Medisch Centrum Leeuwarden

Follow-up of radiologically suspicious lung nodules from screening programs remains complex and unstandardized. This study analyses distribution and characteristics of solid and part-solid non-calcified nodules ≥100mm3 and non-solid nodules ≥8mm detected at baseline in the UK Lung cancer Screening (UKLS) trial, with insights into their relationship to screen-detected lung cancers. UKLS participants with baseline indeterminate and positive lung nodules were included. Nodule location was categorized by lobe and by attachment: intraparenchymal, juxta pleural or pleural-based. Solid and part-solid were classified based on semi-automated volume: 100-300mm3 and ≥300mm3, and non-solid nodules based on diameter ≥8mm. This measurement approach aligns with UKLS protocol and the British Thoracic Society (BTS) guideline. Their relationship to screen-detected lung cancer was based on histological outcomes after a 2-year follow-up period. 279 UKLS participants with 373 solid or part-solid lung nodules ≥100mm3 and 57 participants with 62 nonsolid nodules ≥8mm were included. Among solid and part-solid nodules, 233 were 100-300mm3, with 39.5% in upper lobes and 72.5% intraparenchymal; 140 nodules were ≥300mm3, with 51.4% in upper lobes and 53.6% intraparenchymal. Nodules ≥300mm3 group were more likely to be in the upper lobes (OR 1.97 [95% CI 1.12-3.48]). Within 2years, 34 solid or part-solid nodules were diagnosed as lung cancer, yielding a 2-year cancer probability of 9.1% (95% CI 6.6-12.5). The 2-year lung cancer probability was higher in nodules ≥300mm3 (RR 18.1, 95% CI 5.6-58.4; p<0.001) and in upper lobe nodules (RR 2.7, 95% CI 1.3-5.5; p=0.009). Solid and part-solid nodules with volume ≥300mm3 were more often found in the upper lobes and were associated with a higher probability of lung cancer within a two-year follow-up period.

Introduction. The surgery‑first approach is increasingly used in orthognathic surgery as an alternative to conventional treatment sequencing. By performing skeletal correction at the beginning of therapy, this method allows for an immediate improvement in facial aesthetics.Aim. This study aims to present the surgery‑first approach in the management of skeletal anterior jaw discrepancies, focusing on its aesthetic outcomes as well as its benefits and limitations.Material and methods. A literature review was conducted using PubMed and Google Scholar, following descriptors: facial aesthetics, facial profile, surgery- first approach, orthognathic surgery, and skeletal class III malocclusion. Articles published in English and Polish between 2021 and 2025 were included.Results. The literature review showed that the surgery‑first approach provides immediate improvement in facial profile aesthetics, shortens overall treatment time, and maintains stable postoperative outcomes.Conclusions. The surgery‑first approach is a promising alternative to conventional treatment, particularly with regard to facial aesthetics and early patient satisfaction.

Abstract. A multi-year analysis of aerosol optical depth (AOD, τ) and Ångström exponent (α) was conducted using ground-based photometer data from 15 Arctic and 11 Antarctic sites. Extending the dataset of (Tomasi et al., 2015) through December 2024, the study incorporates stellar and lunar photometric observations to fill data gaps during the polar night. Daily mean values of τ at 0.500 µm and α (0.440–0.870 µm) were used to derive monthly means and seasonal histograms. In the Arctic, persistent haze events in winter and early spring lead to peak τ values. A decreasing trend in Arctic τ suggests the impact of European emission regulations, while biomass-burning aerosols are becoming more significant. In Antarctica, τ increases from the plateau to the coast. Fine-mode aerosols dominate in summer-autumn, while coarse-mode particles are more prevalent in winter-spring. Shipborne photometer data align well with ground-based measurements, confirming the reliability of mobile observations. Trend analyses using the Mann-Kendall test and Theil-Sen regression indicate a significant negative trend in τ at Andenes (−2.43 % per year), likely driven by reduced anthropogenic emissions. Antarctic stations such as Syowa and South Pole show positive trends (+3.84 % and +3.54 % per year), though these are subject to uncertainties from data limitations and instrument changes. This work contributes to the Polar-AOD network (https://polaraod.net/, last access: 15 May 2025), enhancing the understanding of aerosol variability and long-term trends in polar regions while promoting open data access for the scientific community.

Reducing AF-related symptoms and improving health-related quality of life (HRQoL) are important drivers in the decision for pulmonary vein isolation (PVI) in treating symptomatic atrial fibrillation (AF). We assessed the association between various patient characteristics, intervention, and outcome variables, and HRQoL both prior to and one year after PVI, with specific attention to groups that did not improve or were still impaired in HRQoL post PVI. Observational, retrospective multicenter cohort study within 8hospitals participating in the Netherlands Heart Registration (NHR). Patients who underwent PVI between 2016 and 2019 and completed the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire both prior to and one year after were included. Accepted cut-off values for impaired HRQoL and clinically important difference (CID) were used. Mean AFEQT score (n = 2,534) was 55.6 ± 19.7 prior to intervention and 79.8 ± 20.2 after. Post-PVI, 39.5% of the population was still impaired in HRQoL (< 80points), and 19.2% failed to achieve CID (delta ≥ 5points). Lower baseline AFEQT-score (odds ratio [OR], 0.96 [per 1‑point increase]; 95% CI, 0.96-0.97; p < 0.001) and female sex (odds ratio [OR], 1.42; 95% CI, 1.16-1.75; p < 0.001) were the most prominent related factors with impaired HRQoL post-PVI. Higher baseline AFEQT-score (odds ratio [OR], 1.04 [per 1‑point increase]; 95% CI, 1.04-1.05; p < 0.001) was strongly associated with failure to achieve CID. Despite amajor increase in HRQoL across the population, over one-third of patients were still impaired in HRQoL post-PVI. Multiple factors were identified that may guide counselling of AF patients about treatment choice.

BackgroundPhysical activity (PA) is associated with improved overall survival (OS) among colorectal cancer (CRC) patients, but research on PA changes after diagnosis remains limited. This study examines associations between OS and changes in PA from CRC diagnosis onward, across stage- and treatment-related subgroups.MethodsData were analyzed from patients in two large CRC cohorts (PLCRC and COLON) enrolled between August 2010 and December 2022 (follow-up until February 1st, 2024). This included 3395 stage I–IIA patients who underwent surgery only, 2406 stage IIB/C–III patients who received (neo-)adjuvant therapy, and 669 metastatic CRC (mCRC) patients. PA was assessed via the validated SQUASH questionnaire at diagnosis (T0), and at 6, 12, and 24 months post-diagnosis (T6 to T24). Moderate-to-vigorous-intensity recreational activity was quantified by calculating Metabolic Equivalent of Task (MET) hours per week. Associations with OS were examined for change (active [tertile 2 and 3] vs inactive [tertile 1]) between timepoints using multivariable Cox proportional hazards models.ResultsAmong surgery-only patients, change from inactivity to activity between T0 and T6 was significantly associated with OS (HR = 0.58, 95% CI = 0.35 to 0.96). For (neo-)adjuvantly treated patients, significant associations were observed between T6 and T12 (HR = 0.53, 95% CI = 0.31 to 0.90). Among mCRC patients, a significant association was observed between T6 and T12 (HR = 0.53, 95% CI = 0.29 to 0.99).ConclusionChanging from inactivity to activity is significantly associated with prolonged survival during the early months post-diagnosis for surgery-only CRC patients, and later for those undergoing (neo-)adjuvant therapy or with metastatic disease. Validation is warranted in interventional studies.

Case:Drug-induced fever is a rare adverse reaction to antibiotics. This case report describes 2 cases of suspected rifampicin-induced fever in patients undergoing periprosthetic joint infection treatment. Both patients experienced fever with the absence of inflammatory symptoms and a discrepancy between clinical improvement and persistent fever. Discontinuation of rifampicin led to rapid symptom resolution.Conclusion:Drug-induced fever should be considered when fever persists without infectious symptoms and after excluding other causes. Prompt recognition and discontinuation can lead to rapid resolution and minimize unnecessary interventions.

<strong class="journal-contentHeaderColor">Abstract.</strong> A multi-year analysis of aerosol optical depth (AOD, &tau;) and Ångström exponent (&alpha;) was conducted using ground-based photometer data from 15 Arctic and 11 Antarctic sites. Extending the dataset of Tomasi et al. 2015 through December 2024, the study incorporates stellar and lunar photometric observations to fill data gaps during the polar night. Daily mean values of &tau; at 0.500 <em>&mu;</em>m and &alpha; (0.440&ndash;0.870 <em>&mu;</em>m) were used to derive monthly means and seasonal histograms. In the Arctic, persistent haze events in winter and early spring lead to peak &tau; values. A decreasing trend in Arctic &tau; suggests the impact of European emission regulations, while biomass-burning aerosols are becoming more significant. In Antarctica, &tau; increases from the plateau to the coast. Fine-mode aerosols dominate in summer-autumn, while coarse-mode particles are more prevalent in winter-spring. Shipborne photometer data align well with ground-based measurements, confirming the reliability of mobile observations. Trend analyses using the Mann-Kendall test and Theil-Sen regression indicate a significant negative trend in &tau; at Andenes (-2.43 % per year), likely driven by reduced anthropogenic emissions. Antarctic stations such as Syowa and South Pole show positive trends (+3.84 % and +3.54 % per year), though these are subject to uncertainties from data limitations and instrument changes. This work contributes to the Polar-AOD network (<a href="https://polaraod.net/" target="_blank" rel="noopener">https://polaraod.net/</a>; last access 15/05/2025), enhancing the understanding of aerosol variability and long-term trends in polar regions while promoting open data access for the scientific community.

BackgroundPain assessment is a necessary step in pain management in older people in palliative care. In older people, pain assessment can be challenging due to underreporting and atypical pain manifestations by other distressing symptoms. Anxiety, fatigue, loss of appetite, nausea, insomnia, dyspnoea, and bowel problems correlate with pain in palliative care patients. Insight into these symptoms as predictors may help to identify the underlying presence of pain. This study aimed to develop and test a prediction model for pain in community-dwelling frail older people in palliative care.MethodsIn this cross-sectional observational study, community-care nurses from multiple organizations across the Netherlands included eligible patients (life expectancy < 1 year, aged 65+, community-dwelling and frail). The outcome pain and symptoms were assessed by means of the Utrecht Symptom Diary. Also, demographic and illness information, including relevant covariates age, sex and living situation, was collected. Multivariable logistic regression and minimum Akaike Information Criterion(AIC) were used for model development and Receiver Operating Characteristics(ROC)-analysis for model performance. Additionally, predicted probability of pain are given for groups differing in age and sex.ResultsA total of 157 patients were included. The final model consisted of insomnia(Odds Ratio[OR] = 2.13, 95% Confidence Interval[CI] = 1.01–1.30), fatigue(OR = 3.47, 95% CI = 1.11–1.43), sex(female)(OR = 3.83, 95% CI = 2.11–9.81) and age(OR=-1.59, 95% CI = 0.92–1.01) as predicting variables. There is an overall decreasing trend for age, older persons suffer less from pain and females have a higher probability of experiencing pain. Model performance was indicated as fair with a sensitivity of 0.74(95% CI = 0.64–0.83) and a positive predictive value of 0.80(95% CI = 0.70–0.88).ConclusionsInsomnia and fatigue are predicting symptoms for pain, especially in women and younger patients. Further testing of the model in external cohorts is needed before clinical adoption.