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1.
BMJ Open ; 13(6): e069957, 2023 06 27.
Article in English | MEDLINE | ID: mdl-37369412

ABSTRACT

OBJECTIVES: Delirium is a serious complication following neurosurgical procedures. We hypothesise that the beneficial effect of music on a combination of delirium-eliciting factors might reduce delirium incidence following neurosurgery and subsequently improve clinical outcomes. DESIGN: Prospective randomised controlled trial. SETTING: Single centre, conducted at the neurosurgical department of the Erasmus Medical Center, Rotterdam, the Netherlands. PARTICIPANTS: Adult patients undergoing craniotomy were eligible. INTERVENTIONS: Patients in the intervention group received preferred recorded music before, during and after the operation until day 3 after surgery. Patients in the control group were treated according to standard of clinical care. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was presence or absence of postoperative delirium within the first 5 postoperative days measured with the Delirium Observation Screening Scale (DOSS) and, in case of a daily mean score of 3 or higher, a psychiatric evaluation with the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Secondary outcomes included anxiety, heart rate variability (HRV), depth of anaesthesia, delirium severity and duration, postoperative complications, length of stay and location of discharge. RESULTS: We enrolled 189 patients (music=95, control=94) from July 2020 through September 2021. Delirium, as assessed by the DOSS, was less common in the music (n=11, 11.6%) than in the control group (n=21, 22.3%, OR:0.49, p=0.048). However, after DSM-5 confirmation, differences in delirium were not significant (4.2% vs 7.4%, OR:0.47, p=0.342). Moreover, music increased the HRV (root mean square of successive differences between normal heartbeats, p=0.012). All other secondary outcomes were not different between groups. CONCLUSION: Our results support the efficacy of music in reducing the incidence of delirium after craniotomy, as found with DOSS but not after DSM-5 confirmation, substantiated by the effect of music on preoperative autonomic tone. Delirium screening tools should be validated and the long-term implications should be evaluated after craniotomy. TRIAL REGISTRATION NUMBER: Trialregister.nl: NL8503 and ClinicalTrials.gov: NCT04649450.


Subject(s)
Delirium , Music , Neurosurgery , Adult , Humans , Prospective Studies , Delirium/etiology , Delirium/prevention & control , Delirium/diagnosis , Neurosurgical Procedures/adverse effects
2.
Bioresour Technol ; 129: 335-42, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23262009

ABSTRACT

In this study the impact of senescence and harvest time in Miscanthus on the quality of fast pyrolysis liquid (bio-oil) was investigated. Bio-oil was produced using a 1 kg h(-1) fast pyrolysis reactor to obtain a quantity of bio-oil comparable with existing industrial reactors. Bio-oil stability was measured using viscosity, water content, pH and heating value changes under specific conditions. Plant developmental characteristics were significantly different (P≤0.05) between all harvest points. The stage of crop senescence was correlated with nutrient remobilisation (N, P, K; r2=0.9043, r2=0.9920, r2=0.9977 respectively) and affected bio-oil quality. Harvest time and senescence impacted bio-oil quality and stability. For fast pyrolysis processing of Miscanthus, the harvest time of Miscanthus can be extended to cover a wider harvest window whilst still maintaining bio-oil quality but this may impact mineral depletion in, and long term sustainability of, the crop unless these minerals can be recycled.


Subject(s)
Biofuels/analysis , Cellular Senescence/physiology , Heating/methods , Poaceae/chemistry , Poaceae/physiology , Viscosity
3.
Equine Vet J ; 41(4): 335-41, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19562893

ABSTRACT

REASONS FOR PERFORMING STUDY: Extracorporeal shock wave therapy (ESWT) is frequently used in equine practice, but little is known about its biological action. OBJECTIVES: To study the effects of ESWT on matrix structure and gene expression levels in normal, physiologically loaded tendinous structures in ponies. METHODS: Six Shetland ponies, free of lameness and with ultrasonographically normal flexor and extensor tendons and suspensory ligaments (SL), were used. ESWT was applied at the origin of the suspensory ligament and the mid-metacarpal region of the superficial digital flexor tendon (SDFT) 6 weeks prior to sample taking, and at the mid-metacarpal region (ET) and the insertion on the extensor process of the distal phalanx (EP) of the common digital extensor tendon 3 h prior to tendon sampling. In all animals one forelimb was treated and the other limb was used as control. After euthanasia, tendon tissue was harvested for real-time PCR to determine gene expression levels and additional samples were taken for histological evaluation and biochemical analyses RESULTS: Histologically a disorganisation of the normal collagen structure was observed 3 h after ESWT, remnants of which were still visible after 6 weeks. While degraded collagen levels showed an increase at 3 h post treatment (P= 0.012) they were reduced at 6 weeks post ESWT (P = 0.039). Gene expression for both COL1 (P = 0.004) and MMP14 (P = 0.020) was upregulated at 6 weeks after treatment. CONCLUSIONS: Exposure of normal tendinous tissue to ESWT is not uneventful; it leads to a disorganisation of matrix structure and changes in degraded collagen levels. The upregulation of COL1 expression 6 weeks after ESWT may be indicative for repair. POTENTIAL RELEVANCE: The observed disorganisation of the collagen network warrants caution when using ESWT. Exposing noninjured tissue to ESWT should be avoided and it may be advisable to restrict exercise in recently treated patients. However, the induced tissue disorganisation might also be a trigger for repair in chronic tendinopathies.


Subject(s)
Collagen/metabolism , Gene Expression Regulation/physiology , High-Energy Shock Waves , Horses/physiology , Ligaments/physiology , Tendons/physiology , Animals , Gene Expression Profiling/veterinary , Male
4.
Acta Anaesthesiol Scand ; 53(6): 816-25, 2009 Jul.
Article in English | MEDLINE | ID: mdl-19388890

ABSTRACT

BACKGROUND: Patients with complex regional pain syndrome (CRPS) are seen and treated by a variety of physicians. The present study aims to describe referral and treatment patterns for CRPS patients in the Netherlands. METHODS: Patients, who were selected (1996-2005) from an electronic general practice (GP) database (Integrated Primary Care Information Project), were invited for study participation, involving diagnosis verification (International Association for the Study of Pain criteria) and assessment of referrals and treatment through information retrieved from GP journals, patients' questionnaires, pharmacy dispensing lists and specialist letters if available. RESULTS: One hundred and two patients were included. Sixty-one percent had presented first at the GP, while 80% subsequently consulted one or more medical specialists, most frequently an anesthetist (55% of the cases) or a specialist in rehabilitation medicine (41%). Over 90% of the patients received oral or topical pharmacotherapy, 45% received intravenous therapy, 89% received non-invasive therapy (i.e. physiotherapy) and 18% received nerve blocks. Analgesics and free radical scavengers were administered early during CRPS, while vasodilating drugs and drugs against neuropathic pain (antidepressants and anti-epileptics) were administered later on. Pharmacotherapy was usually initiated by a medical specialist. CONCLUSION: The Dutch treatment guidelines, issued in 2006, recommend free radical scavenger prescription (plus physiotherapy) as the initial treatment step for CRPS. Until 2005 only half of the patients received a scavenger within 3 months after disease onset, and the majority presents first at the GP, in particular GPs may be encouraged to initiate treatment with scavengers, while waiting for the results of further specialist consultation.


Subject(s)
Complex Regional Pain Syndromes/therapy , Referral and Consultation/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Analgesics/therapeutic use , Child , Complex Regional Pain Syndromes/diagnosis , Complex Regional Pain Syndromes/epidemiology , Databases, Factual , Drug Utilization , Female , Humans , Longitudinal Studies , Male , Middle Aged , Nerve Block , Netherlands/epidemiology , Pharmacies/statistics & numerical data , Physical Therapy Modalities , Surveys and Questionnaires , Young Adult
5.
Pain ; 142(3): 218-224, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19195784

ABSTRACT

Antihypertensive drugs interact with mediators that are also involved in complex regional pain syndrome (CRPS), such a neuropeptides, adrenergic receptors, and vascular tone modulators. Therefore, we aimed to study the association between the use of antihypertensive drugs and CRPS onset. We conducted a population-based case-control study in the Integrated Primary Care Information (IPCI) database in the Netherlands. Cases were identified from electronic records (1996-2005) and included if they were confirmed during an expert visit (using IASP criteria), or if they had been diagnosed by a medical specialist. Up to four controls per cases were selected, matched on gender, age, calendar time, and injury. Exposure to angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, beta-blockers, calcium channel blockers, and diuretics was assessed from the automated prescription records. Data were analyzed using multivariate conditional logistic regression. A total of 186 cases were matched to 697 controls (102 confirmed during an expert visit plus 84 with a specialist diagnosis). Current use of ACE inhibitors was associated with an increased risk of CRPS (OR(adjusted): 2.7, 95% CI: 1.1-6.8). The association was stronger if ACE inhibitors were used for a longer time period (OR(adjusted): 3.0, 95% CI: 1.1-8.1) and in higher dosages (OR(adjusted): 4.3, 95% CI: 1.4-13.7). None of the other antihypertensive drug classes was significantly associated with CRPS. We conclude that ACE inhibitor use is associated with CRPS onset and hypothesize that ACE inhibitors influence the neuro-inflammatory mechanisms that underlie CRPS by their interaction with the catabolism of substance P and bradykinin.


Subject(s)
Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Complex Regional Pain Syndromes/epidemiology , Complex Regional Pain Syndromes/immunology , Inflammation/epidemiology , Inflammation/immunology , Case-Control Studies , Female , Humans , Male , Middle Aged , Models, Immunological , Netherlands/epidemiology , Retrospective Studies
6.
Pharmacoepidemiol Drug Saf ; 18(1): 44-52, 2009 Jan.
Article in English | MEDLINE | ID: mdl-19111016

ABSTRACT

OBJECTIVE: Since complex regional pain syndrome (CRPS) shows a clear female predominance, we investigated the association between the cumulative as well as current exposure to estrogens, and CRPS. METHODS: A population-based case-control study was conducted in the Integrated Primary Care Information (IPCI) project in the Netherlands. Cases were identified from electronic records (1996-2005) and included if they were confirmed during a visit (using International Association for the Study of Pain Criteria), or had been diagnosed by a specialist. Controls were matched to cases on gender, age, calendar time, and injury. Measures of cumulative endogenous estrogen exposure were obtained by questionnaire and included age of menarche and menopause, menstrual life, and cumulative months of pregnancy and breast-feeding. Current estrogen exposure at CRPS onset was retrieved from the electronic medical records and determined by current pregnancy or by the use of oral contraceptive (OC) drugs or hormonal replacement therapy (HRT). RESULTS: Hundred and forty-three female cases (1493 controls) were included in analyses on drug use and pregnancies, while cumulative endogenous estrogen exposure was studied in 53 cases (58 controls) for whom questionnaire data were available. There was no association between CRPS and either cumulative endogenous estrogen exposure, OC, or HRT use. CRPS onset was increased during the first 6 months after pregnancy (OR: 5.6, 95%CI: 1.0-32.4), although based on small numbers. DISCUSSION: We did not find an association between CRPS onset and cumulative endogenous estrogen exposure or current OC or HRT use, but more powered studies are needed to exclude potential minor associations.


Subject(s)
Complex Regional Pain Syndromes/etiology , Estrogens/adverse effects , Adult , Age of Onset , Aged , Case-Control Studies , Complex Regional Pain Syndromes/epidemiology , Contraceptives, Oral/adverse effects , Estrogen Replacement Therapy/adverse effects , Estrogens/administration & dosage , Estrogens/metabolism , Female , Humans , Lactation/metabolism , Menarche/metabolism , Menopause/metabolism , Middle Aged , Netherlands/epidemiology , Pregnancy , Risk Factors , Sex Factors , Surveys and Questionnaires , Time Factors
7.
Pain ; 139(2): 458-466, 2008 Oct 15.
Article in English | MEDLINE | ID: mdl-18760877

ABSTRACT

Knowledge concerning the medical history prior to the onset of complex regional pain syndrome (CRPS) might provide insight into its risk factors and potential underlying disease mechanisms. To evaluate prior to CRPS medical conditions, a case-control study was conducted in the Integrated Primary Care Information (IPCI) project, a general practice (GP) database in the Netherlands. CRPS patients were identified from the records and validated through examination by the investigator (IASP criteria) or through specialist confirmation. Cases were matched to controls on age, gender and injury type. All diagnoses prior to the index date were assessed by manual review of the medical records. Some pre-specified medical conditions were studied for their association with CRPS, whereas all other diagnoses, grouped by pathogenesis, were tested in a hypothesis-generating approach. Of the identified 259 CRPS patients, 186 cases (697 controls) were included, based on validation by the investigator during a visit (102 of 134 visited patients) or on specialist confirmation (84 of 125 unvisited patients). A medical history of migraine (OR: 2.43, 95% CI: 1.18-5.02) and osteoporosis (OR: 2.44, 95% CI: 1.17-5.14) was associated with CRPS. In a recent history (1-year before CRPS), cases had more menstrual cycle-related problems (OR: 2.60, 95% CI: 1.16-5.83) and neuropathies (OR: 5.7; 95% CI: 1.8-18.7). In a sensitivity analysis, including only visited cases, asthma (OR: 3.0; 95% CI: 1.3-6.9) and CRPS were related. Psychological factors were not associated with CRPS onset. Because of the hypothesis-generating character of this study, the findings should be confirmed by other studies.


Subject(s)
Complex Regional Pain Syndromes/diagnosis , Complex Regional Pain Syndromes/epidemiology , Medical History Taking/statistics & numerical data , Aged , Causality , Female , Humans , Male , Middle Aged , Netherlands/epidemiology , Prevalence
8.
Pain ; 129(1-2): 12-20, 2007 May.
Article in English | MEDLINE | ID: mdl-17084977

ABSTRACT

The complex regional pain syndrome (CRPS) is a painful disorder that can occur in an extremity after any type of injury, or even spontaneously. Data on the incidence of CRPS are scarce and mostly hospital based. Therefore the size of the problem and its burden on health care and society are unknown. The objective of the present study was to estimate the incidence of CRPS in the general population. A retrospective cohort study was conducted during 1996-2005 in the Integrated Primary Care Information (IPCI) project, a general practice research database with electronic patient record data from 600,000 patients throughout The Netherlands. Potential CRPS cases were identified by a sensitive search algorithm including synonyms and abbreviations for CRPS. Subsequently, cases were validated by electronic record review, supplemented with original specialist letters and information from an enquiry of general practitioners. The estimated overall incidence rate of CRPS was 26.2 per 100,000 person years (95% CI: 23.0-29.7). Females were affected at least three times more often than males (ratio: 3.4). The highest incidence occurred in females in the age category of 61-70 years. The upper extremity was affected more frequently than the lower extremity and a fracture was the most common precipitating event (44%). The observed incidence rate of CRPS is more as four times higher than the incidence rate observed in the only other population-based study, performed in Olmsted County, USA. Postmenopausal woman appeared to be at the highest risk for the development of CRPS.


Subject(s)
Community Health Planning , Complex Regional Pain Syndromes/epidemiology , Adult , Age Factors , Aged , Cohort Studies , Complex Regional Pain Syndromes/physiopathology , Confidence Intervals , Female , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Risk Factors , Sex Factors
9.
J Ethnopharmacol ; 55(1): 19-25, 1996 Dec.
Article in English | MEDLINE | ID: mdl-9121163

ABSTRACT

Ethanol extract of propolis (EEP), a natural beehive product, has been known for centuries for a variety of beneficial traditional medical properties, among which an anti-inflammatory effect is a major one. Now that most of its components have been isolated and recently identified, we tested 19 of them (all phenolic compounds) for their degree of anti-inflammatory activity. This was performed by evaluating the luminol-enhanced chemiluminescence, formed after their scavenging free radicals, generated by neutrophils that had been stimulated by phorbol myristate acetate. Caffeic-acid-phenylethyl-ester abolished the chemiluminescence completely at a concentration of 10 microM, while three flavone derivatives and three flavonols (galangin, kaempferol and kaempferid) diminished this chemiluminescence by 73-93% at the same concentration. These results indicate that some of the phenolic components of the ethanol extract of propolis are its active components in exerting its renowned anti-inflammatory activity.


Subject(s)
Neutrophils/drug effects , Propolis/pharmacology , Animals , Anti-Inflammatory Agents/pharmacology , Guinea Pigs , Luminescent Measurements , Male , Neutrophils/physiology , Phenols/pharmacology , Plant Extracts/pharmacology , Tetradecanoylphorbol Acetate/pharmacology
10.
Biochemistry ; 28(21): 8588-96, 1989 Oct 17.
Article in English | MEDLINE | ID: mdl-2690944

ABSTRACT

A simple thermodynamic model is formulated for the purpose of interpreting scanning calorimetry data on proteins that have interacting domains. Interactions are quantified by inclusion of an interface free energy, delta GAB, in the thermodynamics of unfolding for multidomain proteins. The assumption is made that delta GAB goes to zero with the unfolding of either domain involved in pairwise interaction, so the interaction term appears to stabilize only the domain with the lower TM. Application of the model to calorimetric data leads to an estimate of -25,000 cal/mol for interactions between the regulatory and catalytic subunits of native aspartate transcarbamoylase and to a value of 0 for delta GAB between the transmembrane and cytoplasmic domains of band 3 of the human erythrocyte membrane. Estimates of changes in delta GAB are also obtained for mutant forms of yeast phosphoglycerate kinase that have been altered in the hinge region between amino-terminal and carboxy-terminal domains. The model is also applied to ligand binding to proteins having domains that communicate through pairwise interaction. It is shown that whenever the delta GAB term is ligand-dependent, then attachment of the ligand to the binding domain will be partially controlled by the other (regulatory) domain. This situation can sometimes be recognized and quantified when calorimetric scans are carried out at varying ligand concentrations. According to the model, the binding of MgATP to the carboxy-terminal domain of phosphoglycerate kinase is strongly stabilized (ca. 20% of the unitary free energy of binding) by participation of the amino-terminal domain, which acts to increase the binding constant 25-fold.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Models, Biological , Proteins/metabolism , Adenosine Triphosphate/metabolism , Aspartate Carbamoyltransferase/metabolism , Calorimetry, Differential Scanning , Creatine Kinase/metabolism , Erythrocyte Membrane/metabolism , Humans , Ligands , Mutation , Phosphoglycerate Kinase/metabolism , Protein Conformation , Ribonuclease, Pancreatic/metabolism , Saccharomyces cerevisiae/enzymology , Thermodynamics
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