This thesis explores several different aspects of systemic sclerosis, including the role of sex hormones and insulin, the contribution of smoking to disease manifestations, and the applications of... Show moreThis thesis explores several different aspects of systemic sclerosis, including the role of sex hormones and insulin, the contribution of smoking to disease manifestations, and the applications of autologous haematopoietic stem cell transplantation. In this thesis we have analysed data from the prospective Leiden systemic sclerosis cohort, from an Italian cohort and also from patients of the multinational EUSTAR registry. The first part of this thesis is focused on hormones, in particular we revised the overall knowledge about sex hormones and we investigated the association between estrogens and development of microangiopathy. Then we analysed insulin sensitivity in systemic sclerosis patients and how it changes according to the different characteristics of the disease. In the second part, the main topic is cigarette smoking. We evaluated the effects of smoking on the risk of developing the disease, on organ progression and on autoantibody expression. We also assessed longitudinally how changes in respiratory parameters affected quality of life of SSc patients. The third part is on treatment strategies. We assessed the efficacy of HSCT in modifying the evolution of lung involvement and in improving microvascular damage. Finally, we described the changes in the prescription of SSc therapies over the last 10 years. Show less
Turk, Y.; Sin, H.K.; Huisstede, A. van; Birnie, E.; Biter, U.; Hiemstra, P.S.; Braunstahl, G.J. 2019
Morbidly obese subjects with airflow obstruction who underwent laparoscopic bariatric surgery appear to have the greatest risk to develop complications. In a retrospective cohort study, we... Show moreMorbidly obese subjects with airflow obstruction who underwent laparoscopic bariatric surgery appear to have the greatest risk to develop complications. In a retrospective cohort study, we identified a waist circumference >= 120 cm, smoking history >= 5PY and history of obstructive lung disease as statistically significant predictors of airflow obstruction. The resulting algorithm, aimed to identify subjects with airflow obstruction before bariatric surgery, was validated in a prospective study. The algorithm was found to be effective in identifying patients with low risk of airflow obstruction (negative predictive value 94.7%). Airflow obstruction, however, was not associated with post-operative complications as we expected. In contrast, inspiratory capacity and the Epworth Sleepiness scale were more promising predictors for post-operative complications in subjects undergoing bariatric surgery. Show less
Kasteleyn, M.J.; Bonten, T.N.; Mutsert, R. de; Thijs, W.; Hiemstra, P.S.; Cessie, S. le; ... ; Taube, C. 2017
