Increased cancer incidence among patients with hidradenitis suppurativa - a Danish nationwide register study 1977-2017

BACKGROUND

The chronic, inflammatory skin disease hidradenitis suppurativa (HS) (prevalence: 0.5%-1%, diagnostic delay: 7-10 years) primarily arises in younger adults and frequently coincides with autoimmune comorbidities and unhealthy life-styles (smoking and obesity). These factors are known to increase cancer risk, but despite this, information on cancer occurrence among HS patients is scarce.

MATERIALS AND METHODS

A nationwide retrospective register-based study assessing relative risk of cancer - overall and by anatomical site - following HS diagnosis expressed as standardized incidence ratios (SIRs), which is ratios between observed cases among all Danes diagnosed with HS since 1977 and expected cases based on cancer incidence rates of the entire Danish population during the same period.

RESULTS

Participants consisted of a cohort of 13,919 Danes with HS, who during an average of 14.2 years of follow-up developed a total of 1,193 incident cancers, corresponding to a 40% increased risk (SIR = 1.4, 95% CI: 1.3 to 1.4, p < 0.001). Increased risks were observed for cancers of the respiratory system, oral cavity and pharynx, digestive organs and peritoneum, urinary tract, and the lymphatic tissues.

INTERPRETATION

These findings underline an unmet need for health monitoring, lifestyle interventions and cancer screening if and when relevant.

Long-term changes of health-related quality of life in patients with peripheral vascular malformations - a prospective observational study

PURPOSE

The aim of this observational study was to assess health-related quality of life (HRQOL) changes in patients with vascular malformations, over a period of almost eight years, and to assess clinical and demographic characteristics possibly associated with HRQOL changes.

METHODS

Eighty out of 111 patients who were included in a previously published comparative HRQOL study accepted inclusion in this follow-up study. HRQOL at baseline and follow-up was assessed with the Short-Form 36-item questionnaire (SF-36). Median observation time was 7.9 years. Linear mixed models and linear regression models were applied to assess HRQOL change and possible associations with demographic and clinical variables.

RESULTS

The median age of the patient cohort at baseline evaluation (n = 111) was 27.0 years. Ninety-six out of 111 (86.5%) patients were diagnosed with venous malformations. Significantly higher SF-36 scores at follow-up were found for the physical domains Role limitations due to (RLDT) physical problems (difference=13.5; 95% CI [1.6, 25.3]) and Bodily pain (difference=11.3; 95% CI [3.8, 18.8]). No deterioration of HRQOL was found in any domain. In multivariate analyses, female gender, muscle/bone involvement, and higher age were associated with a positive relative change in SF-36 in the domains Physical functioning, RLDT physical problems, and RLDT emotional problems, respectively. Invasive treatment was not associated with long-term HRQOL change.

CONCLUSIONS

Over a period of almost eight years, significant improvement of SF-36 scores was observed in the physical domains RLDT physical problems and bodily pain. Female gender, muscle/bone involvement, and higher age were associated with HRQOL improvement in certain domains.

Pulmonary endarterectomy and balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: Comparison of changes in hemodynamics and functional capacity

The treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). Balloon pulmonary angioplasty (BPA) is an emerging option for inoperable patients. Comparisons of the hemodynamic and functional outcome between these treatments are scarce. In this single-center observational cohort study, we compared hemodynamics by right heart catheterization and peak oxygen consumption before and 5 months (±14 days) after either PEA or BPA. Comprehensive evaluation and selection for PEA or BPA was performed by an expert CTEPH team. Fourty-two and fourty consecutive patients were treated with PEA or BPA, respectively. Demographics were similar between groups. Both PEA and BPA significantly reduced mean pulmonary artery pressure (from 46 ± 11 mmHg at baseline to 28 ± 13 mmHg at follow-up; p < 0.001 and from 43 ± 12 mmHg to 31 ± 9 mmHg; p < 0.001) and pulmonary vascular resistance (from 686 ± 347 dyn s cm-5 at baseline to 281 ± 197 dyn s cm-5 at follow-up; p < 0.001 and from 544 ± 322 dyn s cm-5 to 338 ± 180 dyn s cm-5; p < 0.001), with significantly lower reductions for both parameters in the former group. However, cardiopulmonary exercise testing revealed no significant between group differences in exercise capacity. Diffusion capacity for carbon monoxide at baseline was the only follow-up predictor for peak VO2. In our study, PEA reduced pulmonary pressures more than BPA did, but similar improvements were observed for exercise capacity. Thus, while long term data after BPA is lacking, BPA treated CTEPH patients can expect physical gains in line with PEA.

Interprofessional education on complex patients in nursing homes: a focus group study

BACKGROUND

An ageing population leads up to increasing multi-morbidity and polypharmacy. This demands a comprehensive and interprofessional approach in meeting patients' complex needs. This study describes graduate students' experiences of working practice based in interprofessional teams with complex patients' care needs in nursing homes.

METHOD

Students from advanced geriatric nursing, clinical nutrition, dentistry, medicine and pharmacy at the University of Oslo in Norway were assigned to groups to examine and develop a care plan for a nursing home patient during a course. Focus groups were used, 21 graduate students participating in four groups. Data were collected during spring 2018, were inductively analysed according to a thematic analysis method (Systematic Text Condensation). An analytical framework of co-ordination practices was applied to get an in-depth understanding of the data.

RESULTS

Three themes were identified: 1) Complex patients as learning opportunities- an eye-opener for future interprofessional collaboration 2) A cobweb of relations, and 3) Structural facilitators for new collective knowledge. Graduate university students experienced interprofessional education (IPE) on complex patients in nursing homes as a comprehensive learning arena. Overall, different co-ordination practices for work organization among the students were identified.

CONCLUSIONS

IPE in nursing homes facilitated the students' scope from a fragmented approach of the patients towards a relational and collaborative practice that can improve patient care and strengthen understanding of IPE. The study also demonstrated the need for preparatory teamwork training to gain maximum benefit from the experience. Something that can be organized by the education institutions in the form of a stepwise learning module and as an online pre-training course in interprofessional teamwork. Further, focusing on the need for well thought through processes of the activity by the institutions and the timing the practice component in students' curricula. This could ensure that IPE is experienced more efficient by the students.

The influence of impaired processing speed on cognition in first-episode antipsychotic-naïve schizophrenic patients

Background:

Impaired cognition is a prominent feature of schizophrenia. To what extent the heterogeneous cognitive impairments can be accounted for by considering only a single underlying impairment or a small number of core impairments remains elusive. This study examined whether cognitive impairments in antipsychotic-naïve, first-episode schizophrenia patients may be determined by a relative slower speed of information processing.

Method:

Forty-eight antipsychotic-naïve patients with first-episode schizophrenia and 48 matched healthy controls were administered a comprehensive battery of neuropsychological tests to assess domains of cognitive impairments in schizophrenia. Composite scores were calculated, grouping tests into cognitive domains.

Results:

There were significant differences between patients and healthy controls on global cognition and all cognitive domains, including verbal intelligence, processing speed, sustained attention, working memory, reasoning and problem solving, verbal learning and memory, visual learning and memory, and reaction time. All these significant differences, except for verbal intelligence and global cognition, disappeared when processing speed was included as a covariate.

Conclusion:

At the first stage of illness, antipsychotic-naïve patients with schizophrenia display moderate/severe impairments in all the cognitive domains assessed. The results support the contention of a global cognitive dysfunction in schizophrenia that to some extent may be determined by impaired processing speed.

Enzymatic Determination of Free Glutamic Acid in Dried Soups and in Minced Sausages: NMKL1 Collaborative Study

An enzymatic method for the determination of free glutamic acid in meat products and dried soups was collaboratively studied in 11 laboratories. In the presence of the enzyme glutamate dehydrogenase, L-giutamic acid is oxidatively deaminated by nicotinamide adenine dinucleotide (NAD) to 2-oxoglutarate. In a reaction catalyzed by diaphorase, the NADH thus formed converts 2-(p-iodophenyl)-3-(p-nitrophenyl)-5-phenyltetrazolium chloride to a formazan, which is measured in the visible range at 492 nm. Fourteen samples (7 samples of minced sausage and 7 samples of dried cauliflower soup) with glutamate contents varying between 0.4 and 16 g/kg were included In the study. Materials were distributed to participants as blind duplicates and as split level pairs. The mean relative standard deviation (RSDR) for reproducibility for the dried soup material containing glutamate between 7 and 16 g/kg was 4.6%. RSDR values for samples of minced sausage containing glutamate at lower levels (0.4-1.3 g/kg) were between 12 and 16%.

Health impact of substituting red meat by fish: addressing variability in risk-benefit assessments

Background

Sufficient intake of fish and limited red meat intake is commonly encouraged by national dietary guidelines to prevent various lifestyle diseases. One way to fulfill these guidelines would be to substitute red meat by fish. However, quantitative evidence of the public health gain of such substitution is lacking. Moreover, contaminants in these foods may compromise nutritional benefits. We aimed to estimate the health impact of substituting red meat by fish in the Danish diet in a risk-benefit assessment (RBA). Our study can support policy makers in defining evidence-based public health strategies.

Methods

We quantified the health impact of substituting red meat by fish among Danish adults in terms of Disability-Adjusted Life Years (DALY) using data from a national dietary survey and food monitoring. We investigated the use of probabilistic methods to model variability in individual substitution behaviors and to assess health impact distributions in RBA of food.

Results

Health impact of the substitution varied largely by the type of fish consumed and by age and sex of the consumer. We estimated that 134 (95% uncertainty interval: 102; 169) DALYs/100,000 could be averted per year if a mix of lean and fatty fish is consumed in the Danish recommended amounts and intake of red meat decreased among Danish adults. The highest benefit was estimated for women in the childbearing age and for men above 50 years of age. However, a small fraction of women were assigned an overall health loss due to methylmercury exposure during pregnancy and the associated adverse effects in unborn children.

Conclusions

Our study estimated an overall health gain of substituting red meat by fish in the general Danish adult population, while providing insight in the variability in health impact at the level of individual consumers. Our approach can be applied in other RBAs and the results support the need for targeted public health strategies to ensure consumer health and safety.

Key messages

The health impact of substituting red meat by fish in Danish adults was quantified in terms of disability-adjusted life years (DALYs), while accounting for variability between individuals. We estimated that young women and men above 50 years of age will experience the largest health gain while a small fraction of the women were assigned a health loss due to chemical exposure.

Quality of life in patients with vascular malformations outside the central nervous system: Comparison with the general Norwegian population

PURPOSE

The aim of this study was to assess Health-Related Quality of Life (HRQoL) in a population of patients with vascular malformations outside the central nervous system (CNS) and to compare the results with data from a national reference population.

METHODS

In total, 111 consecutive patients above 14 years of age and referred for the first time to the national vascular malformation center from September 2011 to December 2012 were included. HRQoL was assessed using the Short-Form 36-item questionnaire (SF-36), which is a validated questionnaire with eight domains, covering both physical and mental aspects of HRQoL. The results were compared with national reference values. Possible association between HRQoL and selected demographic and clinical variables was analyzed using linear regression analysis.

RESULTS

The sample consisted of 47 men (42.3%) and 64 women (57.7%). The median age of patients was 27 years (range 14-63 years). Ninety-six patients (86.5%) were diagnosed with venous malformations and nine patients (8.1%) with arteriovenous malformations. Six patients had other types of malformations (9%). The patients had significantly lower SF-36 scores in all domains, except for General health, than the general population. There was a significant association between muscular involvement and lower SF-36 scores in the physical domains Bodily pain and Role limitation due to physical problems.

CONCLUSIONS

Our data suggest that patients with vascular malformations outside the CNS have impaired quality of life when compared with the general population. Muscular involvement seems to be associated with worse HRQoL in the physical aspects.

Coronary computed tomography in heart transplant patients: detection of significant stenosis and cardiac allograft vasculopathy, image quality, and radiation dose

Background Cardiac allograft vasculopathy (CAV) is an accelerated form of atherosclerosis unique to heart transplant (HTX) patients. Purpose To investigate the detection of significant coronary artery stenosis and CAV, determinants of image quality, and the radiation dose in coronary computed tomography angiography (CCTA) of HTX patients with 64-slice multidetector CT (64-MDCT). Material and Methods Fifty-two HTX recipients scheduled for invasive coronary angiography (ICA) were prospectively enrolled and underwent CCTA before ICA with intravascular ultrasound (IVUS). Results Interpretable CCTA images were acquired in 570 (95%) coronary artery segments ≥2 mm in diameter. Sensitivity, specificity, and positive and negative predictive values of CCTA for the detection of segments with significant stenosis (lumen reduction ≥50%) on ICA were 100%, 98%, 7.7%, and 100%, respectively. Twelve significant stenoses were located in segments with uninterpretable image quality or vessel diameter <2 mm; only one was eligible for intervention. IVUS detected CAV (maximal intimal thickness ≥0.5 mm) in 33/41 (81%) patients; CCTA and ICA identified CAV (any wall or luminal irregularity) in 18 (44%) and 14 (34%) of these 33 patients, respectively. The mean estimated radiation dose was 19.0 ± 3.4 mSv for CCTA and 5.7 ± 3.3 mSv for ICA ( P < 0.001). Conclusion CCTA with interpretable image quality had a high negative predictive value for ruling out significant stenoses suitable for intervention. The modest detection of CAV by CCTA implied a limited value in identifying subtle CAV. The high estimated radiation dose for 64-MDCT is of concern considering the need for repetitive examinations in the HTX population.

Health Effects of 12 Weeks of Team-Sport Training and Fitness Training in a Community Health Centre for Sedentary Men with Lifestyle Diseases

This study compares the effects of team-sport training, for sedentary men with lifestyle diseases, with fitness training in a pragmatic set-up in a community health centre (CHC). Thirty-two men in the fitness group (FiG) and 36 men in the team-sport group (TsG) completed the training and trained for 60-90 min, two times/week for 12-16 weeks. In FiG and TsG, mean heart rate (HR) during training was 73.2% and 74.5% of HRmax, respectively. Percentage of training time above 90%HRmax was 6 ± 9% and 10 ± 15% and the percentage of participants who spent > 10% of total training time with HR > 90%HRmax was 20% and 41%, in FiG and TsG, respectively. In FiG, total fat mass was reduced by 3.5%  (P < 0.01), while performance in the 6 min walking test (6MWT) increased by 11%  (P < 0.001). In TsG, total fat mass was reduced by 2.2%  (P < 0.01), while 6MWT performance improved by 5%  (P < 0.05). Between-group differences were observed for systolic BP (P = 0.041) and mean arterial pressure (P = 0.050) in favour of TsG and for sit-to-stand test (P = 0.031) in favour of FiG. In conclusion, small-sided team sport is a worthy alternative to fitness training since the overall health effects are comparable, for example, improved balance and reduced fat mass. Team sport elicits high heart rates and improves cardiovascular health by reducing blood pressure, while fitness training improves sit-to-stand test performance related to activity of daily living.

An 8-year population description from a national treatment centre on lymphatic malformations

INTRODUCTION

Lymphatic malformations are rare developmental non-malignant abnormalities that present as masses consisting of abnormal growth of fluid filled channels or spaces in the skin or deep tissue that result in abnormalities of lymphatic flow. They may cause symptoms like pain, recurrent lymphorrea, abnormal bone growth, and disturbance of bodily functions. They may also be a cosmetic problem. The study aims to describe the population with lymphatic malformations (LM) treated at a national referral centre.

MATERIALS AND METHODS

This is a retrospective review of patients with the diagnosis lymphatic malformation seen at the centre between 2006-2013. The authors performed a systematic review of the hospital records and a reevaluation of the radiological findings. Eighty-five patients with 102 lymphatic malformations were included.

RESULTS

The majority of the patients (67%) were diagnosed before the age of 2 years. Lesions were located mainly to the head and neck (64%) and half (52%) were macrocystic. Treatment was: sclerotherapy (69%), surgery (49%), laser therapy (19%), or a combination of these treatment modalities (33%). The best outcome was found in the patients with macrocystic lesions (p = .029), and 76% of the patients reported a good or very good outcome.

CONCLUSION

Most patients presented before the age of 2 years with complex lesions which required unique, often multimodal treatment plans and in general they experienced good outcome.

Computed VS. Film-Screen Magnification Radiography of Fingers in Hyperparathyroidism

One hundred randomly selected patients with suspected or known hyperparathyroidism were examined in a prospective study of the 2nd and 3rd fingers with film-screen and digital luminescence radiographs using magnification technique. The digital images were displayed on a work-station and printed as hard-copies. Two radiologists evaluated the film-screen images regarding subperiosteal and intracortical resorption and their results were defined as “gold standard” regarding the absence or presence of these changes. Four radiologists evaluated these changes in the 3 image forms and an ROC analysis was performed. Comparing the areas under the ROC curves no significant difference was found between the film-screen images and the 2 digital display forms. These results suggest that currently available digital systems provide adequate diagnostic accuracy for evaluation of subtle skeletal changes.

Association of body fat and vitamin D status and the effect of body fat on the response to vitamin D supplementation in Pakistani immigrants in Denmark

Vitamin D deficiency and obesity are both prevalent conditions in the northern countries, especially among immigrants. The aims were to assess the possible relationship between body fat and vitamin D status, and to investigate the effect of body fat on the response to oral vitamin D supplementation in Pakistani immigrants in Denmark. Data were obtained from a 1-year double-blind randomised controlled trial with oral vitamin D supplementation. A total of 122 women and men received either vitamin D3 supplementation (10 or 20 μg/day) or placebo. No association was found between body fat percentage and vitamin D status in a multiple linear regression model (P<0.001). No effect of body fat was seen on the vitamin D status response following the intervention with vitamin D. In conclusion, there was no baseline association between body fat percentage and vitamin D status, and body fat percentage had no effect on the response to vitamin D supplementation.

Change in sleep duration and proposed dietary risk factors for obesity in Danish school children

BACKGROUND

Recent cross-sectional studies found higher consumption of energy-dense foods among children with short sleep duration; however, longitudinal studies examining changes in sleep and diet over time are needed.

OBJECTIVE

This study aimed to investigate prospective associations between changes in objectively measured sleep duration and alterations in proposed dietary risk factors for obesity in 8-11-year-old Danish children.

METHODS

Four hundred forty-one children recorded dietary intake during seven consecutive days, along with accelerometer measurements estimating sleep duration at baseline and after ∼200 days.

RESULTS

Baseline sleep duration did not predict changes in dietary intake or vice versa (all P ≥ 0.69). However, 1-h lower sleep duration was associated with higher intake of added sugar (1.59 E%; P = 0.001) and sugar-sweetened beverages (0.90 E%; P = 0.002) after 200 days with no change in energy density of the diet (P = 0.78).

CONCLUSION

Our results suggest that a negative change in sleep duration is associated with higher intakes of sugar containing foods/beverages.

Atherosclerotic lesions in lymphoma survivors treated with radiotherapy

BACKGROUND AND PURPOSE

Radiotherapy causes premature atherosclerosis in Hodgkin's lymphoma survivors (HLSs). We determined whether atherosclerosis within the radiation field was predicted by traditional risk factors independent of radiation and compared the extent of atherosclerosis in HLSs treated with mantle field radiotherapy with non-irradiated patients.

MATERIAL AND METHODS

Forty-three HLSs (median age 50 years, range 38-63) treated with mantle field radiotherapy were included. Cardiovascular risk factors were registered at first follow-up (FU-1) 5-13 years after treatment. A second follow-up (FU-2) occurred 18-27 years after treatment. At FU-2, in-field atherosclerosis was assessed by computed tomography with calculation of coronary artery calcium volume score (CACS) and pre-cranial artery atherosclerosis score (PAS). Peripheral endothelial dysfunction was assessed by ante-brachial strain-gauge plethysmography. CT angiography of pre-cranial vessels was also performed in 43 non-irradiated patients.

RESULTS

Multiple linear regression analyses showed that cholesterol at FU-1 was a predictor of CACS (β 308 (95% CI 213-403), p < 0.001), PAS (β 3.67 (95% CI 2.29-5.04), p < 0.001) and peripheral endothelial dysfunction (β 2.74 (95% CI 0.47-5.01), p = 0.02). There were more atherosclerotic lesions in HLSs (n = 141) than in non-irradiated patients (n = 73, p = 0.001).

CONCLUSION

Irradiated arteries are characterized by widespread atherosclerotic lesions aggravated by elevated levels of cholesterol.

Genetics of steroid-resistant nephrotic syndrome: a review of mutation spectrum and suggested approach for genetic testing

Identification of genes, associated mutations and genotype-phenotype correlations in steroid-resistant nephrotic syndrome (SRNS) is being translated to clinical practice through genetic testing. This review provides an update on the genes and mutations associated with SRNS along with a suggested approach for genetic testing in patients with SRNS.

CONCLUSION

The number of indentified genes associated with SRNS is increasing along with our understanding of their impact on treatment response and risk of recurrence. A systematic approach to genetic testing in patients with SRNS might aid the physician in selecting appropriate treatment.

Short sleep duration and large variability in sleep duration are independently associated with dietary risk factors for obesity in Danish school children

BACKGROUND

Lack of sleep and increased consumption of energy-dense foods and sugar-sweetened beverages (SSBs) have all been suggested as factors contributing to the increased prevalence of overweight and obesity.

OBJECTIVE

To evaluate whether objectively measured sleep duration (average and day-to-day variability) as well as parent-reported sleep problems are independently associated with proposed dietary risk factors for overweight and obesity in 8-11-year-old children.

DESIGN

In this cross-sectional study, data on sleep duration and day-to-day variability in sleep duration were measured in 676 Danish, apparently healthy children by an objective measure (actigraphy) for 8 nights, and the Children's Sleep Habits Questionnaire (CSHQ) was filled out by the parents. Diet was recorded using a web-based food record for 7 consecutive days. Fasting blood samples were obtained for measurements of plasma leptin and ghrelin levels.

RESULTS

Sleep duration (h per night) was negatively associated with energy density (ED) of the diet (β = -0.32 kJ g(-1)), added sugar (β = -1.50 E%) and SSBs (β = -1.07 E%) (all P ≤ 0.003). Furthermore, variability in sleep duration (10-min per night) was positively associated with SSBs (β = 0.20 E%, P = 0.03), independent of sleep duration, and CSHQ score was positively associated with ED (β = 0.16 kJ g(-1), P = 0.04). All of these associations were independent of potential confounders (age, sex, pubertal status, height, weight, screen time, moderate-to-vigorous physical activity and parental education and ethnicity).

CONCLUSION

Our study suggests that short sleep duration, high sleep duration variability and experiencing sleep problems are all associated with a poor, obesity-promoting diet in children.

Balloon pulmonary angioplasty in patients with inoperable chronic thromboembolic pulmonary hypertension

OBJECTIVE

To examine the effect of balloon pulmonary angioplasty (BPA) on chronic thromboembolic pulmonary hypertension (CTEPH) in patients with inoperable disease or persistent pulmonary hypertension after pulmonary endarterectomy.

DESIGN

Observational cohort study.

SETTING

Referred patients with inoperable or persistent CTEPH.

PATIENTS

Twenty consecutive CTEPH patients (10 females), aged 60±10 years.

INTERVENTIONS BPA MAIN OUTCOME MEASURES

Right heart catheterisation, functional capacity (cardiopulmonary exercise testing (CPET) and NYHA class) and blood sampled biomarkers N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin T examined at the time of diagnosis and repeated in all patients 3 months after the last BPA.

RESULTS

Seventy-three catheterisations were performed with 18.6±6.1 BPAs per patient on segmental and subsegmental arteries. Two deaths occurred following the first BPA, with an overall 10% periprocedural death rate. Reperfusion oedema complicated seven procedures. Comparisons before and after BPA showed significant haemodynamic improvements, including decreased mean pulmonary artery pressure (mPAP) (45±11 mm Hg vs 33±10 mm Hg; p<0.001) and increased cardiac output (4.9±1.6 L/min vs 5.4±1.9 L/min; p=0.011). Reduced right ventricular strain was indicated by significantly lower plasma levels of NT-proBNP and troponin T. Significant improvement in functional capacity was evident as assessed by NYHA class (3.0±0.5 vs 2.0±0.5; p<0.001) and CPET (13.6±5.6 mL/kg/min vs 17.0±6.5 mL/kg/min; p<0.001). Seventeen patients (85%) were alive after 51±30 months of follow-up.

CONCLUSIONS

BPA may offer an alternative form of treatment in selected CTEPH patients. While prognostic markers such as haemodynamics, functional capacity and biomarkers improve, significant periprocedural complications must be recognised. Randomised trials are warranted.

Objectively measured physical activity and C-reactive protein: National Health and Nutrition Examination Survey 2003-2004

The association between physical activity (PA) and C-reactive protein (CRP) is inconsistent, with nearly all studies using self-report measures of PA. The purpose of this study was to examine the association between objectively measured PA and CRP in US adults and children. Adults (N=2912) and children (N=1643) with valid accelerometer data and CRP data were included in the analyses. Logistic regression analysis was used to assess the odds of meeting PA guidelines across CRP quartiles for children and among adults with low, average, and high CRP levels. For adults, after adjustments for age, gender, race, body mass index, smoking, diabetes, and high-density lipoprotein cholesterol (HDL-C), compared with those with low CRP levels, odds ratios were 0.59 (CI=0.45-0.77) and 0.46 (CI=0.28-0.76) for participants with average and high CRP levels, respectively. For children, after adjustments for age, gender, race, weight status, and HDL-C, compared with those in CRP quartile 1, odds ratios were 0.96 (CI=0.5-1.84), 1.23 (CI=0.71-2.12), and 0.79 (CI=0.33-1.88) for participants in quartiles 2, 3, and 4, respectively. Objectively measured PA is inversely associated with CRP in adults, with PA not related to CRP in children.

Affect regulation and psychopathology in women with borderline personality disorder

INTRODUCTION

Dysfunction in affect regulation is a prominent feature that grossly impairs behavioural and interpersonal domains of experience and underlies a great deal of the psychopathology in borderline personality disorder (BPD). However, no study has yet been published that evaluates the psychometric properties of the translated Danish version of self-report measures sensitive to the different aspects and dimensions of dysfunction in affect regulation prevalent in BPD.

MATERIAL AND METHODS

This study comprised a group of women diagnosed with BPD (n = 29) and a comparison group of healthy subjects (n = 29) who reported psychopathology and levels of affective instability, aggression, impulsivity and alexithymia by self-report measures.

RESULTS

Our results demonstrated that women with BPD have significant psychopathology and report significantly higher levels of dysfunction in separate components of affect regulation by self-report measures than the comparison group of healthy subjects. Our results also provided partial support for the psychometric appropriateness and clinical relevance of the translated Danish version of affect regulation measures.

CONCLUSION

The normative reference range indicated by our results makes the measures useful as a practical assessment tool.

FUNDING

not relevant.

TRIAL REGISTRATION

not relevant.

[Neurobiology in borderline personality disorder]

Borderline personality disorder (BPD) is a severe psychiatric disorder characterised by instability of affect regulation, impulse control, interpersonal relationships, and self-image. The aim of this status article is to provide a brief overview of the neurobiological underpinnings of the core dimensions in BPD, as well as of the potential clinical implications. The latest results from genetic, endocrinologic, neuropsychologic, and neuroimaging research in identifying the dysfunctional neurobiological systems that could play a role in diathesis to BPD are presented.

Prevalence and risk factors for coronary artery calcification following kidney transplantation for systemic lupus erythematosus

OBJECTIVES

Patients with SLE who undergo kidney transplantation are at increased risk of premature cardiovascular disease. The current study aimed to investigate the prevalence of coronary artery calcification in transplanted SLE patients without coronary symptoms and to explore risk factors associated with coronary atherosclerosis.

METHODS

This was a cross-sectional study in transplanted SLE patients with a functioning graft. Evaluation included laboratory tests, SLE disease activity indices, multi-slice CT for quantification of coronary calcification (Agatston score >400 = high calcification, <400 = mild to moderate calcification). Arterial and aortic stiffness was assessed by carotid-femoral pulse wave velocity (PWV).

RESULTS

Thirty-nine patients were analysed, three of whom had a prior history of coronary events. Coronary artery calcification was present in 82% of patients (n = 32), with 36% (n = 14) with a high level of arterial calcification. Multivariate regression analysis showed the following factors to be independently associated with high coronary calcification: PWV (0.41, 95% CI 0.17, 0.66, P = 0.001), time since diagnosis of LN (0.66, 95% CI 0.43, 0.71, P < 0.001) and BMI (0.39, 95% CI 0.15, 0.63, P = 0.002). Immunosuppression regimen was not significantly different between groups.

CONCLUSIONS

Coronary artery calcification is widespread in transplanted SLE patients despite a normal profile of conventional cardiovascular risk factors. The risk of calcification increases with disease duration, BMI and PWV in this population.