Wendy J. Post

Safety of laparoscopy versus laparotomy in early-stage endometrial cancer : a randomised trial

BACKGROUNDnThe standard surgery for early-stage endometrial cancer is total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy, which is associated with substantial morbidity. Total laparoscopic hysterectomy (TLH) and bilateral salpingo-oophorectomy is less invasive and is assumed to be associated with lower morbidity, particularly in obese women. This study investigated the complication rate of TLH versus TAH in women with early-stage endometrial cancer.nnnMETHODSnThis randomised trial was done in 21 hospitals in The Netherlands, and 26 gynaecologists with proven sufficient skills in TLH participated. 283 patients with stage I endometrioid adenocarcinoma or complex atypical hyperplasia were randomly allocated (2:1) to the intervention group (TLH, n=187) or control group (TAH, n=96). Randomisation by sequential number generation was done centrally in alternate blocks of six and three participants, with stratification by trial centre. After assignment, the study coordinators, patients, gynaecologists, and members of the panel were not masked to intervention. The primary outcome was major complication rate, assessed by an independent panel. Data were analysed by a modified intention-to-treat analysis, since two patients in both groups were excluded from the main analysis. This trial is registered with the Dutch trial registry, number NTR821.nnnFINDINGSnThe proportion of major complications was 14.6% (27 of 185) in the TLH group versus 14.9% (14 of 94) in the TAH group, with a difference of -0.3% (95% CI -9.1 to 8.5; p=0.95). The proportion of patients with an intraoperative major complication (nine of 279 [3.2%]) was lower than the proportion with a postoperative major complication (32 of 279 [11.5%]) and did not differ between TLH (five of 185 [2.7%]) and TAH (four of 94 [4.3%]; p=0.49). The proportion of patients with a minor complication was 13.0% (24 of 185) in the TLH group and 11.7% (11 of 94) in the TAH group (p=0.76). Conversion to laparotomy occurred in 10.8% (20 of 185) of the laparoscopic procedures. TLH was associated with significantly less blood loss (p<0.0001), less use of pain medication (p<0.0001), a shorter hospital stay (p<0.0001), and a faster recovery (p=0.002), but the procedure took longer than TAH (p<0.0001).nnnINTERPRETATIONnOur results showed no evidence of a benefit for TLH over TAH in terms of major complications, but TLH (done by skilled surgeons) was beneficial in terms of a shorter hospital stay, less pain, and quicker resumption of daily activities.nnnFUNDINGnThe Dutch Organization for Health Research and Development (ZonMw), programme efficacy.

Monitoring stress and recovery: new insights for the prevention of injuries and illnesses in elite youth soccer players

Objective Elite youth soccer players have a relatively high risk for injuries and illnesses due to increased physical and psychosocial stress. The aim of this study is to investigate how measures to monitor stress and recovery, and its analysis, provide useful information for the prevention of injuries and illnesses in elite youth soccer players. Methods 53 elite soccer players between 15 and 18 years of age participated in this study. To determine physical stress, soccer players registered training and match duration and session rating of perceived exertion for two competitive seasons by means of daily training logs. The Dutch version of the Recovery Stress Questionnaire for athletes (RESTQ-Sport) was administered monthly to assess the psychosocial stress–recovery state of players. The medical staff collected injury and illness data using the standardised Fédération Internationale de Football Association registration system. ORs and 95% CIs were calculated for injuries and illnesses using multinomial regression analyses. The independent measures were stress and recovery. Results During the study period, 320 injuries and 82 illnesses occurred. Multinomial regression demonstrated that physical stress was related to both injury and illness (range OR 1.01 to 2.59). Psychosocial stress and recovery were related the occurrence of illness (range OR 0.56 to 2.27). Conclusions Injuries are related to physical stress. Physical stress and psychosocial stress and recovery are important in relation to illness. Individual monitoring of stress and recovery may provide useful information to prevent soccer players from injuries and illnesses.

Oesophageal endoscopic ultrasound with fine needle aspiration improves and simplifies the staging of lung cancer

Background: Positron emission tomography (PET) is accurate for mediastinal staging of lung cancer but has a moderate positive predictive value, necessitating pathological verification. Endoscopic ultrasonography with fine needle aspiration (EUS-FNA) is a technique for tissue verification of mediastinal and upper retroperitoneal abnormalities. The use of EUS-FNA may decrease the number of surgical procedures and thereby staging costs. Methods: EUS-FNA was used prospectively for the cytological assessment of mediastinal and/or upper retroperitoneal PET hot spots in patients with suspected lung cancer. Only if EUS-FNA was positive for malignancy was subsequent mediastinoscopy or exploratory thoracotomy cancelled. The cost effectiveness of EUS-FNA was determined. Results: Of 488 consecutive patients with suspected lung cancer, 81 were enrolled with mediastinal and/or upper retroperitoneal PET hot spots. EUS-FNA was positive in 50 (62%) patients, negative in six, and inconclusive in 25. Of the 31 negative or inconclusive patients, 26 underwent surgical staging (resulting in 14 patients with and 12 without mediastinal malignancy), while five patients had mediastinal metastases during follow up. No EUS-FNA related morbidity or mortality was encountered. The accuracy of the decision to proceed to surgery (or not) on the basis of EUS-FNA was 77% (95% CI 68 to 86). EUS-FNA detected more mediastinal abnormalities than PET except for the upper mediastinal region. Addition of EUS-FNA to conventional lung cancer staging reduced staging costs by 40% per patient, mainly due to a decrease in surgical staging procedures. Conclusion: EUS-FNA can replace more than half of the surgical staging procedures in lung cancer patients with mediastinal and/or upper retroperitoneal PET hot spots, thereby saving 40% of staging costs.

The impact of executive functions on verb production in patients with Parkinson's disease

A growing number of studies suggest that language problems in Parkinsons disease (PD) are a result of executive dysfunction. To test this hypothesis we compared Dutch verb production in sentence context in a group of 28 PD patients with a control group consisting of 28 healthy participants matched for age, gender and education. All subjects were assessed on both verb production in sentence context as well as on cognitive functions relevant for sentence processing. PD patients scored lower than healthy controls on the verb production ability-scale and showed a response pattern in which performance was worse (1) in base than in derived position; (2) in present than in past tense; (3) for intransitive than in transitive verbs. For the PD group the score on the verb production ability-scale correlated significantly with set-switching and working memory. These results provide support for previous research suggesting that executive dysfunctions underlie the performance of the PD patients on verb production. It is furthermore suggested that because of failing automaticity, PD patients rely more on the cortically represented executive functions. Unfortunately, due to the disturbed intimate relation between the basal ganglia and the frontal cortex, these executive functions are also dysfunctional.

Development of dribbling in talented youth soccer players aged 12-19 years: a longitudinal study.

Abstract The aims of the current study were to assess the development and determine the underlying mechanisms of sprinting and dribbling needed to compete at the highest level in youth soccer. Talented soccer players aged 12–19 years (n = 267) were measured on a yearly basis in a longitudinal study over 7 years, resulting in 519 measurements. Two field tests, the Shuttle Sprint and Dribble Test and the Slalom Sprint and Dribble Test, were assessed. Anthropometric characteristics, years of soccer experience, and duration of practice were recorded. The longitudinal data were analysed with multi-level modelling. Comparing the two tests at baseline, low correlations were observed (sprinting: r = 0.49; dribbling: r = 0.22), indicating that each test measures distinct qualities (acceleration vs. agility). Low-to-moderate correlations were found between dribbling and sprinting within each test (Shuttle Sprint and Dribble Test: r = 0.54; Slalom Sprint and Dribble Test: r = 0.38). Both dribbling and sprinting improved with age, especially from ages 12 to 14, but the tempo of development was different. From ages 14 to 16, sprinting improved rapidly in contrast to dribbling; this was especially evident on the Slalom Sprint and Dribble Test. In contrast, after age 16 dribbling improved considerably but sprinting hardly improved. Besides age, the factors that contribute to dribbling performance are lean body mass, hours of practice, and playing position.

Soccer Skill Development in Professionals

The purpose of this study was to investigate the relationship between the development of the technical skill dribbling during ages 14-18 and adulthood playing level. The results gained insight in the required level of the technical skill dribbling during adolescence to be capable of becoming a professional soccer player. Talented players (n=131), aged 14-18 were measured while they were part of a developmental soccer program, testing took place annually. The players were identified as professional (n=54) or amateur (n=77) later on in their career (age>20). In total 238 measurements of dribbling performance were assessed by means of the Shuttle Dribble Test. A longitudinal model estimated the development for optimal dribbling performance (peak dribbling) and for dribbling performance under fatigue (repeated dribbling), for players ultimately reaching professional status and for players reaching amateur status. The longitudinal results showed that during adolescence the talented players who ultimately became professionals were on average 0.3 s faster on 30m peak dribbling performance and on average 1 second faster on 3 x 30m repeated dribbling performance than the players who ultimately turned amateur (p=0.001). It is concluded that during adolescence dribbling performance can assist in identifying the best players for the future.

Cancer-Related Fatigue and Rehabilitation: A Randomized Controlled Multicenter Trial Comparing Physical Training Combined With Cognitive-Behavioral Therapy With Physical Training Only and With No Intervention

Background Research suggests that cancer rehabilitation reduces fatigue in survivors of cancer. To date, it is unclear what type of rehabilitation is most beneficial. Objective This randomized controlled trial compared the effect on cancer-related fatigue of physical training combined with cognitive behavioral therapy with physical training alone and with no intervention. Design In this multicenter randomized controlled trial, 147 survivors of cancer were randomly assigned to a group that received physical training combined with cognitive-behavioral therapy (PT+CBT group, n=76) or to a group that received physical training alone (PT group, n=71). In addition, a nonintervention control group (WLC group) consisting of 62 survivors of cancer who were on the waiting lists of rehabilitation centers elsewhere was included. Setting The study was conducted at 4 rehabilitation centers in the Netherlands. Patients All patients were survivors of cancer. Intervention Physical training consisting of 2 hours of individual training and group sports took place twice weekly, and cognitive-behavioral therapy took place once weekly for 2 hours. Measurements Fatigue was assessed with the Multidimensional Fatigue Inventory before and immediately after intervention (12 weeks after enrollment). The WLC group completed questionnaires at the same time points. Results Baseline fatigue did not differ significantly among the 3 groups. Over time, levels of fatigue significantly decreased in all domains in all groups, except in mental fatigue in the WLC group. Analyses of variance of postintervention fatigue showed statistically significant group effects on general fatigue, on physical and mental fatigue, and on reduced activation but not on reduced motivation. Compared with the WLC group, the PT group reported significantly greater decline in 4 domains of fatigue, whereas the PT+CBT group reported significantly greater decline in physical fatigue only. No significant differences in decline in fatigue were found between the PT+CBT and PT groups. Conclusions Physical training combined with cognitive-behavioral therapy and physical training alone had significant and beneficial effects on fatigue compared with no intervention. Physical training was equally effective as or more effective than physical training combined with cognitive-behavioral therapy in reducing cancer-related fatigue, suggesting that cognitive-behavioral therapy did not have additional beneficial effects beyond the benefits of physical training.

In-vitro orthodontic bond strength testing: A systematic review and meta-analysis

INTRODUCTIONnThe aims of this study were to systematically review the available literature regarding in-vitro orthodontic shear bond strength testing and to analyze the influence of test conditions on bond strength.nnnMETHODSnOur data sources were Embase and Medline. Relevant studies were selected based on predefined criteria. Study test conditions that might influence in-vitro bond strength were independently assessed by 2 observers. Studies reporting a minimum number of test conditions were included for meta-analysis by using a multilevel model with 3 levels, with author as the highest level, study as the second level, and specimens in the study as the lowest level. The primary outcome measure was bond strength.nnnRESULTSnWe identified 121 relevant studies, of which 24 were included in the meta-analysis. Methodologic drawbacks of the excluded studies were generally related to inadequate reporting of test conditions and specimen storage. The meta-analysis demonstrated that 3 experimental conditions significantly affect in-vitro bond strength testing. Although water storage decreased bond strength on average by 10.7 MPa, each second of photopolymerization time and each millimeter per minute of greater crosshead speed increased bond strength by 0.077 and 1.3 MPa, respectively.nnnCONCLUSIONSnMany studies on in-vitro orthodontic bond strength fail to report test conditions that could significantly affect their outcomes.

Volumetric measurement of pulmonary nodules at low-dose chest CT: effect of reconstruction setting on measurement variability.

ObjectiveTo assess volumetric measurement variability in pulmonary nodules detected at low-dose chest CT with three reconstruction settings.MethodsThe volume of 200 solid pulmonary nodules was measured three times using commercially available semi-automated software of low-dose chest CT data-sets reconstructed with 1xa0mm section thickness and a soft kernel (A), 2xa0mm and a soft kernel (B), and 2xa0mm and a sharp kernel (C), respectively. Repeatability coefficients of the three measurements within each setting were calculated by the Bland and Altman method. A three-level model was applied to test the impact of reconstruction setting on the measured volume.ResultsThe repeatability coefficients were 8.9, 22.5 and 37.5% for settings A, B and C. Three-level analysis showed that settings A and C yielded a 1.29 times higher estimate of nodule volume compared with setting B (Pu2009=u20090.03). The significant interaction among setting, nodule location and morphology demonstrated that the effect of the reconstruction setting was different for different types of nodules. Low-dose CT reconstructed with 1xa0mm section thickness and a soft kernel provided the most repeatable volume measurement.ConclusionA wide, nodule-type-dependent range of agreement between volume measurements with different reconstruction settings suggests strict consistency is required for serial CT studies.

Ultrasonography to Quantify Hepatic Fat Content: Validation by 1H Magnetic Resonance Spectroscopy

An abundance of fat stored within the liver, or steatosis, is the beginning of a broad hepatological spectrum, usually referred to as fatty liver disease (FLD). For studies on FLD, quantitative hepatic fat ultrasonography would be an appealing study modality. Objective of this study was to develop a technique for quantifying hepatic fat content by ultrasonography and validate this using proton magnetic resonance spectroscopy (1H MRS) as gold standard. Eighteen white volunteers (BMI range 21.0–42.9) were scanned by both ultrasonography and 1H MRS. Altered ultrasound characteristics, present in the case of FLD, were assessed using a specially developed software program. Various attenuation and textural based indices of FLD were extracted from ultrasound images. Using linear regression analysis, the predictive power of several models (consisting of both attenuation and textural based measures) on log 10–transformed hepatic fat content by 1H MRS were investigated. The best quantitative model was compared with a qualitative ultrasonography method, as used in clinical care. A model with four ultrasound characteristics could modestly predict the amount of liver fat (adjusted explained variance 43.2%, P = 0.021). Expanding the model to seven ultrasound characteristics increased adjusted explained variance to 60% (P = 0.015), with r = 0.789 (P < 0.001). Comparing this quantitative model with qualitative ultrasonography revealed a significant advantage of the quantitative model in predicting hepatic fat content (P < 0.001). This validation study shows that a combination of computer‐assessed ultrasound measures from routine ultrasound images can be used to quantitatively assess hepatic fat content.