Abdominal aortic aneurysm (AAA) is a common cause of morbidity and mortality and has a significan... more Abdominal aortic aneurysm (AAA) is a common cause of morbidity and mortality and has a significant heritability. We carried out a genome-wide association discovery study of 1866 patients with AAA and 5435 controls and replication of promising signals (lead SNP with a p value < 1 3 10 À5 ) in 2871 additional cases and 32,687 controls and performed further follow-up in 1491 AAA and 11,060 controls. In the discovery study, nine loci demonstrated association with AAA (p < 1 3 10 À5 ). In the replication sample, the lead SNP at one of these loci, rs1466535, located within intron 1 of low-density-lipoprotein receptor-related protein 1 (LRP1) demonstrated significant association (p ¼ 0.0042). We confirmed the association of rs1466535 and AAA in our follow-up study (p ¼ 0.035). In a combined analysis (6228 AAA and 49182 controls), rs1466535 had a consistent effect size and direction in all sample sets (combined p ¼ 4.52 3 10 À10 , odds ratio 1.15 [1.10-1.21]). No associations were seen for either rs1466535 or the 12q13.3 locus in independent association studies of coronary artery disease, blood pressure, diabetes, or hyperlipidaemia, suggesting that this locus is specific to AAA. Gene-expression studies demonstrated a trend toward increased LRP1 expression for the rs1466535 CC genotype in arterial tissues; there was a significant (p ¼ 0.029) 1.19-fold (1.04-1.36) increase in LRP1 expression in CC homozygotes compared to TT homozygotes in aortic adventitia. Functional studies demonstrated that rs1466535 might alter a SREBP-1 binding site and influence enhancer activity at the locus. In conclusion, this study has identified a biologically plausible genetic variant associated specifically with AAA, and we suggest that this variant has a possible functional role in LRP1 expression.
Recently, two common sequence variants on 9p21, tagged by rs10757278-G and rs10811661-T, were rep... more Recently, two common sequence variants on 9p21, tagged by rs10757278-G and rs10811661-T, were reported to be associated with coronary artery disease (CAD) and type 2 diabetes (T2D), respectively. We proceeded to further investigate the contributions of these variants to arterial diseases and T2D. Here we report that rs10757278-G is associated with, in addition to CAD, abdominal aortic aneurysm (AAA; odds ratio (OR) = 1.31, P = 1.2 x 10(-12)) and intracranial aneurysm (OR = 1.29, P = 2.5 x 10(-6)), but not with T2D. This variant is the first to be described that affects the risk of AAA and intracranial aneurysm in many populations. The association of rs10811661-T to T2D replicates in our samples, but the variant does not associate with any of the five arterial diseases examined. These findings extend our insight into the role of the sequence variant tagged by rs10757278-G and show that it is not confined to atherosclerotic diseases.
Background: The first-line intervention for intermittent claudication is usually supervised exerc... more Background: The first-line intervention for intermittent claudication is usually supervised exercise therapy (SET). The literature describes a range of exercise programs varying in setting, duration, and content. The purpose of the present study was to examine the exercise protocols offered and to identify the impact of the intensity of the SET programs (in terms of frequency, duration, and type of exercise) on improvements in walking distance (response) in the first 3 months. The present study is part of the Exercise Therapy in Peripheral Arterial Disease (EXITPAD) study, a multicenter randomized clinical trial comparing the effects of SET provided by regional physiotherapists, with or without daily feedback, on the level of activities with the effects of walking advice. Methods: The analysis included patients randomized to receive SET with or without feedback. The physical therapists administering the SET were asked to fill out therapy evaluation sheets stating frequency, duration, and type of exercises. The relationship between training volume and the impact on walking distance was explored by dividing training volume data into tertiles and relating them to the median change in maximum walking distance at 3 and 12 months.
Supervised exercise is recommended as a first-line treatment for intermittent claudication. Combi... more Supervised exercise is recommended as a first-line treatment for intermittent claudication. Combination therapy of endovascular revascularization plus supervised exercise may be more promising but few data comparing the 2 therapies are available. To assess the effectiveness of endovascular revascularization plus supervised exercise for intermittent claudication compared with supervised exercise only. Randomized clinical trial of 212 patients allocated to either endovascular revascularization plus supervised exercise or supervised exercise only. Data were collected between May 17, 2010, and February 16, 2013, in the Netherlands at 10 sites. Patients were followed up for 12 months and the data were analyzed according to the intention-to-treat principle. A combination of endovascular revascularization (selective stenting) plus supervised exercise (n = 106) or supervised exercise only (n = 106). The primary end point was the difference in maximum treadmill walking distance at 12 months ...
The impact of postoperative complications after lung surgery for cancer is substantial, with the ... more The impact of postoperative complications after lung surgery for cancer is substantial, with the increasing age of patients and the presence of comorbidities. This systematic review summarises the effects of Preoperative Exercise Therapy (PET) in patients scheduled for lung surgery on aerobic capacity, physical fitness, postoperative complications, length of hospital stay, quality of life and recovery. A systematic search on PET prior to lung surgery was conducted. The methodological quality of the included studies was rated using the Physiotherapy Evidence Database (PEDro) scale. The agreement between the reviewers was assessed with Cohen's kappa. A total of eleven studies were included with a methodological quality ranging from poor to good. The agreement between the reviewers, assessed with the Cohen's kappa, was 0.79. Due to substantial heterogeneity in the interventions across the included studies, it was impossible to conduct a meta-analysis. The most important finding...
Endovascular repair of aortic abdominal aneurysms (AAA) is more and more becoming part of clinica... more Endovascular repair of aortic abdominal aneurysms (AAA) is more and more becoming part of clinical practice. Up to approximately 30 clinical procedures however are necessary to obtain the surgical skills to make the procedure reliable and safe. The current study aims to generate a VR trainer to speed up the training process of experienced vascular surgeons to become experienced EVAR (endovascular AAA repair) surgeons by introducing a VR environment. This manuscript describes the contents and validation of the first step in the VREST - EVAR trainer, i.e. the proper definition of the knowledge and skills that need to be transferred.
In the treatment of coronary artery disease, peripheral loss of a coronary stent is an unusual co... more In the treatment of coronary artery disease, peripheral loss of a coronary stent is an unusual complication. We present the case of a patient who suggested that his right leg claudication was caused by a slipped coronary stent 2 years previously. The patient was convinced about this unusual finding based on an airport security check. Examination proved him to be right. However, the ability to detect an object using eddy currents is dependent on the object&#39;s permeability and its conductivity. Ferrous (iron) content is not the critical factor. Modern implant materials and processing techniques result in implants that are difficult to magnetize i.e. their permeability is very low. In addition their conductivity is very low. This enables modern implants to escape detection at airports. For this reason the event at the airport, as described by our patient, is considered coincidental.
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie
Over the past two decades, damage control surgery (DCS) rather than definitive repair of all inju... more Over the past two decades, damage control surgery (DCS) rather than definitive repair of all injuries has become established as the appropriate surgical strategy in the severely injured patient needing operative intervention. This change
The respiratory function is affected by obesity due to an increased deposition of fat on the ches... more The respiratory function is affected by obesity due to an increased deposition of fat on the chest wall. The objective of this study was to investigate the strength of the inspiratory respiratory muscles of obese individuals and the possible influence of bariatric surgery on it by measuring the maximum inspiratory pressure (MIP). Patients referred to a bariatric centre between the 3rd of October 2011 and the 3rd of May 2012 were screened preoperatively by a multidisciplinary team. Their MIP was measured at screening and 3, 6 and 9 months postoperative. In case of a preoperative MIP lower than 70% of predicted pressure training was provided supervised by a physiotherapist. The mean age of 124 included patients was 42.9 ± 11.0 years and mean BMI was 43.1 ± 5.2 kg/m(2). The mean predicted MIP preoperatively was 127 ± 31 in cm H2O and the mean measured MIP was 102 ± 24 in cm H2O. Three patients (2.4%) received training. Three months after surgery the MIP was 76 ± 26 cm H2O, after 6 months 82 ± 28 cm H2O and after 9 months 86 ± 28 cm H2O. All postoperative measurements were significant lower than preoperatively (P &amp;amp;amp;amp;lt; 0.05). The only influencing factor for the preoperative MIP was age (p = 0.014). The preoperative MIP values were significantly lower than the predicted MIP values, probably due to altered respiratory mechanics.
OBJECTIVE: To determine the optimal patient position for subclavian-vein catheterisation. DESIGN:... more OBJECTIVE: To determine the optimal patient position for subclavian-vein catheterisation. DESIGN: Descriptive. METHOD: The anteroposterior diameter of the right and left subclavian vein was measured using B-mode ultrasound in 26 healthy volunteers lying in 4 different positions: horizontally with or without a rolled towel between the should blades, or in the Trendelenburg position with or without a rolled towel. RESULTS: The mean diameter of the subclavian vein was 10.7 mm. There was a statistically significant association between the diameter of the vein and the position of the volunteer, the use of the rolled towel, and the side of the body. The least favourable results were obtained on the left side when the patient was lying horizontally with a rolled towel (8.65 mm). The most favourable results were obtained on the right side when the patient was in the Trendelenburg position without a rolled towel (12.05 mm). CONCLUSION: For successful catheterisation of the subclavian vein, t...
Background: Disease severity in patients with intermittent claudication (IC) is often assessed us... more Background: Disease severity in patients with intermittent claudication (IC) is often assessed using walking distances and treadmill tests. The aim of this study was to determine the agreement between walking distance as estimated by the patient, as measured during outside walking, and as determined using a nongraded treadmill protocol (NGTP), and an incremental graded (GardnereSkinner) treadmill protocol (GSP). Methods: In this prospective observational study, 30 patients with IC estimated their maximal walking distance (MWD) and completed a ''Walking Impairment Questionnaire'' (WIQ). Outside walking was determined using a measuring wheel and a GSP controlled device. Primary outcomes were differences in MWD and variability (coefficient of variation, COV). Secondary outcomes were results of WIQ and differences in walking speed. Results: Estimated walking distance was significantly higher than MWD as objectively measured during outside walking (400 m vs. 309 m, respectively, P ¼ 0.02). A substantial variability (COV ¼ 55%) was found between both parameters. A small 35-m MWD difference between outside walking and GSP was found with a substantial scatter (COV ¼ 42%). In contrast, a much larger 122-m MWD difference was present between outside walking and NGTP (COV ¼ 89%). Patients walked significantly faster in the open air than on treadmills (median outside walking speed ¼ 3.8 km/hr, GSP ¼ 3.2 km/hr, NGTP ¼ 2.8 km/hr; P < 0.001). Conclusions: An incremental graded (GardnereSkinner) treadmill protocol demonstrated the best agreement to outside walking. Discrepancies between treadmill tests and outside walking may be explained by a difference in walking speed. A single determination of a walking distance is a poor reflection of true walking capacity.
Abdominal aortic aneurysm (AAA) is a common cause of morbidity and mortality and has a significan... more Abdominal aortic aneurysm (AAA) is a common cause of morbidity and mortality and has a significant heritability. We carried out a genome-wide association discovery study of 1866 patients with AAA and 5435 controls and replication of promising signals (lead SNP with a p value < 1 3 10 À5 ) in 2871 additional cases and 32,687 controls and performed further follow-up in 1491 AAA and 11,060 controls. In the discovery study, nine loci demonstrated association with AAA (p < 1 3 10 À5 ). In the replication sample, the lead SNP at one of these loci, rs1466535, located within intron 1 of low-density-lipoprotein receptor-related protein 1 (LRP1) demonstrated significant association (p ¼ 0.0042). We confirmed the association of rs1466535 and AAA in our follow-up study (p ¼ 0.035). In a combined analysis (6228 AAA and 49182 controls), rs1466535 had a consistent effect size and direction in all sample sets (combined p ¼ 4.52 3 10 À10 , odds ratio 1.15 [1.10-1.21]). No associations were seen for either rs1466535 or the 12q13.3 locus in independent association studies of coronary artery disease, blood pressure, diabetes, or hyperlipidaemia, suggesting that this locus is specific to AAA. Gene-expression studies demonstrated a trend toward increased LRP1 expression for the rs1466535 CC genotype in arterial tissues; there was a significant (p ¼ 0.029) 1.19-fold (1.04-1.36) increase in LRP1 expression in CC homozygotes compared to TT homozygotes in aortic adventitia. Functional studies demonstrated that rs1466535 might alter a SREBP-1 binding site and influence enhancer activity at the locus. In conclusion, this study has identified a biologically plausible genetic variant associated specifically with AAA, and we suggest that this variant has a possible functional role in LRP1 expression.
Recently, two common sequence variants on 9p21, tagged by rs10757278-G and rs10811661-T, were rep... more Recently, two common sequence variants on 9p21, tagged by rs10757278-G and rs10811661-T, were reported to be associated with coronary artery disease (CAD) and type 2 diabetes (T2D), respectively. We proceeded to further investigate the contributions of these variants to arterial diseases and T2D. Here we report that rs10757278-G is associated with, in addition to CAD, abdominal aortic aneurysm (AAA; odds ratio (OR) = 1.31, P = 1.2 x 10(-12)) and intracranial aneurysm (OR = 1.29, P = 2.5 x 10(-6)), but not with T2D. This variant is the first to be described that affects the risk of AAA and intracranial aneurysm in many populations. The association of rs10811661-T to T2D replicates in our samples, but the variant does not associate with any of the five arterial diseases examined. These findings extend our insight into the role of the sequence variant tagged by rs10757278-G and show that it is not confined to atherosclerotic diseases.
Background: The first-line intervention for intermittent claudication is usually supervised exerc... more Background: The first-line intervention for intermittent claudication is usually supervised exercise therapy (SET). The literature describes a range of exercise programs varying in setting, duration, and content. The purpose of the present study was to examine the exercise protocols offered and to identify the impact of the intensity of the SET programs (in terms of frequency, duration, and type of exercise) on improvements in walking distance (response) in the first 3 months. The present study is part of the Exercise Therapy in Peripheral Arterial Disease (EXITPAD) study, a multicenter randomized clinical trial comparing the effects of SET provided by regional physiotherapists, with or without daily feedback, on the level of activities with the effects of walking advice. Methods: The analysis included patients randomized to receive SET with or without feedback. The physical therapists administering the SET were asked to fill out therapy evaluation sheets stating frequency, duration, and type of exercises. The relationship between training volume and the impact on walking distance was explored by dividing training volume data into tertiles and relating them to the median change in maximum walking distance at 3 and 12 months.
Supervised exercise is recommended as a first-line treatment for intermittent claudication. Combi... more Supervised exercise is recommended as a first-line treatment for intermittent claudication. Combination therapy of endovascular revascularization plus supervised exercise may be more promising but few data comparing the 2 therapies are available. To assess the effectiveness of endovascular revascularization plus supervised exercise for intermittent claudication compared with supervised exercise only. Randomized clinical trial of 212 patients allocated to either endovascular revascularization plus supervised exercise or supervised exercise only. Data were collected between May 17, 2010, and February 16, 2013, in the Netherlands at 10 sites. Patients were followed up for 12 months and the data were analyzed according to the intention-to-treat principle. A combination of endovascular revascularization (selective stenting) plus supervised exercise (n = 106) or supervised exercise only (n = 106). The primary end point was the difference in maximum treadmill walking distance at 12 months ...
The impact of postoperative complications after lung surgery for cancer is substantial, with the ... more The impact of postoperative complications after lung surgery for cancer is substantial, with the increasing age of patients and the presence of comorbidities. This systematic review summarises the effects of Preoperative Exercise Therapy (PET) in patients scheduled for lung surgery on aerobic capacity, physical fitness, postoperative complications, length of hospital stay, quality of life and recovery. A systematic search on PET prior to lung surgery was conducted. The methodological quality of the included studies was rated using the Physiotherapy Evidence Database (PEDro) scale. The agreement between the reviewers was assessed with Cohen's kappa. A total of eleven studies were included with a methodological quality ranging from poor to good. The agreement between the reviewers, assessed with the Cohen's kappa, was 0.79. Due to substantial heterogeneity in the interventions across the included studies, it was impossible to conduct a meta-analysis. The most important finding...
Endovascular repair of aortic abdominal aneurysms (AAA) is more and more becoming part of clinica... more Endovascular repair of aortic abdominal aneurysms (AAA) is more and more becoming part of clinical practice. Up to approximately 30 clinical procedures however are necessary to obtain the surgical skills to make the procedure reliable and safe. The current study aims to generate a VR trainer to speed up the training process of experienced vascular surgeons to become experienced EVAR (endovascular AAA repair) surgeons by introducing a VR environment. This manuscript describes the contents and validation of the first step in the VREST - EVAR trainer, i.e. the proper definition of the knowledge and skills that need to be transferred.
In the treatment of coronary artery disease, peripheral loss of a coronary stent is an unusual co... more In the treatment of coronary artery disease, peripheral loss of a coronary stent is an unusual complication. We present the case of a patient who suggested that his right leg claudication was caused by a slipped coronary stent 2 years previously. The patient was convinced about this unusual finding based on an airport security check. Examination proved him to be right. However, the ability to detect an object using eddy currents is dependent on the object&#39;s permeability and its conductivity. Ferrous (iron) content is not the critical factor. Modern implant materials and processing techniques result in implants that are difficult to magnetize i.e. their permeability is very low. In addition their conductivity is very low. This enables modern implants to escape detection at airports. For this reason the event at the airport, as described by our patient, is considered coincidental.
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie
Over the past two decades, damage control surgery (DCS) rather than definitive repair of all inju... more Over the past two decades, damage control surgery (DCS) rather than definitive repair of all injuries has become established as the appropriate surgical strategy in the severely injured patient needing operative intervention. This change
The respiratory function is affected by obesity due to an increased deposition of fat on the ches... more The respiratory function is affected by obesity due to an increased deposition of fat on the chest wall. The objective of this study was to investigate the strength of the inspiratory respiratory muscles of obese individuals and the possible influence of bariatric surgery on it by measuring the maximum inspiratory pressure (MIP). Patients referred to a bariatric centre between the 3rd of October 2011 and the 3rd of May 2012 were screened preoperatively by a multidisciplinary team. Their MIP was measured at screening and 3, 6 and 9 months postoperative. In case of a preoperative MIP lower than 70% of predicted pressure training was provided supervised by a physiotherapist. The mean age of 124 included patients was 42.9 ± 11.0 years and mean BMI was 43.1 ± 5.2 kg/m(2). The mean predicted MIP preoperatively was 127 ± 31 in cm H2O and the mean measured MIP was 102 ± 24 in cm H2O. Three patients (2.4%) received training. Three months after surgery the MIP was 76 ± 26 cm H2O, after 6 months 82 ± 28 cm H2O and after 9 months 86 ± 28 cm H2O. All postoperative measurements were significant lower than preoperatively (P &amp;amp;amp;amp;lt; 0.05). The only influencing factor for the preoperative MIP was age (p = 0.014). The preoperative MIP values were significantly lower than the predicted MIP values, probably due to altered respiratory mechanics.
OBJECTIVE: To determine the optimal patient position for subclavian-vein catheterisation. DESIGN:... more OBJECTIVE: To determine the optimal patient position for subclavian-vein catheterisation. DESIGN: Descriptive. METHOD: The anteroposterior diameter of the right and left subclavian vein was measured using B-mode ultrasound in 26 healthy volunteers lying in 4 different positions: horizontally with or without a rolled towel between the should blades, or in the Trendelenburg position with or without a rolled towel. RESULTS: The mean diameter of the subclavian vein was 10.7 mm. There was a statistically significant association between the diameter of the vein and the position of the volunteer, the use of the rolled towel, and the side of the body. The least favourable results were obtained on the left side when the patient was lying horizontally with a rolled towel (8.65 mm). The most favourable results were obtained on the right side when the patient was in the Trendelenburg position without a rolled towel (12.05 mm). CONCLUSION: For successful catheterisation of the subclavian vein, t...
Background: Disease severity in patients with intermittent claudication (IC) is often assessed us... more Background: Disease severity in patients with intermittent claudication (IC) is often assessed using walking distances and treadmill tests. The aim of this study was to determine the agreement between walking distance as estimated by the patient, as measured during outside walking, and as determined using a nongraded treadmill protocol (NGTP), and an incremental graded (GardnereSkinner) treadmill protocol (GSP). Methods: In this prospective observational study, 30 patients with IC estimated their maximal walking distance (MWD) and completed a ''Walking Impairment Questionnaire'' (WIQ). Outside walking was determined using a measuring wheel and a GSP controlled device. Primary outcomes were differences in MWD and variability (coefficient of variation, COV). Secondary outcomes were results of WIQ and differences in walking speed. Results: Estimated walking distance was significantly higher than MWD as objectively measured during outside walking (400 m vs. 309 m, respectively, P ¼ 0.02). A substantial variability (COV ¼ 55%) was found between both parameters. A small 35-m MWD difference between outside walking and GSP was found with a substantial scatter (COV ¼ 42%). In contrast, a much larger 122-m MWD difference was present between outside walking and NGTP (COV ¼ 89%). Patients walked significantly faster in the open air than on treadmills (median outside walking speed ¼ 3.8 km/hr, GSP ¼ 3.2 km/hr, NGTP ¼ 2.8 km/hr; P < 0.001). Conclusions: An incremental graded (GardnereSkinner) treadmill protocol demonstrated the best agreement to outside walking. Discrepancies between treadmill tests and outside walking may be explained by a difference in walking speed. A single determination of a walking distance is a poor reflection of true walking capacity.
Uploads
Papers by Joep Teijink