Tumour-stroma ratio to predict pathological response to neo-adjuvant treatment in rectal cancer.

INTRODUCTION: Management of rectal cancer has advanced, with an increasing use of neoadjuvant chemoradiotherapy (nCRT). This opens options for organ preserving treatment for those with a major response to nCRT. However, the degree of clinical response, based on MRI and post-treatment biopsies, only poorly matches the degree of actual pathological response. In order to select patients with major pathological response without surgical resection, it is of importance to define tumour markers predicting the degree of pathological response to nCRT. The intra-tumoural tumour-stroma ratio (TSR) might be this marker. METHODS: TSR in pre-treatment biopsies was estimated according to the method described by van Pelt et al. The degree of pathological response was assessed on the tumour resection according to tumour regression grading (TRG) by Mandard. The primary endpoint of this study was the difference in pathological response to nCRT between TSR-high and TSR-low groups. RESULTS: We found that 26.2% of patients with major response was classified as TSR-high, while 73.8% of patients were classified as TSR-low. A high TSR in pre-treatment biopsies was associated with a lower chance of major-response to nCRT (OR = 0.37, 95%CI; 0.19-0.73), p = 0.004), independent of tumour stage and time between nCRT and surgery. CONCLUSION: In rectal cancer, TSR in pre-treatment biopsies predicts pathologic response to nCRT, with a high TSR bringing twice the risk of poor to no response compared to low TSR. In future, assessment of TSR may fulfil a role in a therapeutic algorithm identifying patients who will or will not respond to nCRT prior to treatment initiation.

Prevalence of underlying malignancies in complex cysts of the breast.

INTRODUCTION: The management of complex cysts of the breast is an ongoing topic of discussion. The aim of this study was to determine the prevalence of underlying malignancy in radiologically diagnosed complex cysts, and to assess whether watchful waiting could be the preferred method to safely manage complex cysts of the breast. SUBJECTS AND METHODS: A single-center retrospective study was performed between May 2003 and November 2019 in the VieCuri Medical Centre. Women with a radiologically diagnosed complex cyst of the breast were included. Prevalence of underlying malignancy was calculated, as were absolute risk reduction and number needed to treat in order to diagnose malignancy. In addition, patient characteristics were compared to determine characteristics associated with malignancy. RESULTS: Of 78 radiologically diagnosed complex cysts of the breast, five (6,4%) were found to be malignant. The number needed to treat was calculated at 12,8 (absolute riks reduction 0,078). Age (P = 0,003) was associated with malignancy. CONCLUSION: Complex cysts of the breast could be managed more conservatively. Patient characteristics can be used to assess the eligibility for radiological follow-up. This, in turn, would lead to a lower NNT and possibly a decrease in disease burden and healthcare costs.

Preoperative segmental localization of colorectal carcinoma: CT colonography vs. optical colonoscopy.

BACKGROUND: Adequate preoperative segmental localization of colorectal cancer is important to indicate the right surgical treatment. Preoperative localization has become more important in the era of minimally invasive surgery. The aim of this study was to compare optical colonoscopy (OC) and CT colonography (CTC) with respect to the error rates in the segmental localization of colorectal carcinoma. METHODS: A total of 420 patients with histopathologically proven colorectal carcinoma underwent CTC between December 2006 and February 2017. 284 Of these patients underwent surgical resection and had their carcinomas located on CTC report as well as OC report and surgical report. The segmental localization error rates of OC and CTC were compared using surgery as golden standard. McNemar's test was used to evaluate the differences in error rate. RESULTS: 284 Patients with a total of 296 colorectal carcinomas were evaluated. The segmental localization error rate of CTC (39/296, 13.2%) was found to be lower than the segmental localization error rate of OC (64/296, 21.6%) (p < 0.001). Per segment analysis showed that OC had a significantly higher error rate for carcinomas located in the descending colon (60.6% vs. 21.2% [p < 0.001] and cecum(60.0% vs. 23.3% [p = 0.001]). In 9.2% of the patients (26/284), localization based on CTC would lead to a change in surgical plan. CONCLUSION: CTC has a lower localization error rate than OC, which is most relevant for tumors located in the descending colon. If there is a doubtful localization on OC, particularly in the left-sided colon, an additional CTC should be performed to choose the best surgical treatment.

Detection of potentially relevant extracolonic and colorectal findings at CT colonography in a low-risk symptomatic patient population.

PURPOSE: CT colonography (CTC) is a widely accepted examination tool for detection of colorectal lesions but evidence of the proportions of relevant extracolonic findings (ECF) in a large symptomatic but still relatively low-risk cohort is lacking, as well as their relationship to symptoms, age, and sex. METHODS: All patients (n = 3208) with colorectal symptoms, imaged between January 2007 and September 2016 with first-time CTC, were retrospectively selected. The majority (96.7%) was examined with low-dose unenhanced protocol. The most relevant ECF and colorectal lesions (≥6 mm) were prospectively assessed according to C-RADS classifications. Follow-up was elaborated based on the electronic record review. Chi-square test was utilized for evaluating the associations between relevant findings and symptoms, age, and sex. RESULTS: A total of 270 (8.4%) patients were classified as C-RADS E3, 63 (2.0%) patients as C-RADS E4, and 437 (13.6%) patients were assessed with colorectal lesions (C-RADS C2-4). At follow-up, two thirds of ECF turned out to be a malignancy or relevant disease that required further medical attention. The proportion of ECF was not related to specific colorectal symptoms. Patients aged ≥65 years and men had significantly higher proportions of ECF than younger patients (C-RADS E3 p = 0.005; C-RADS E4 p < 0.001) and women (C-RADS E3 p = 0.013; C-RADS E4 p = 0.009), respectively. CONCLUSION: Proportions of relevant ECF and colorectal findings are relatively low in symptomatic low-risk patients. By use of CTC as a singular examination, especially in elderly patients, most colonoscopies can be avoided with the benefit of diagnosing relevant ECF without introducing substantial over-diagnosis.

Mid- to long-term functional outcome after open reduction and internal fixation of tibial plateau fractures.

BACKGROUND: Tibial plateau fractures account for approximately 1% of all fractures. They usually occur after a direct high-energy trauma. Despite adequate treatment, these fractures can result in malalignment and secondary osteoarthritis (OA). Research concerning long-term functional outcome is limited. The primary aim of this study was to evaluate mid- to long-term functional outcome of surgically treated tibial plateau fractures. The secondary aim was to investigate whether radiological characteristics of OA one year after surgery are predictive of functional outcome at follow-up. METHODS: All consecutive patients with fractures of the proximal tibia, which were surgically treated in our level-2 trauma centre between 2004 and 2010, were included in this study. Initial trauma radiographs were analysed for fracture classification, using both the Schatzker and AO/OTA classification systems, by three different raters. Immediate postoperative and 1-year postoperative radiographs were analysed for osteoarthritis by an experienced radiologist, using the Kellgren and Lawrence scale. Functional outcome of the included patients was measured using the Dutch version of the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. RESULTS: Seventy one patients out of a group of 96 included patients completed the survey. Median KOOS scores are 89.8% for pain, 91.1% for 'other symptoms', 89.7% for daily function, 72.5% for sports and recreation and 75.0% for quality of life. Median KOOS overall score is 82.99%. We did not find a correlation between the KOOS scores and the absolute age for any of the subscales. There was no significant relationship between radiological characteristics of osteoarthritis and functional outcome. CONCLUSIONS: This is the first study to describe mid- to long-term functional outcome after ORIF for all types of tibial plateau fractures, with the use of the KOOS. Patients should be informed about the likelihood of lower functional outcome in the long-term. This study shows that radiological characteristics of osteoarthritis are not related with lower functional outcomes in the mid- to long-term.

Miss rate of colorectal cancer at CT colonography in average-risk symptomatic patients.

OBJECTIVES: Computed tomographic colonography (CTC) is a less burdensome alternative to colonoscopy in excluding colorectal cancer (CRC) in symptomatic patients. We evaluated the proportion of patients who underwent CTC in whom CRC was missed. METHODS: Patients who had undergone CTC in the period 1 January 2007 to 1 January 2011 were merged with all cases of CRC recorded in the Cancer Registry between 1 January 2007 and 1 July 2011 to identify all patients who had undergone CTC less than 2 years before CRC had been diagnosed. RESULTS: In 53 out of 1,855 patients who had undergone CTC, CRC was diagnosed. Of these, 40 patients had suspected CRC and 5 had large polyps at CTC. In five patients with an indeterminate mass, further investigation confirmed malignancy. One cancer in the caecum was missed because of poor distension. Two cancers were missed: one in the distal rectum and one in the ascending colon. Sensitivity of CTC for CRC was 94.3 % (95 % CI 88-100 %). The true miss rate, excluding the inadequate distended study, was 2 out of 53 (3.8 %). CONCLUSION: This study shows that the miss rate for CTC is low, which means that CTC is accurate in excluding CRC in symptomatic patients at a relatively low risk of CRC.

Long-term results of primary stent placement to treat infrarenal aortic stenosis.

OBJECTIVE: To determine the safety and the long-term results of primary stent placement for localized distal aortic occlusive disease. DESIGN: Retrospective observational study. PATIENTS AND METHODS: From July 1998 to July 2005 17 patients (14 female and 3 men, mean age 57 years (39-80)) were treated for intermittent claudication. Five of these patients underwent additional endovascular treatment of focal iliac lesions. RESULTS: Technical success defined as residual stenosis of less than 50% or a trans-stenotic systolic pressure gradient <10% was achieved in 14 of 17 (82%) patients. Major complications included dissection at the puncture site in one patient and thrombosis of additional iliac stents in another patient. Both of these complications were successfully treated. During a mean follow-up of 27 months (range 1-86), four patients had recurrence of symptoms due to in-stent restenoses (n=2), femoral (n=1) or iliac occlusion (n=1), respectively. By Kaplan-Meier analysis, primary aortic hemodynamic patency was 83% at 3 years. Secondary aortic hemodynamic patency was 100%. The primary clinical patency was 68% at 3 years. CONCLUSION: Primary stent placement for distal aortic stenoses is an alternative to surgical treatment because of its high patency and relatively low complication rates.

Effects of ambient temperature, arginine-to-lysine ratio, and electrolyte balance on performance, carcass, and blood parameters in commercial male turkeys.

The effects of ambient temperature (T; 15 C vs. 30 C from 6 wk of age onwards), dietary Arg:Lys ratio (Arg:Lys ratio; 1.00 vs. 1.25), dietary electrolyte balance (DEB: 164 vs. 254 meq/kg), and their interactions on growth performance and carcass yields of male turkeys were studied. The experiment was designed as a split plot, including T x DEB as the main plot and Arg:Lys ratio as the sub-plot, with 24 pens containing 35 male turkeys each. Feed consumption, BW gain, mortality, and processing yields were measured. Temperature had a clear effect on performance during all age periods. Feed intake was significantly lower for the high T group compared with the low T group (322.7 vs. 432.3 g/bird per day; P < 0.001). Consequently, BW gain during the experimental period (28 to 140 d of age) was significantly lower for the high T group compared with the low T group (14.54 vs. 18.74 kg; P < 0.001). Feed:gain during the period of 28 to 140 d of age was significantly lower for the high T group compared with the low T group (2.51 vs. 2.61; P < 0.001). The high dietary Arg:Lys ratio increased feed intake significantly until 56 d of age (200.6 vs. 197.6; P < or = 0.034). A high Arg:Lys ratio resulted in significantly higher BW gain until 98 d of age (10.03 vs. 9.84 kg; P < or = 0.024). The Arg:Lys ratio did not affect feed:gain throughout the experiment. Dietary electrolyte balance did not affect performance parameters. No consistent two- or three-way interactions were observed. Processing yields were only affected significantly by T, and not by Arg:Lys ratio or DEB main effects. High T resulted in lower cold carcass (73.2 vs. 74.9%) and breast meat yields (33.5 vs. 36.0%), and higher thigh (18.9 vs. 18.1%), drumstick (14.5 vs. 13.2%), and wing yields (11.7 vs. 10.6%) compared with low T. We concluded that growth performance is compromised by higher T, and altering the Arg:Lys ratio or DEB does not alleviate this impaired performance. Dietary Arg levels seem to be important when dietary Lys is marginal relative to the requirement.

[Prevalence and treatment of hypercholesterolemia in patients with manifest vascular disease according to practice guidelines of the current cholesterol consensus]. / Prevalentie en behandeling van hypercholesterolemie bij patiënten met manifest vaatlijden volgens de maatstaven van de huidige cholesterolconsensus.

OBJECTIVE: To determine the prevalence of hypercholesterolaemia and the use of lipid-lowering medication in patients with a manifest vascular disease. DESIGN: Prospective, cross-sectional. METHODS: In patients who visited the University Medical Centre Utrecht, the Netherlands, for the first time with a manifestation of atherosclerosis in the period 1 September 1996-15 November 1998, we determined by a single measurement of the cholesterol if they were eligible for lipid-lowering medication according to the cholesterol cut-off value mentioned in the new Dutch cholesterol guidelines (1998) of the Dutch Institute for Health Care Improvement. RESULTS: The study group comprised 737 patients: 539 (73%) males and 198 (27%) females, with a mean age of 62 year. 500 (68%) were eligible for lipid-lowering treatment. 66 patients (9%) were being treated according to the guidelines and in 106 (14%) the aim of a cholesterol lower than 5.0 mmol/1 was not reached despite cholesterol lowering medication. In 328 patients (45%) hyperlipidaemia was not treated pharmacologically. CONCLUSION: Two-thirds of the patients with manifest vascular disease had hypercholesterolaemia. Many of these patients were not yet being treated.

Second manifestations of ARTerial disease (SMART) study: rationale and design.

The Second Manifestations of ARTerial disease (SMART) study is a single-centre prospective cohort study among patients, newly referred to the hospital with (1) clinically manifest atherosclerotic vessel disease, or (2) marked risk factors for atherosclerosis. The first objectives of the SMART study are to determine the prevalence of concomitant arterial disease at other sites, and risk factors in patients presenting with a manifestation of arterial disease or vascular risk factor and to study the incidence of future cardiovascular events and its predictors in these high-risk patients. At least 1000 patients, aged 18 to 80 years, will undergo baseline examinations, including a questionnaire on cardiovascular disease, height, weight and blood pressure measurements, blood tests for glucose, lipids, creatinine and homocysteine, urinary tests for microproteinuria, resting twelve-lead electrocardiogram, ultrasound scanning of the abdominal aorta, kidneys and the carotid arteries, measurements of common carotid intima-media thickness and arterial stiffness, and a treadmill test to assess atherosclerosis of the leg arteries. Abnormal findings are reported to the treating specialist and general practitioner with a treatment suggestion according to current practice guidelines. Recruitment and baseline examinations began in September 1996. All cohort members will be followed for clinical cardiovascular events for a minimum of three years. In the scope of secondary prevention, the study is expected to support the design of solid based screening and treatment programmes and evidence-based cardiovascular medicine to reduce morbidity and mortality, and improve quality of life, in high-risk patients.

Common carotid intima-media thickness in patients with peripheral arterial disease or abdominal aortic aneurysm: the SMART study. Second Manifestations of ARTerial disease.

Evidence is emerging that the contribution of atherosclerosis to the development of abdominal aortic aneurysm may differ from that of other manifestations of arterial disease. B-mode ultrasound may be helpful in understanding the characteristics and factors that contribute to the development of different manifestations of arterial disease. We examined whether there is a difference in common carotid intima-media thickness (IMT), an indicator of generalized atherosclerosis, in patients with peripheral arterial disease (PAD) and abdominal aortic aneurysm (AAA). IMT of the left and right common carotid artery was measured in the first 172 patients (123 PAD and 49 AAA) enrolled in the Second Manifestations of ARTerial disease (SMART) study, a cohort study among patients with a manifestation of atherosclerotic vascular disease or risk factors for atherosclerosis. Mean IMT was 0.98 +/- 0.34 mm in patients with PAD and 0.91 +/- 0.20 mm in patients with AAA, with an age and sex adjusted mean difference of 0.18 mm (95% CI 0.08; 0.28). After additional adjustments for cardiovascular risk factors, the difference remained 0.11 mm (95% Cl 0.01; 0.21). Common carotid IMT in patients with AAA is on average smaller than in patients with PAD, independent of other determinants of IMT. These findings support the view that the development of AAA cannot completely be explained by atherosclerosis and is in part due to other pathophysiological mechanisms.

Common carotid intima-media thickness and arterial stiffness: indicators of cardiovascular risk in high-risk patients. The SMART Study (Second Manifestations of ARTerial disease).

BACKGROUND: Common carotid intima-media thickness (IMT) and distensibility are markers of structural and functional vessel wall properties. Both parameters have been found in population-based studies to be associated with cardiovascular risk factors and prevalent cardiovascular disease. We investigated cross-sectionally whether IMT and distensibility are associated with cardiovascular risk in patients who already have vascular disease or atherosclerotic risk factors and evaluated the diagnostic ability of IMT and distensibility to discriminate between low- and high-risk patients. METHODS AND RESULTS: IMT and distensibility (change of diameter) of the left and right common carotid arteries were measured in the first 570 patients (537 for distensibility) enrolled in the Second Manifestations of ARTerial disease (SMART) study, a cohort study among patients with a manifestation of vascular disease or cardiovascular risk factors. Three risk scores were used to classify each patient's vascular risk. Areas under the curve (AUCs) of receiver-operating characteristic curves were calculated for IMT and distensibility after the patients were dichotomized on the median of the risk scores as the outcome. Risk scores increased nearly linearly with increasing IMT and decreasing distensibility. The AUCs for IMT predicting high-risk patients were 0.77, 0.73, and 0.77 based on the 3 risk scores. The AUCs for distensibility were 0. 65, 0.62, and 0.66. CONCLUSIONS: Common carotid IMT and distensibility are clear markers of cardiovascular risk in patients who already have vascular disease or atherosclerotic risk factors. IMT appears to discriminate between low- and high-risk patients better than distensibility.

Carotid artery stenosis in patients with peripheral arterial disease: the SMART study. SMART study group.

PURPOSE: The prevalence of asymptomatic internal carotid artery stenosis (ICAS) in patients with peripheral arterial disease (PAD) and characteristics that are associated with ICAS were studied. METHODS: We used data from the first 600 patients enrolled in the Second Manifestations of ARTerial disease (SMART) study, a single-center, prospective cohort study among patients referred with a manifestation of cardiovascular disease, diabetes mellitus, hypertension, or hyperlipidemia. Included in the analysis were 162 patients with PAD or a history of PAD, who were not known to have ICAS at the time of referral and who had no history of cerebrovascular symptoms or previous carotid endarterectomy. ICAS was detected with duplex scanning and defined as a peak systolic velocity more than 150 cm/s (diameter reduction 50% or higher) on at least one side. Cardiovascular risk factors were measured. Logistic regression analysis was performed to investigate associations between these characteristics and ICAS. RESULTS: The prevalence of previously unknown ICAS was 14%. A patient age of 67 years or older, body weight of 68 kg or less, and diastolic blood pressure of 75 mm Hg or lower were independently associated with ICAS. The Prevalence Of Icas In Patients With One Of These Characteristics (38% Of The Patients) Was 8%, In Those With Two Characteristics (21% Of The Patients) Was 32%, And In Those With Three Characteristics (6% Of The Patients) Was 50%. CONCLUSIONS: The prevalence of ICAS increases as much as 50% in patients who have PAD and the risk indicators of an age of 67 years or older, a body weight of 68 kg or less, and a diastolic blood pressure of 75 mm Hg or lower, and, therefore, these characteristics may be used as a means of increasing the likelihood of detecting ICAS.

[The screening for asymptomatic vascular disease and risk factors in high risk patients: current practice]. / Screenen op asymptomatische vaatziekten en risicofactoren bij hoogrisicopatiënten: de huidige praktijk.

OBJECTIVE: To assess current practice in screening for asymptomatic vascular disease and risk factors in patients referred with vascular disease or cardiovascular risk factors. DESIGN: Descriptive, retrospective. SETTING: University Hospital Utrecht, Utrecht, the Netherlands. METHOD: By means of the computerized hospital registration system all patients who were referred to the outpatient clinic with carotid stenosis, peripheral artery disease, abdominal aortic aneurysm, diabetes mellitus, hyperlipidaemia or hypertension during one year were identified. By means of the same hospital registration system the frequency of diagnostic tests performed to detect atherosclerosis or risk factors in these patients within a period of 5 months round the first attendance was determined. RESULTS: 372 Patients with a vascular disease and 317 patients with a risk factor were identified. Tests to detect carotid stenosis, peripheral artery disease or an abdominal aortic aneurysm were each performed in less then 6% of all patients except the test for abdominal aortic aneurysm. Tests to detect coronary artery disease were performed in about 50% of all patients. Tests to detect diabetes mellitus were performed in 35% of the patients with vascular disease and in 81% of the patients presenting with hyperlipidaemia or hypertension. Tests to detect hyperlipidaemia were performed in 18% of the patients with a vascular disease and in 76% of the patients with diabetes or hypertension. CONCLUSION: The results of this study suggest that in current practice patients referred for vascular disease or cardiovascular risk factors are infrequently screened for asymptomatic macrovascular disease and risk factors.

Protein kinase C-theta phosphorylation of moesin in the actin-binding sequence.

Moesin, a member of the ezrin-radixin-moesin (ERM) family of membrane/cytoskeletal linkage proteins, is known to be threonine-phosphorylated at Thr558 in activated platelets within its conserved putative actin-binding domain. The pathway leading to this phosphorylation step and its control have not been previously elucidated. We have detected and characterized reactions leading to moesin phosphorylation in human leukocyte extracts. In vitro phosphorylation of endogenous moesin, which was identified by peptide microsequencing, was dependent on phosphatidylglycerol (PG) or to a lesser extent, phosphatidylinositol (PI), but not phosphatidylserine (PS) and diacylglycerol (DAG). Analysis of charge shifts, phosphoamino acid analysis, and stoichiometry was consistent with a single phosphorylation site. By using mass spectroscopy and direct microsequencing of CNBr fragments of phospho-moesin, the phosphorylation site was identified as KYKT*LRQIR (where * indicates the phosphorylation site) (Thr558), which is conserved in the ERM family. Recombinant moesin demonstrated similar in vitro phospholipid-dependent phosphorylation compared with the endogenous protein. The phosphorylation site sequence of moesin displays a high degree of conservation with the pseudosubstrate sequences of the protein kinase C (PKC) family. We identified the kinase activity as PKC-theta on the basis of immunodepletion of the moesin kinase activity and copurification of PKC-theta with the enzymic activity. We further demonstrate that PKC-theta displays a preference for PG vesicles over PI or PS/DAG, with minimal activation by DAG, as well as specificity for moesin compared with myelin basic protein, histone H1, or other cellular proteins. Expression of a human His6-tagged PKC-theta in Jurkat cells and purification by Ni2+ chelate chromatography yield an active enzyme that phosphorylates moesin. PG vesicle binding experiments with expressed PKC-theta and moesin demonstrate that both bind to vesicles independently of one another. Thus, PKC-theta is identified as a major kinase within cells with specificity for moesin and with activation under non-classical PKC conditions. It appears likely that this activity corresponds to a specific intracellular pathway controlling the function of moesin as well as other ERM proteins.

C-terminal threonine phosphorylation activates ERM proteins to link the cell's cortical lipid bilayer to the cytoskeleton.

The plasma membrane consists of a lipid bilayer with integral membrane proteins stabilized by regulated linkages to the cortical actin cytoskeleton. The regulation is necessary for cells to change shape ormigrate. The ERM (ezrin-radixin-moesin) proteins are believed to provide such links, with the N-terminal halves associating with integral membrane proteins, either directly or indirectly through adapter molecules like EBP50 (ERM binding phosphoprotein, 50 kDa), and their C-terminal halves associating with F-actin. However, isolated ERM proteins largely exist in a dormant state by virtue of an intramolecular interaction between amino- and carboxyl-terminal domains, thereby masking membrane and cytoskeletal association sites. C-terminal threonine phosphorylation of a fragment of radixin has been found to destroy its ability to bind the amino-terminal domain without affecting the C-terminal F-actin binding site. Here we show that C-terminal phosphorylation of full-length, dormant ezrin and moesin by protein kinase C-theta simultaneously unmasks both the F-actin and EBP50 binding sites. Increased phosphorylation of moesin in cells correlated with increased association of moesin with the cortical actin cytoskeleton. These results show that activation of ERM proteins can be accomplished by phosphorylation of a single C-terminal threonine residue.

Effect of timing of blood pressure measurement in the assessment of arterial stiffness: the SMART Study.

In the assessment of arterial stiffness, pulse pressure is measured. Presently, there is no consensus on how pulse pressure should be measured. Distensibility of the left and right common carotid arteries was measured noninvasively in 224 patients participating in the Second Manifestations of ARTerial disease (SMART) study. Blood pressure was recorded every 4 min, using a semiautomatic oscillometric device. Distensibility coefficients (DC) were calculated with pulse pressure obtained as an average of (A) all measurements during the session; (B) the second, third, and fourth measurement; (C) measurements before and after distensibility assessment; and (D) three measurements nearest to distensibility assessment. Associations of cardiovascular risk factors with the four calculated DCs were evaluated with linear regression analysis. DC estimates were slightly more precise with methods A and B than with C or D. The magnitude of the associations showed a slight trend to higher precision for methods A and B. Pulse pressures obtained as an average of all or the second, third, and fourth blood pressure measurements during an arterial stiffness measurement session yield slightly more precise estimates of DC. However, the differences between the methods are small; therefore, we suggest that pragmatic arguments dominate the choice between the methods.