MEFV and NLRP3 Inflammasome Expression Is Attributed to Immature Macrophages and Correlates with Serum Inflammatory Proteins in Crohn´s Disease Patients

Inflammation - Inflammasomes are intracellular protein complexes whose activation results in proinflammatory cytokines. Inflammasomes are implicated in Crohn´s disease (CD) pathogenesis, yet...     

A gap between the philosophy and the practice of palliative healthcare: sociological perspectives on the practice of nurses in specialised palliative homecare

Medicine, Health Care and Philosophy - Palliative care philosophy is based on a holistic approach to patients, but research shows that possibilities for living up to this philosophy seem limited by...     

The phenomenon of the inducement of demand and various concepts in the economics of health

The article looks at the behaviour of practitioners and patients from an economic point of view, in particular at supplier-induced demand (SID). The objective is to be able to describe the factors which impact on the market for health care. To define the market for health care/dental care in general and the SID concept in particular, the following economic terminology is relevant. uncertainty, asymmetric information, moral hazard, and the agency relationship between practitioner and patient. Essentially SID results from the existence of asymmetric information (information "gap") on the health care market. The patient is less informed than the practitioner and cannot accurately assess his need for medical care. Hence decision-making authority is delegated to the practitioner who acts as the patient's agent to determine the optimal (amount of) care. This enables the practitioner to influence the demand for medical/dental care. If the practitioner is more interested in the rate of return than in the patient s need for care, a difference might arise between the care recommended by the practitioner and the care the patient would have asked for if he had the same level of information as the practitioner. This difference is called the amount of SID.     

Subclinical inflammation phenotypes and long‐term outcomes after pediatric kidney transplantation

The implementation of surveillance biopsies in pediatric kidney transplantation remains controversial. Surveillance biopsies detect subclinical injury prior to clinical dysfunction, which could allow for early interventions that prolong allograft survival. We conducted a single‐center retrospective cohort study of 120 consecutive pediatric kidney recipients, of whom 103 had surveillance biopsies ≤6 months posttransplant. We tested the hypothesis that subclinical inflammation (borderline or T cell–mediated rejection without clinical dysfunction) is associated with a 5‐year composite endpoint of acute rejection and allograft failure. Overall, 36% of subjects had subclinical inflammation, which was associated with increased hazard for the composite endpoint (adjusted hazard ratio 2.89 [1.27, 6.57]; P < .01). Subjects with treated vs untreated subclinical borderline rejection had a lower incidence of the composite endpoint (41% vs 67%; P < .001). Subclinical vascular injury (subclinical inflammation with Banff arteritis score > 0) had a 78% incidence of the composite endpoint vs 11% in subjects with no major surveillance abnormalities (P < .001). In summary, we showed that subclinical inflammation phenotypes were prevalent in pediatric kidney recipients without clinical dysfunction and were associated with increased acute rejection and allograft failure. Once prospectively validated, our data would support implementation of surveillance biopsies as standard of care in pediatric kidney transplantation.     

Characterisation of human AV-nodal properties using a network model

Characterisation of the AV-node is an important step in determining the optimal form of treatment for supraventricular tachycardias. To integrate and analyse patient-specific measurements, mathematical modelling has emerged as a valuable tool. Here we present a model of the human AV-node, consisting of a series of interacting nodes, each with separate dynamics in refractory time and conduction delay. The model is evaluated in several scenarios, including atrial fibrillation (AF) and clinical pacing, using simulated and measured data. The model is able to replicate signals derived from clinical ECG data as well as from invasive measurements, both under AF and pacing. To quantify the uncertainty in parameter estimation, 1000 parameter sets were sampled, showing that model output similar to data corresponds to limited regions in the model parameter space. The model is the first human AV-node model to capture both spatial and temporal dynamics while being efficient enough to allow interactive use on clinical timescales, as well as parameter estimation and uncertainty quantification. As such, it fills a new niche in the current set of published models and forms a valuable tool for both understanding and clinical research.     

Participation profiles in domestic life and peer relations as experienced by adolescents with and without impairments and long-term health conditions

Purpose: To investigate how individual and environmental factors relate to self-reported participation profiles in adolescents with and without impairments or long-term health conditions. Methods: A person-oriented approach (hierarchical cluster analysis) was used to identify cluster groups of individuals sharing participation patterns in the outcome variables frequency perceived importance in domestic life and peer relations. Cluster groups were compared using one-way analysis of variance (ANOVA). Results: A nine-cluster solution was chosen. All clusters included adolescents with impairment and long-term health conditions. Perceived importance of peer relations was more important than frequent attendance in domestic-life activities. Frequency of participation in dialogues and family interaction patterns seemed to affect the participation profiles more than factors related to body functions. Conclusion: Type of impairment or long-term health condition is a weaker determinant of membership in clusters depicting frequency and perceived importance in domestic life or peer relations than dialogue and family environment.