Cuno S P M Uiterwaal

Hogeschool Utrecht, Utrecht, Utrecht, Netherlands

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Publications (369)1490.28 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Antiepileptic drugs (AEDs) have cognitive side effects that, particularly in children, may affect intellectual functioning. With the TimeToStop study, we showed that timing of AED withdrawal does not majorly influence long-term seizure outcomes. We now aimed to evaluate the effect of AED withdrawal on postoperative IQ, and change in IQ (delta IQ) following pediatric epilepsy surgery. We collected IQscores of children from the TTS cohort with both pre- and postoperative neuropsychological assessments (NPA) (n=301) and analysed whether reduction of AEDs prior to the latest NPA was related to postoperative IQ and delta IQ, using linear regression analyses. Factors previously identified to independently relate to (delta) IQ, and currently identified predictors of (delta) IQ, were considered possible confounders and used for adjustment. Additionally, we adjusted for a compound propensity score that contained previously identified determinants of timing of AED withdrawal. Mean interval to latest NPA was 19.8±18.9 months. Reduction of AEDs at latest NPA significantly improved postoperative IQ and delta IQ (adjusted RC 3.4(0.6, 6.2), p=0.018, and 4.5(1.7, 7.4), p=0.002), as did complete withdrawal (4.8(1.4, 8.3), p=0.006 and 5.1(1.5, 8.7), p=0.006). AED reduction also predicted ≥10 points IQ increase (p=0.019). The higher the number of AEDs reduced, the higher the IQ (gain) after surgery (2.2(0.6, 3.7), p= 0.007 and 2.6(1.0, 4.2), p=0.001, IQ points per AED reduced). Start of AED withdrawal, number of AEDs reduced, and complete AED withdrawal were associated with improved postoperative IQ scores and gain in IQ, independent of other determinants of cognitive outcome. This article is protected by copyright. All rights reserved. © 2015 American Neurological Association.
    Annals of Neurology 04/2015; DOI:10.1002/ana.24427 · 11.91 Impact Factor
  • PLoS ONE 04/2015; 10(4):e0121572. DOI:10.1371/journal.pone.0121572 · 3.53 Impact Factor
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    ABSTRACT: Introduction Asthma control is considered the major goal of asthma management, while many determinants of control are difficult to modify. We studied the association between respiratory infection episodes (RTIs) of various types and asthma control. Methods Cross-sectional data were used from children aged 4-18 years with physician-diagnosed asthma who participated in a web-based electronic portal for children with asthma, allergies or infections. Asthma control was measured using the Childhood Asthma Control Test (C-ACT) or the Asthma Control Test (ACT). Linear regression was used to analyse the association between categories of numbers of various types of RTIs sustained in the preceding 12 months (categorized) and asthma control, adjusted for potential confounders. Results Asthma control was assessed in 654 children, and 68.5% were clinically well controlled (ACT≥20). Higher total numbers of RTIs in the last 12 months were strongly associated with a lower level of asthma control (ptrend<0.001). Similarly strong statistically significant associations were found for subtypes of RTI: ≥4 vs. 0 otitis episodes: coefficient -1.7 (95% CI -3.3 to -0.2); ≥5 vs.0 colds: coefficient -2.3 (95% CI -3.0 to -1.6); ≥3 vs. 0 bronchitis episodes: coefficient -3.1 (95% CI -4.0 to -2.3), each with ptrend <0.05. Conclusion Higher numbers of reported respiratory tract infections are associated with lower level of asthma control. The different type of respiratory tract infections contribute equally to less controlled asthma.
    Respiratory Medicine 10/2014; 108(10). DOI:10.1016/j.rmed.2014.07.007 · 2.92 Impact Factor
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    ABSTRACT: Background Atherosclerosis is a process that begins in childhood, develops over decades and underlies the majority of cardiovascular events in adulthood. Previously, we demonstrated in adults with cardiovascular disease that levels of extracellular vesicle (EV) proteins CD14, Serpin F2 and cystatin C predict vascular outcome. Here, we study for the first time whether these EV proteins are related to vascular characteristics in healthy, young children. Methods and results In 141 eight-year old children of the Wheezing-Illnesses-Studie-LEidsche-Rijn birth cohort, anthropometrics and blood pressure were measured. In addition, common carotid intima-media thickness, carotid distensibility and carotid Young's elastic modulus were obtained non-invasively using ultrasound imaging. A fasting lipid spectrum was obtained and EVs were isolated from plasma. Levels of EV proteins CD14, Serpin F2 and cystatin C were measured using a multiplex assay. In a multivariable linear regression model we assessed the relation between these EV proteins and the selected vascular characteristics. Of the studied EV proteins, CD14 levels were positively related to common carotid intima-media thickness (log transformed, beta = 7.31 ln(mm)/(ng/mg) (1.24, 13.38), p = 0.02). EV proteins Serpin F2 and cystatin C were not related to common carotid intima-media thickness. In addition, we found no relation between all three EV proteins and carotid distensibility or carotid Young's elastic modulus. Conclusion In healthy eight-year old children, extracellular vesicle protein CD14 levels seem positively related to common carotid intima-media thickness. This would point towards inflammatory vascular alterations inflicted by extracellular vesicle protein CD14 already in early life and warrants further investigation.
    Atherosclerosis 10/2014; 236(2):270–276. DOI:10.1016/j.atherosclerosis.2014.07.018 · 3.97 Impact Factor
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    ABSTRACT: Many Muslim women worldwide are pregnant during Ramadan and adhere to Ramadan fasting during pregnancy. In the present study, we determined whether maternal adherence to Ramadan fasting during pregnancy has an impact on the birth weight of the newborn, and whether the effects differed according to trimester in which Ramadan fasting took place. A prospective cohort study was conducted in 130 pregnant Muslim women who attended antenatal care in Amsterdam and Zaanstad, The Netherlands. Data on adherence to Ramadan fasting during pregnancy and demographics were self-reported by pregnant women, and the outcome of the newborn was retrieved from medical records after delivery. The results showed that half of all the women adhered to Ramadan fasting. With strict adherence to Ramadan fasting in pregnancy, the birth weight of newborns tended to be lower than that of newborns of non-fasting mothers, although this was not statistically significant ( - 198 g, 95 % CI - 447, 51, P= 0·12). Children of mothers who fasted in the first trimester of pregnancy were lighter at birth than those whose mothers had not fasted ( - 272 g, 95 % CI - 547, 3, P= 0·05). There were no differences in birth weight between children whose mothers had or had not fasted if Ramadan fasting had taken place later in pregnancy. Ramadan fasting during early pregnancy may lead to lower birth weight of newborns. These findings call for further confirmation in larger studies that should also investigate potential implications for perinatal and long-term morbidity and mortality.
    British Journal Of Nutrition 09/2014; 112(9):1-7. DOI:10.1017/S0007114514002219 · 3.34 Impact Factor
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    ABSTRACT: Prospective studies examining the association between coffee and tea consumption and gastric cancer risk have shown inconsistent results. We investigated the association between coffee (total, caffeinated and decaffeinated) and tea consumption and the risk of gastric cancer by anatomical site and histological type in the EPIC study. Coffee and tea consumption was assessed by dietary questionnaires at baseline. Adjusted hazard ratios (HRs) were calculated using Cox regression models. During 11.6 years of follow up, 683 gastric adenocarcinoma cases were identified among 477,312 participants. We found no significant association between overall gastric cancer risk and consumption of total coffee (HR 1.09, 95%-CI: 0.84-1.43; quartile 4 vs. non/quartile 1), caffeinated coffee (HR 1.14, 95%-CI: 0.82-1.59; quartile 4 vs. non/quartile 1), decaffeinated coffee (HR 1.07, 95%-CI: 0.75-1.53; tertile 3 vs. non/tertile 1) and tea (HR 0.81, 95%-CI: 0.59-1.09; quartile 4 vs. non/quartile 1). When stratified by anatomical site, we observed a significant positive association between gastric cardia cancer risk and total coffee consumption per increment of 100mL/day (HR 1.06, 95%-CI: 1.03-1.11). Similarly, a significant positive association was observed between gastric cardia cancer risk and caffeinated coffee consumption (HR 1.98, 95%-CI: 1.16-3.36, P-trend=0.06; quartile 3 vs. non/quartile 1) and per increment of 100mL/day (HR 1.09, 95%-CI: 1.04-1.14). In conclusion, consumption of total, caffeinated and decaffeinated coffee and tea is not associated with overall gastric cancer risk. However, total and caffeinated coffee consumption may be associated with an increased risk of gastric cardia cancer. Further prospective studies are needed to rule out chance or confounding. © 2014 Wiley Periodicals, Inc.
    International Journal of Cancer 09/2014; 136(6). DOI:10.1002/ijc.29223 · 5.01 Impact Factor
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    ABSTRACT: Aim. It was recently suggested that early postoperative seizure relapse implicates a failure to define and resect the epileptogenic zone, that late recurrences reflect the persistence or re-emergence of epileptogenic pathology, and that early recurrences are associated with poor treatment response. Timing of antiepileptic drugs withdrawal policies, however, have never been taken into account when investigating time to relapse following epilepsy surgery. Methods. Of the European paediatric epilepsy surgery cohort from the "TimeToStop" study, all 95 children with postoperative seizure recurrence following antiepileptic drug (AED) withdrawal were selected. We investigated how time intervals from surgery to AED withdrawal, as well as other previously suggested determinants of (timing of) seizure recurrence, related to time to relapse and to relapse treatability. Uni- and multivariable linear and logistic regression models were used. Results. Based on multivariable analysis, a shorter interval to AED reduction was the only independent predictor of a shorter time to relapse. Based on univariable analysis, incomplete resection of the epileptogenic zone related to a shorter time to recurrence. Timing of recurrence was not related to the chance of regaining seizure freedom after reinstallation of medical treatment. Conclusion. For children in whom AED reduction is initiated following epilepsy surgery, the time to relapse is largely influenced by the timing of AED withdrawal, rather than by disease or surgery-specific factors. We could not confirm a relationship between time to recurrence and treatment response. Timing of AED withdrawal should be taken into account when studying time to relapse following epilepsy surgery, as early withdrawal reveals more rapidly whether surgery had the intended curative effect, independently of the other factors involved.
    Epileptic disorders: international epilepsy journal with videotape 09/2014; 16(3). DOI:10.1684/epd.2014.0681 · 0.90 Impact Factor
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    ABSTRACT: To evaluate the feasibility and reproducibility of free fatty acid (FFA) measurement for diagnosing adipose tissue dysfunction by (1) H-magnetic resonance spectroscopy ((1) H-MRS) in different abdominal adipose tissue depots in healthy obese and lean subjects. Polyunsaturated fatty acids (PUFA), total unsaturated fatty acids (TUFA), triglycerides (TG), and their ratios were determined in three adipose tissue depots of 12 obese and 13 lean subjects. Subjects underwent two separate examinations to assess reproducibility. In lean subjects, 44% of measurements failed due to inclusion of nonadipose tissue in the spectroscopy voxel, as opposed to 23% in obese subjects. Reproducibility of PUFA, TUFA, and TG was moderate to good in obese subjects (intraclass correlation coefficients [ICCs] 0.18-0.75), and poor to moderate in lean subjects (ICCs -1.04-0.55) in subcutaneous and omental adipose tissue. In the perirenal adipose tissue, ICCs were poor in both lean and obese subjects (-0.794-0.013). PUFA/TUFA and PUFA/TG were higher in omental adipose tissue in obese vs. lean subjects (35*10(-3) vs. 0.16*10(-3) , P = 0.01 and 2.05*10(-3) vs. 0.01*10(-3) , P = 0.02, respectively). (1) H-MRS is a feasible and reproducible method for FFA profiling in abdominal adipose tissue in abdominally obese individuals. (1) H-MRS has potential as diagnostic tool for noninvasive identification of adipose tissue dysfunction. J. Magn. Reson. Imaging 2013;. © 2013 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 08/2014; 40(2). DOI:10.1002/jmri.24368 · 2.79 Impact Factor
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    ABSTRACT: Increases in human population size, dengue vector-density and human mobility cause rapid spread of dengue virus in Indonesia. We investigated the changes in dengue haemorrhagic fever (DHF) incidence in Indonesia over a 45-year period and determined age-specific trends in annual DHF incidence.
    BMC Infectious Diseases 07/2014; 14(1):412. DOI:10.1186/1471-2334-14-412 · 2.56 Impact Factor
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    ABSTRACT: It is unknown why respiratory syncytial virus (RSV) causes mild disease in some children and severe disease, requiring hospitalisation, in others. We aimed to assess whether diminished premorbid lung function in healthy term infants predisposes to hospitalisation during RSV bronchiolitis, and to post-RSV wheeze. In a prospective birth cohort study of unselected term healthy children, neonatal lung function was measured before the age of 2 months (n = 2133). From birth through the first year of life, respiratory symptoms were recorded in a diary, and general practitioner consultations and hospitalisations were documented. In a subgroup (n = 417) repeated nose and throat swabs were collected for PCR to detect RSV infections. Median neonatal respiratory system compliance (Crs) was significantly lower (41.2 versus 47.4 mL·kPa(-1), p = 0.03) and resistance (Rrs) was higher (8.2 versus 6.3 kPa·s·L(-1), p = 0.10) in hospitalised RSV patients (n = 18) compared with nonhospitalised RSV-positive infants (n = 84). Every 10 mL·kPa(-1) increase in Crs was associated with 55% less post-RSV wheeze (OR 0.56, 95% CI 0.35-0.90), and each kPa·s·L(-1) increase in Rrs was associated with 42% more post-RSV wheeze, which was only marginally explained by pre-RSV wheeze or severity of the RSV disease. This unselected birth cohort study shows for the first time that decreased lung function at birth predisposes to severe RSV disease, and to post-RSV wheeze.
    European Respiratory Journal 07/2014; 44(3). DOI:10.1183/09031936.00009314 · 7.13 Impact Factor
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    ABSTRACT: To compare whole-body magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI), to computed tomography (CT) for staging newly diagnosed lymphoma. In all, 108 patients with newly diagnosed lymphoma prospectively underwent whole-body MRI (T1-weighted and T2-weighted short inversion time inversion recovery [n = 108], and DWI [n = 104]) and CT. Ann Arbor stages were assigned according to whole-body MRI and CT findings. Staging disagreements were resolved using bone marrow biopsy, FDG-PET, and follow-up studies. The results were descriptively analyzed. Staging results of whole-body MRI without DWI were equal to those of CT in 66.6%, higher in 24.1%, and lower in 9.3%, with correct/incorrect/unresolved higher staging and incorrect/unresolved lower staging relative to CT in 15/7/4 and 9/1 patient(s), respectively. Staging results of whole-body MRI with DWI were equal to those of CT in 65.4%, higher in 27.9%, and lower in 6.7%, with correct/incorrect/unresolved higher staging and incorrect/unresolved lower staging relative to CT in 18/6/5 and 6/1 patient(s), respectively. The results of this study suggest that whole-body MRI staging equals CT staging in the majority of patients with newly diagnosed lymphoma. No advantage of additional DWI was demonstrated. Whole-body MRI can be a good alternative to CT if radiation exposure should be avoided. J. Magn. Reson. Imaging 2013;. © 2013 Wiley Periodicals, Inc.
    Journal of Magnetic Resonance Imaging 07/2014; 40(1). DOI:10.1002/jmri.24356 · 2.79 Impact Factor
  • European Respiratory Journal 05/2014; 44(2). DOI:10.1183/09031936.00006814 · 7.13 Impact Factor
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    ABSTRACT: Background There is accumulating evidence of hypothalamic–pituitary–adrenal (HPA) axis hypofunction in chronic fatigue syndrome (CFS). However, knowledge of this hypofunction has so far come exclusively from research in adulthood, and its clinical significance remains unclear. The objective of the current study was to assess the role of the HPA-axis in adolescent CFS and recovery from adolescent CFS. Method Before treatment, we compared the salivary cortisol awakening response of 108 diagnosed adolescent CFS patients with that of a reference group of 38 healthy peers. Salivary cortisol awakening response was measured again after 6 months of treatment in CFS patients. Results Pre-treatment salivary cortisol levels were significantly lower in CFS-patients than in healthy controls. After treatment recovered patients had a significant rise in salivary cortisol output attaining normalization, whereas non-recovered patients improved slightly, but not significantly. The hypocortisolism found in CFS-patients was significantly correlated to the amount of sleep. Logistic regression analysis showed that an increase of one standard deviation in the difference between pre- and post-treatment salivary cortisol awakening response was associated with a 93% higher odds of recovery (adjusted OR 1.93 (1.18 to 3.17), p = 0.009). Pre-treatment salivary cortisol did not predict recovery. Conclusions Hypocortisolism is associated with adolescent CFS. It is not pre-treatment cortisol but its change to normalization that is associated with treatment success. We suggest that this finding may have clinical implications regarding the adaptation of future treatment strategies.
    Psychoneuroendocrinology 04/2014; 42:199–206. DOI:10.1016/j.psyneuen.2014.01.017 · 5.59 Impact Factor
  • Jacobien B Eising, Cuno S P M Uiterwaal, Cornelis K van der Ent
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    ABSTRACT: RATIONALE: Wheezing is a very common symptom in preschool children. Nocturnal wheezing is present in many asthmatic patients, due to enhanced airflow limitation overnight. We assessed the prevalence of nocturnal wheezing in young children and correlated this with respiratory system resistance and history of wheezing symptoms. METHODS: Using a continuous overnight recording of respiratory sounds we analyzed wheeze rate (ratio between wheezing time and recorded breathing time), oxygen saturation and heart rate during one night in 59 three-year-old children of an ongoing birth cohort study, the WHISTLER-project. We associated the nocturnal measurements with the patient's history of wheezing symptoms and with measurement of respiratory system resistance (Rint). RESULTS: Analysis of wheeze rate was successful in 44 children. The overall wheeze rate of these children was low, with the highest wheeze rate of 0.63% measured by the tracheal sensor during expiration. In total, 21/44 children had a wheeze rate of ≥5% during at least 1 min. There was no statistically significant difference in wheeze rate between the children with and without a history of wheezing. The wheeze rate of the tracheal sensor had a significant correlation with Rint (correlation coefficients of inspiration and expiration: 0.308 and 0.382, P-values 0.05 and 0.01, respectively). CONCLUSIONS: Overall, the wheeze rate in young children is low, but seems to increase over nighttime. Almost 50% of the children have sporadic wheeze during the night. Although higher nocturnal wheeze rates are related to increased respiratory system resistance, it is not related to clinical wheezing symptoms. Pediatr Pulmonol. 2013 9999:XX-XX. © 2013 Wiley Periodicals, Inc.
    Pediatric Pulmonology 03/2014; 49(3). DOI:10.1002/ppul.22803 · 2.30 Impact Factor
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    ABSTRACT: 10.1183/09031936.00172013
    European Respiratory Journal 03/2014; 43(3):921-2. DOI:10.1183/09031936.00172013 · 7.13 Impact Factor
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    ABSTRACT: Alterations in extracellular vesicles (EVs), including exosomes and microparticles, contribute to cardiovascular disease. We hypothesized that obesity could favour enhanced release of EVs from adipose tissue, and thereby contribute to cardiovascular risk via obesity-induced metabolic complications. The objectives of this study were: 1) to investigate the relation between the quantity, distribution and (dys) function of adipose tissue and plasma concentrations of atherothrombotic EV-markers; 2) to determine the relation between these EV-markers and the prevalence of the metabolic syndrome; and 3) to assess the contribution of EV markers to the risk of incident type 2 diabetes. In 1012 patients with clinically manifest vascular disease, subcutaneous and visceral fat thickness was measured ultrasonographically. Plasma EVs were isolated and levels of cystatin C, serpin G1, serpin F2 and CD14 were measured, as well as fasting metabolic parameters, hsCRP and adiponectin. The association between adiposity, EV-markers, and metabolic syndrome was tested by multivariable linear and logistic regression analyses. As sex influences body fat distribution, sex-stratified analyses between adipose tissue distribution and EV-markers were performed. The relation between EV-markers and type 2 diabetes was assessed with Cox regression analyses. Higher levels of hsCRP (β 5.59; 95% CI 3.00-8.18) and lower HDL-cholesterol levels (β-11.26; 95% CI -18.39 - -4.13) were related to increased EV-cystatin C levels, and EV-cystatin C levels were associated with a 57% higher odds of having the metabolic syndrome (OR 1.57; 95% CI 1.19-2.27). HDL-cholesterol levels were positively related to EV-CD14 levels (β 5.04; 95% CI 0.07-10.0), and EV-CD14 levels were associated with a relative risk reduction of 16% for development of type 2 diabetes (HR 0.84, 95% CI 0.75-0.94), during a median follow up of 6.5 years in which 42 patients developed type 2 diabetes. In patients with clinically manifest vascular disease, EV-cystatin C levels were positively related, and EV-CD14 levels were negatively related to metabolic complications of obesity.
    Cardiovascular Diabetology 02/2014; 13:37. DOI:10.1186/1475-2840-13-37 · 3.71 Impact Factor
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    ABSTRACT: Background A relationship between hospitalization for respiratory syncytial virus (RSV) bronchiolitis and asthma development has been suggested in case-control studies. Objective The aim of this study was to assess the risk of current wheeze, asthma, and lung function at school age in infants previously hospitalized for RSV bronchiolitis compared to non-hospitalized children. Methods For this study, data from a prospective birth cohort of unselected, term-born infants (n = 553), of whom 4 (0.7%) were hospitalized for RSV bronchiolitis, and a prospective patient cohort of 155 term infants hospitalized for RSV bronchiolitis were used. Respiratory outcomes at age 6 in children hospitalized for RSV bronchiolitis were compared to non-hospitalized children. Results The risk of current wheeze was higher in hospitalized patients (n = 159) compared to non-hospitalized children (n = 549) (adjusted odds ratio (OR) 3.2 (95% CI 1.2–8.1). Similarly, the risk of current asthma, defined as a doctor’s diagnosis of asthma plus current symptoms or medication use, was higher in hospitalized patients (adjusted OR 3.1 (95% CI 1.3–7.5). Compared to non-hospitalized children, RSV bronchiolitis hospitalization was associated with lower lung function (mean difference FEV1% predicted −6.8 l (95% CI (−10.2 to −3.4). Conclusions and Clinical Relevance This is the first study showing that hospitalization for RSV bronchiolitis during infancy is associated with increased risk of wheezing, current asthma, and impaired lung function as compared to an unselected birth cohort at age 6.
    PLoS ONE 01/2014; DOI:10.1371/journal.pone.0087162 · 3.53 Impact Factor
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    ABSTRACT: Extracellular vesicles (EVs) and their protein levels have been identified as a potential risk marker for the development of vascular disease. In the present study, we assessed whether levels of four previously identified EV proteins (cystatin C, serpin G1, serpin F2 and CD14) are associated with cerebral white matter lesions (WMLs) and brain atrophy. Cohort study; cross-sectional and prospective. Single centre, secondary and tertiary setting. 1309 patients with manifest vascular disease from the Second Manifestations of ARTerial disease-MR (SMART-MR) study, of which 994 had successful brain MRI and EV protein level measurements. WML and brain parenchymal fraction (BPF), as parameter for brain atrophy, at baseline and follow-up. The relationship between EV protein levels and WML volume (expressed as log transformed percentage of intracranial volume) and BPF (expressed percentage of intracranial volume) on 1.5 T brain MRI was assessed with multivariable linear regression modelling. Subsequently, the relationship between baseline EV protein levels and progression of atrophy and WML was analysed in 534 patients, in whom a follow-up MRI was obtained after 4 years. Higher EV-cystatin C and EV-CD14 were significantly associated with larger WML volume (linear regression coefficient (95% CI) 0.10 log %/SD (0.04 to 0.17) and 0.14 log %/SD (0.07 to 0.20), respectively. Higher EV-CD14 was associated with more brain atrophy (-0.14%/SD; -0.27 to -0.01). Baseline EV-CD14 was significantly associated with increase of WMLs (0.11 log %/SD (0.04 to 0.18)). No relationship with EV-serpins was observed at baseline or at follow-up. EV proteins cystatin C and CD14 are related to cerebral WMLs and the progression of brain atrophy in patients with manifest vascular disease, potentially identifying EVs in the aetiology of structural brain changes.
    BMJ Open 01/2014; 4(1):e003824. DOI:10.1136/bmjopen-2013-003824 · 2.06 Impact Factor
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    ABSTRACT: Undernutrition during critical periods of growth and development may permanently affect lung physiology and function. To investigate whether acute undernutrition in childhood or young adulthood increases the risk of later hospitalization for obstructive airways disease, chronic obstructive pulmonary disease (COPD), or asthma. We studied 7,841 women from Prospect-EPIC who experienced the 1944-45 Dutch famine between ages 0 and 21. Pulmonary outcomes were measured by registered hospital admissions and exposure-blinded computed tomography (CT) in a subgroup of 295 women. With Cox proportional hazard regression we explored effects of famine exposure on risk of hospitalization for obstructive airways disease, COPD, and asthma. With logistic regression we explored effects of famine on risk of CT evidence of pulmonary disease. RISKS OF HOSPITALIZATION FOR OBSTRUCTIVE AIRWAYS DISEASE, COPD, AND ASTHMA WERE INCREASED AFTER MODERATE FAMINE EXPOSURE, AND SIGNIFICANTLY INCREASED AFTER SEVERE FAMINE EXPOSURE: hazard ratios for obstructive airways disease were 1.31 (95% CI: 0.97 to 1.77) and 1.57 (95% CI: 1.10 to 2.23) respectively. Associations between famine exposure and hospitalization for COPD were stronger in ever-smokers than in never-smokers. Acute undernutrition in childhood or young adulthood is associated with an increased risk of later COPD and asthma hospitalization, possibly through increased sensitivity for tobacco smoke.
    PLoS ONE 12/2013; 8(12):e82636. DOI:10.1371/journal.pone.0082636 · 3.53 Impact Factor
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    ABSTRACT: Coffee and tea contain numerous antimutagenic and antioxidant components and high levels of caffeine that may protect against colorectal cancer (CRC). We investigated the association between coffee and tea consumption and CRC risk and studied potential effect modification by CYP1A2 and NAT2 genotypes, enzymes involved in the metabolization of caffeine. Data from 477,071 participants (70.2% female) of the European Investigation into Cancer and Nutrition (EPIC) cohort study were analyzed. At baseline (1992-2000) habitual (total, caffeinated and decaffeinated) coffee and tea consumption was assessed with dietary questionnaires. Cox proportional hazards models were used to estimate adjusted hazard ratio's (HR) and 95%-confidence intervals (95%-CI). Potential effect modification by genotype-based CYP1A2 and NAT2 activity was studied in a nested case-control set of 1,252 cases and 2,175 controls. After a median follow-up of 11.6 years, 4,234 participants developed CRC (mean age 64.7±8.3 years). Total coffee consumption (high vs. non/low) was not associated with CRC risk (HR 1.06, 95%-CI 0.95-1.18) or subsite cancers, and no significant associations were found for caffeinated (HR 1.10, 95%-CI 0.97-1.26) and decaffeinated coffee (HR 0.96, 95%-CI 0.84-1.11) and tea (HR 0.97, 95%-CI 0.86-1.09). High coffee and tea consuming subjects with slow CYP1A2 or NAT2 activity had a similar CRC risk compared to non/low coffee and tea consuming subjects with a fast CYP1A2 or NAT2 activity, which suggest that caffeine metabolism does not affect the link between coffee and tea consumption and CRC risk. This study shows that coffee and tea consumption is not likely to be associated with overall CRC. © 2013 Wiley Periodicals, Inc.
    International Journal of Cancer 12/2013; DOI:10.1002/ijc.28655 · 5.01 Impact Factor

Publication Stats

7k Citations
1,490.28 Total Impact Points

Institutions

  • 2014
    • Hogeschool Utrecht
      Utrecht, Utrecht, Netherlands
  • 2001–2014
    • University Medical Center Utrecht
      • • Julius Center for Health Sciences and Primary Care
      • • Division of Pediatrics
      • • Urology
      Utrecht, Utrecht, Netherlands
  • 2012
    • Gelre Ziekenhuis
      Apeldoorn, Gelderland, Netherlands
  • 2008
    • Maastricht University
      • Department of Biochemistry
      Maestricht, Limburg, Netherlands
  • 2001–2008
    • Utrecht University
      • • Department of Pediatric Urology
      • • Department of Epidemiology
      Utrecht, Utrecht, Netherlands
  • 1999–2007
    • Canisius-Wilhelmina Ziekenhuis
      Nymegen, Gelderland, Netherlands
  • 2006
    • St. Antonius Ziekenhuis
      • Department of Internal Medicine
      Nieuwegein, Provincie Utrecht, Netherlands
  • 2004–2005
    • Erasmus MC
      Rotterdam, South Holland, Netherlands
  • 2003
    • Leiden University
      Leyden, South Holland, Netherlands
  • 1994–1997
    • Erasmus Universiteit Rotterdam
      Rotterdam, South Holland, Netherlands