BackgroundAlthough vitamin D is well known for its function in calcium homeostasis and bone mineralization, several studies have shown positive effects on muscle strength and physical function. In addition, vitamin D has been associated with pulmonary function and the incidence of airway infections. As vitamin D deficiency is highly prevalent in chronic obstructive pulmonary disease (COPD) patients, supplementation might have a beneficial effect in these patients.ObjectiveTo assess the effect of vitamin D supplementation on respiratory muscle strength and physical performance in vitamin D-deficient COPD patients. Secondary outcomes are pulmonary function, handgrip strength, exacerbation rate, and quality of life.MethodsWe performed a randomized, double-blind, placebo-controlled pilot trial. Participants were randomly allocated to receive 1,200 IU vitamin D3 per day (n=24) or placebo (n=26) during 6 months. Study visits were conducted at baseline, and at 3 and 6 months after randomization. During the visits, blood was collected, respiratory muscle strength was measured (maximum inspiratory and expiratory pressure), physical performance and 6-minute walking tests were performed, and handgrip strength and pulmonary function were assessed. In addition, participants kept a diary card in which they registered respiratory symptoms.ResultsAt baseline, the mean (standard deviation [SD]) serum 25-hydroxyvitamin D (25(OH)D) concentration (nmol/L) was 42.3 (15.2) in the vitamin D group and 40.6 (17.0) in the placebo group. Participants with vitamin D supplementation had a larger increase in serum 25(OH)D compared to the placebo group after 6 months (mean difference (SD): +52.8 (29.8) vs +12.3 (25.1), P<0.001). Primary outcomes, respiratory muscle strength and physical performance, did not differ between the groups after 6 months. In addition, no differences were found in the 6-minute walking test results, handgrip strength, pulmonary function, exacerbation rate, or quality of life.ConclusionVitamin D supplementation did not affect (respiratory) muscle strength or physical performance in this pilot trial in vitamin D-deficient COPD patients.

NCT01232140.

Diagnosis of a complete scapholunate ligament (SLL) injury is most often largely based on history, clinical examination, and plain radiographs.1-3 Unfortunately, an unequivocal diagnosis cannot always be made because a rupture is partial or because a complete rupture has intact secondary scaphoid stabilizers (the scaphotrapeziotrapezoidal, scaphocapitate, and radioscaphocapitate ligaments). AbstractObjective To determine the sensitivity and specificity of 3.0-tesla (T) magnetic resonance imaging (MRI) and a dedicated hand coil in diagnosing scapholunate ligament (SLL) injury compared with intraoperative findings. Methods From January 2006 until September 2010, 3.0-T MRI scans were performed on 38 wrists (37 patients) with clinically unclear but suspected lesions of the SLL. These scans were evaluated by two experienced radiologists. Radiological findings were compared with intraoperative findings during arthrotomy. Sensitivity, specificity, accuracy, and positive and negative predictive value were calculated. Results An SLL lesion was identified during arthrotomy in 37 wrists. The first radiologist identified an SLL lesion on MRI in 26 wrists, all of which were confirmed intraoperatively. The second radiologist identified SLL lesions in 31 patients; however, intraoperatively it was found that there was no lesion of the ligament in one patient. Sensitivity ranged from 70 to 81% with a specificity of 100% and a positive predictive value of 97 to 100%. Accuracy measured 71 to 79%. Conclusions 3.0-T MRI of the wrist is moderately sensitive and very specific for detection of SLL lesions. However, if there is a high clinical suspicion of an SLL rupture, a 3.0-T MRI does not often have an additional value. Level of Evidence Diagnostic, level II

ClinicalTrials.gov; No.: NCT00857038 URL: clinicaltrials.gov.

BackgroundWe developed the chronic obstructive pulmonary disease (COPD)-Lower Respiratory Tract Infection-Visual Analogue Score (c-LRTI-VAS) in order to easily quantify symptoms during exacerbations in patients with COPD. This study aimed to validate this score.MethodsIn our study, patients with stable COPD as well as those with an acute exacerbations of COPD (AECOPD) were included. The results of c-LRTI-VAS were compared with other markers of disease activity (lung function parameters, oxygen saturation and two health related quality of life questionnaires (St Georges Respiratory Questionnaire (SGRQ) and Clinical COPD Questionnaire (CCQ)) and validity, reliability and responsiveness were assessed.ResultsEighty-eight patients with clinically stable COPD and 102 patients who had an AECOPD completed the c-LRTI-VAS questionnaire. When testing on two separate occasions for repeatability, no statistically significant difference between total scores was found 0.143 (SD 5.42) (p=0.826). Internal consistency was high across items (Cronbach’s apha 0.755). Correlation with SGRQ and CCQ total scores was moderate to high. After treatment for hospitalised AECOPD, the mean c-LRTI-VAS total score improved 8.14 points (SD 9.13; p≤0.001).Conclusionsc-LRTI-VAS showed proper validity, responsiveness to change and moderate to high correlation with other questionnaires. It, therefore, appears a reliable tool for symptom measurement during AECOPD.Trial registration numberNCT01232140.

Chronic Obstructive Pulmonary Disease (COPD) is a chronic disorder of airways and lung tissue that causes suffering and death and recurrent exacerbations are an important driver of progression of disease. Exacerbations are treated with antibiotics if patient report sputum purulence, but not all patients need antimicrobial treatment that in turn leads to emerging antimicrobial resistance. We tried to reduce antimicrobials for patients with exacerbations of COPD admitted to hospital, comparing two strategies - patient reported sputum purulence-guidance, or C-Reactive Protein (CRP) (cut-off ≥50 mg/l) guided antimicrobial treatment. The CRP-guided regimen resulted in a reduction of 14.5% in antimicrobial use without compromising patient safety. Additionally in a subgroup analysis we showed that eosinophilic granulocytes in blood are a risk factor for recurrent exacerbations yet their absence in peripheral blood is associated with early treatment failure. Besides we performed a Chest CT in 100 participants of the trial mentioned above. 24 patients had infiltrative changes not detected by regular chest x-ray. Although inflammatory biomarkers where increased in patients with changes on chest CT, they were not able to reliable predict these changes. In our second trial investigated the anti-inflammatory properties of doxycycline in patients with stable COPD. We performed a double blind randomized controlled trial investigating the effect of a 3-week course of doxycycline on sputum and systemic inflammatory parameters in stable COPD. Doxycycline did not influence sputum inflammatory markers nor did it influence systemic inflammation.

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