations with people with shoulder problems, obtained through convenience sampling, were analyzed for the level of patient-centered communication using the Four Habit Coding Scheme (4HCS) (0-100, higher 4HCS scores indicate higher level of patient-centered communication). The relation between the level of patient-centered communication and the SDM was analysed in multiple steps. A total of 100 initial physical therapy consultations of 41 participating physical therapists were included. The mean 4HCS score was 45(range 18-90). The correlation between the 4HCS and the OPTION-5 scores was 0.610(CI95 % 0.470 - 0.720). The four categories in the relation between patient-centered communication and SDM show that the most consultations are in the group of low patient-centered communication and low SDM and that there are only two consultations in the low patient-centered communication and high SDM. Our results show that there is room for improvement in the application of patient-centered communication in physiotherapy practice although physiotherapists do apply patient-centered communication more than SDM. Patient-centered communication does not guarantee the application of SDM, although a higher level of SDM does indicate a higher degree of patient-centered communication. Practice implications This study offers clinical guidance on how to improve the integration of patient's perspective, values, and preferences in the decision making.

Results SLE CD4+ T cells displayed higher mitochondrial mass than HC across nave, CM, EM, and TEMRA-like subsets (figure 1A).CD8+ T cells showed subset-specific reductions (figure 1B).Ex vivo SLE CD4+ T cells had elevated basal and maximal OXPHOS (figure 1C-D), and increased basal and maximal glycolysis (figure 1E-F).Despite higher respiration, spare respiratory capacity was unchanged (figure 1G), while proton leak was increased (figure 1H), uncoupling efficiency reduced (figure 1I), and ATP production higher (figure 1J), indicating a hypermetabolic yet energetically inefficient state with mitochondrial stress.IFN-alpha had minimal effect on basal OXPHOS in HC and reduced glycolytic flux, consistent with context-dependent restraint.In SLE CD4+ T cells, IFN-alpha further increased basal OXPHOS without altering maximal capacity (figure 1K-L) and raised basal glycolysis with unchanged maximal ECAR (figure 1M-N), amplifying baseline bioenergetic demand.Conclusions SLE CD4+ T cells exhibit mitochondrial expansion and a hypermetabolic profile.IFN-alpha selectively augments basal respiratory and glycolytic flux, implicating IFN-I in sustaining pathogenic T cell metabolism.These data support a model in which IFN-driven metabolic reprogramming of CD4+ T cells contribute to SLE pathogenesis and highlight bioenergetic checkpoints as rational targets for immunometabolic intervention.

Patients with Chronic Obstructive Pulmonary Disease (COPD) often experience limited health literacy, hampering health status assessment via standard questionnaires like the Clinical COPD Questionnaire (CCQ). We aimed to develop and validate a modified, literacy-sensitive version, the CCQgraphic (CCQg), for all patients with COPD co-designed with a large stakeholder group. CCQ items were rephrased and complemented with graphics, followed by optimization through semi-structured interviews with patients with limited health literacy. In adequate health literacy (n = 64) concordance of CCQg and CCQ was 0.88 (95% CI: 0.82-0.92). Correlation with the COPD Assessment Test (CAT) was 0.81 (95% CI: 0.70–0.88). Agreement showed a mean bias of 0.22 (95% CI: 0.10–0.34, P < 0.001) with higher scores on mental and functional domains compared to the original CCQ. Test-retest reliability in limited health literacy (n = 25) was high, CCC = 0.93 (95% CI: 0.86–0.97). The majority (88%) rated the CCQg as equal or better to the original. The CCQg offers a validated, literacy-sensitive tool, narrowing the gap in health status assessment for patients with COPD with varying literacy skills.

Surgery for rectal prolapse has long been shaped as much by the heterogeneity of methods and measurements as by true differences between operations.A recent multicenter audit of ventral mesh rectopexy (VMR) demonstrated striking interhospital variation in indication, operative steps, fixation, and peri-operative pathways, underlining how inconsistent reporting and follow-up dilute any comparative inference [1].Against this background, the two recent Controversies in Coloproctology papers, one advocating VMR and the other defending resection rectopexy (RR), should be read less as opposing manifestos than as complementary calls for phenotype-driven, standardized surgery [2,3].

Chikungunya, caused by a mosquito-borne alphavirus, has emerged as a major public health concern due to its expanding geographical range and debilitating health outcomes in affected populations. Although research on chikungunya is growing, variations in the clinical presentation between age groups remain poorly understood. Understanding these variations is crucial for appropriate diagnoses, treatments, and timely prevention efforts. Therefore, this study aims to assess the clinical presentation of chikungunya across age groups and identify age-related differences and similarities. We conducted a systematic literature review (17-09-2024) using Embase, MEDLINE, and gray literature, including a risk of bias assessment (Downs and Black, National Institute of Health). Results were descriptively presented. A total of 101 studies reported clinical outcomes in three age groups: children (<18 years), adults (18-64 years), and the elderly (≥65 years), with fourteen directly comparing age groups. The findings highlight substantial differences in disease presentation. Hospitalization and mortality rates were highest among the elderly and younger children, while faster recovery was reported for older children compared to other age groups. Symptom presentation also varied by age, with rash and headache being more common in adolescents and adults than in younger children and the elderly. Fever was more prevalent among adults and the elderly compared with children. Arthralgia was less commonly reported in children and the elderly than in adults, warranting attention for potential misdiagnosis due to atypical disease presentation. Lastly, the occurrence of chronic chikungunya symptoms appears to increase with age. Yet, the heterogeneity in reporting and scarcity of articles describing clinical features of children and the elderly limit definitive conclusions. Our findings highlight the age-related variations in chikungunya disease presentation, reinforcing the need for tailored diagnostics, clinical management, and prevention strategies in all age groups. By identifying these differences, our study helps guide future research and public health policies aimed at reducing the impact of chikungunya worldwide.

Molar Incisor Hypomineralization (MIH) is a dynamic condition in which demarcated opacities can progress to post-eruptive enamel breakdown, increasing the risk of dental caries. This study aimed to evaluate the clinical and economic impact of late diagnosis of MIH. A total of 803 children aged 6-11years were examined, of whom 172 were diagnosed with MIH and classified into 2 groups based on age at diagnosis: early diagnosis (under 8years) and late diagnosis (8years or older). A treatment plan was developed according to the severity and clinical presentation of MIH in each child, and the associated financial costs were calculated. Children in the late-diagnosis group presented more severe MIH, with a higher prevalence of demarcated opacities, atypical carious lesions, and atypical restorations. Although the estimated overall financial cost of treatment did not differ significantly between groups, a 2-year delay in MIH diagnosis led to more severe clinical presentations and higher expenses from the more complex interventions required. In conclusion, a 2-year delay in the diagnosis of MIH was associated with a more severe clinical presentation, necessitating more complex restorative treatments and leading to increased financial costs related to these treatments.Research Ethics Committee: CAAE 12161019.2.0000.5419, date 29.04.2019.