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31.
Daphne M. Stol Monika Hollander Markus M. J. Nielen Ilse F. Badenbroek François G. Schellevis Niek J. de Wit 《Scandinavian journal of primary health care》2018,36(1):20-27
Objective: Current guidelines acknowledge the need for cardiometabolic disease (CMD) prevention and recommend five-yearly screening of a targeted population. In recent years programs for selective CMD-prevention have been developed, but implementation is challenging. The question arises if general practices are adequately prepared. Therefore, the aim of this study is to assess the organizational preparedness of Dutch general practices and the facilitators and barriers for performing CMD-prevention in practices currently implementing selective CMD-prevention.Design: Observational study.Setting: Dutch primary care.Subjects: General practices.Main outcome measures: Organizational characteristics.Results: General practices implementing selective CMD-prevention are more often organized as a group practice (49% vs. 19%, p?=?.000) and are better organized regarding chronic disease management compared to reference practices. They are motivated for performing CMD-prevention and can be considered as ‘frontrunners’ of Dutch general practices with respect to their practice organization. The most important reported barriers are a limited availability of staff (59%) and inadequate funding (41%).Conclusions: The organizational infrastructure of Dutch general practices is considered adequate for performing most steps of selective CMD-prevention. Implementation of prevention programs including easily accessible lifestyle interventions needs attention. All stakeholders involved share the responsibility to realize structural funding for programmed CMD-prevention. Aforementioned conditions should be taken into account with respect to future implementation of selective CMD-prevention.
- Key Points
There is need for adequate CMD prevention. Little is known about the organization of selective CMD prevention in general practices.
??The organizational infrastructure of Dutch general practices is adequate for performing most steps of selective CMD prevention.
??Implementation of selective CMD prevention programs including easily accessible services for lifestyle support should be the focus of attention.
??Policy makers, health insurance companies and healthcare professionals share the responsibility to realize structural funding for selective CMD prevention.
32.
33.
Theodorou Daphne J. Theodorou Stavroula J. Georgiadis Georgios Papakostidis Konstantinos 《Emergency radiology》2022,29(1):219-223
Emergency Radiology - Carpal scaphoid fracture is rare in children and is important to recognize early because of an increased risk for serious complications including non-union, avascular... 相似文献
34.
William Dickey M.D. Ph.D. F.A.C.G. Daphne Garrett R.G.N. 《The American journal of gastroenterology》2002,97(1):79-82
OBJECTIVE: We set out to compare the success of colonoscopy using long and intermediate length standard adult instruments. METHODS: An intermediate length (133 cm working length) and long (168 cm) videocolonoscope were used on an alternate patient basis during routine endoscopy lists. Completion rates, times, and the need for external abdominal pressure were documented, as were causes of failed cecal intubation. RESULTS: Among patients with no history of colon resection and with satisfactory bowel preparation, 173 procedures were performed with the intermediate and 167 with the long colonoscope. There was no significant difference in completion rates (96% for both, excluding patients with strictures), completion times (intermediate mean = 7.73 min, long = 8.11 min; p = 0.44), or need for external abdominal pressure. Similarly, no difference was observed for male and female patients analyzed separately. Though there was no significant difference in completion rates for males and females overall (99% vs 95% excluding patients with strictures, p = 0.08), the latter had significantly longer completion times (mean = 8.75 vs 6.76 min, p < 0.001) and were more likely to require external abdominal pressure. Intermediate colonoscope length was responsible for failure to reach the cecum in one patient only (0.6%). CONCLUSIONS: Although the length of the intermediate instrument rarely compromises colonoscopy, it offers no significant advantage over the long scope for routine procedures. 相似文献
35.
Meng‐Hsuan Ho Hatice Hasturk Daphne F. Young Hua Xie 《Molecular oral microbiology》2020,35(5):193-201
Chronic periodontitis is one of the most common infectious inflammatory diseases worldwide. Current therapeutic options for the disease are only partially and temporarily successful due to periodontal re‐emergence of pathogens such as Porphyromonas gingivalis, a keystone bacterium in the oral microbial communities, which elicits a dysbiosis between the microbiota and the host. Previously, we reported a peptide inhibitor of P. gingivalis (SAPP) that specifically targets P. gingivalis and reduces its virulence potential in vitro. Here, we show that SAPP can modulate the ability of P. gingivalis to suppress the host innate immune system. Using a cytokine array analysis, we found that the levels of several cytokines including IL‐6, IL‐8, and MCP‐1 in the culture media of human oral keratinocytes (HOKs) were significantly diminished in the presence of P. gingivalis. Whereas the levels of these cytokines were restored, at least partially, in the culture media of HOKs by SAPP treatment. Furthermore, we also observed in an ex vivo assay that SAPP efficiently inhibited biofilm primed formation by mixed‐species oral bacteria, and significantly dampened the abnormally innate immune responses induced by these bacteria. We also demonstrated, using a mouse model, that SAPP could prevent alveolar bone loss induced by P. gingivalis. Our results suggest that SAPP specifically targets P. gingivalis and its associated bacterial communities and could be envisioned as an emerging therapy for periodontitis. 相似文献
36.
Marie Jos Kersten Julia Driessen Jose M. Zijlstra Wouter J. Plattel Franck Morschhauser Pieternella J. Lugtenburg Pauline Brice Martin Hutchings Thomas Gastinne Roberto Liu Coreline N. Burggraaff Marcel Nijland Sanne H. Tonino Anne I.J. Arens Roelf Valkema Harm van Tinteren Marta Lopez-Yurda Arjan Diepstra Daphne De Jong Anton Hagenbeek 《Haematologica》2021,106(4):1129
Achieving a metabolic complete response (mCR) before high-dose chemotherapy (HDC) and autologous peripheral blood stem cell transplant (auto-PBSCT) predicts progression-free survival (PFS) in relapsed/refractory classical Hodgkin lymphoma (R/R cHL). We added brentuximab vedotin (BV) to DHAP (dexamethasone, high-dose cytarabine, cisplatin) to improve the mCR rate. In a phase I dose-escalation part of the study in 12 patients, we showed that BV-DHAP is feasible. This phase II study included 55 R/R cHL patients (23 primary refractory). Treatment consisted of three 21-day cycles of BV 1.8 mg/kg on day 1, and DHAP (dexamethasone 40 mg days 1-4, cisplatin 100 mg/m² day 1 and cytarabine 2x2 g/m² day 2). Patients with a metabolic partial response (mPR) or mCR proceeded to HDC/auto-PBSCT. Based on independent central [18F]fluorodeoxyglucose (FDG) - positron emission tomography (PET) - computed tomography (CT) scan review, 42 of 52 evaluable patients (81% [95%CI: 67-90]) achieved an mCR before HDC/auto-PBSCT, five had an mPR and five had progressive disease (3 were not evaluable). After HDC/auto-PBSCT, four patients with an mPR converted to an mCR. Two-year PFS was 74% [95%CI: 63-86] and overall survival 95% [95%CI: 90-100]. Toxicity was manageable and mainly consisted of grade 3/4 hematologic toxicity, fever, nephrotoxicity, ototoxicity (grade 1/2), and transiently elevated liver enzymes during BV-DHAP. Eighteen patients developed new onset peripheral neuropathy (maximum grade 1/2); all recovered. In conclusion, BV-DHAP is a very effective salvage regimen in R/R cHL patients, but patients should be monitored closely for toxicity. (clinicaltrials.gov identifier: ). NCT02280993相似文献
37.
The Binding Characteristics and Number of β-Adrenergic Receptors on the Turkey Erythrocyte 总被引:2,自引:11,他引:2 下载免费PDF全文
Alexander Levitzki Daphne Atlas Michael L. Steer 《Proceedings of the National Academy of Sciences of the United States of America》1974,71(7):2773-2776
Turkey erythrocyte ghosts (empty membranes) possess a class of receptors that can bind both L-[(3)H]isoproterenol and DL-[(3)H]propranolol. The binding of [(3)H]isoproterenol to these receptors occurs with a dissociation constant of 0.15 muM and can be fully inhibited by 1 muM propranolol. The binding of [(3)H]propranolol occurs with a dissociation constant of 2.5 nM and can be fully inhibited by 0.2 mM DL-isoproterenol. Ligand binding is sensitive to sonication, boiling, and 8 M urea. The cells possess 500 to 1000 beta-adrenergic receptors per cell. Binding of propranolol to the beta-receptor was found to be stereospecific for the L stereoisomer. If one assumed a 1:1 relationship between beta-adrenergic receptors and adenylate cyclase, the turnover number of this adenylate cyclase would be close to 100 min(-1). 相似文献
38.
Daphne A. C. Stapels Kasra X. Ramyar Markus Bischoff Maren von K?ckritz-Blickwede Fin J. Milder Maartje Ruyken Janina Eisenbeis William J. McWhorter Mathias Herrmann Kok P. M. van Kessel Brian V. Geisbrecht Suzan H. M. Rooijakkers 《Proceedings of the National Academy of Sciences of the United States of America》2014,111(36):13187-13192
Neutrophils are indispensable for clearing infections with the prominent human pathogen Staphylococcus aureus. Here, we report that S. aureus secretes a family of proteins that potently inhibits the activity of neutrophil serine proteases (NSPs): neutrophil elastase (NE), proteinase 3, and cathepsin G. The NSPs, but not related serine proteases, are specifically blocked by the extracellular adherence protein (Eap) and the functionally orphan Eap homologs EapH1 and EapH2, with inhibitory-constant values in the low-nanomolar range. Eap proteins are together essential for NSP inhibition by S. aureus in vitro and promote staphylococcal infection in vivo. The crystal structure of the EapH1/NE complex showed that Eap molecules constitute a unique class of noncovalent protease inhibitors that occlude the catalytic cleft of NSPs. These findings increase our insights into the complex pathogenesis of S. aureus infections and create opportunities to design novel treatment strategies for inflammatory conditions related to excessive NSP activity.Infections with the human pathogen Staphylococcus aureus constitute a major risk to human health. Although this bacterium harmlessly colonizes more than 30% of the population via the nose or skin, it causes severe morbidity and mortality upon invasion of deeper tissues (1). To avert these serious infections, neutrophils play an indispensable role (2). Neutrophil serine proteases (NSPs), including neutrophil elastase (NE), proteinase 3 (PR3), and cathepsin G (CG), are important for various neutrophil functions. Active NSPs are stored within the azurophilic granules (3), but upon neutrophil activation, they either enter the nucleus to regulate extracellular trap (NET) formation (4) or they are released into the extracellular milieu to kill certain bacteria (5), cleave bacterial virulence factors (5, 6), or regulate immune responses by cleaving chemokines and receptors (7). Recently, a fourth neutrophil serine protease, denoted NSP4, was identified (8).Given the central role of NSPs in neutrophil function, we wondered whether S. aureus had evolved mechanisms to cope with NSPs. In this study, we discover that S. aureus secretes a family of proteins that specifically and potently block NSPs: extracellular adherence protein (Eap) and the hitherto functional orphans Eap-homologue (EapH) 1 and 2. Structural studies presented here show that Eap molecules represent a unique class of noncovalent NSP inhibitors that is distinct from the well-known chelonianin class of inhibitors. These mechanistic insights can initiate development of novel, broad-range NSP inhibitors to be used in various inflammatory conditions. Furthermore, these insights increase our understanding of the pathogenicity of S. aureus and underline the exceptional capability of this pathogen to adapt to its host by modulating the immune response. 相似文献
39.
Benjamin Buecking Daphne Eschbach Christopher Bliemel Ludwig Oberkircher Johannes Struewer Steffen Ruchholtz Ulrich J. Sachs 《Thrombosis research》2014
Introduction
Vitamin K antagonists are often used for anticoagulant treatment in hip fracture patients. The optimal handling with such anticoagulants is unclear.We aimed to determine when anticoagulation reversal occurred after vitamin K administration and how often prothrombin complex concentrates (PCCs) were administered. We compared patients’ treatments and outcomes with those of a control group not receiving treatment for anticoagulation.Patients and Methods
A total of 402 geriatric hip fracture patients were included in this observational study. We collected data on treatment for anticoagulation, time to surgery, and reasons for delay of surgery. In patients taking vitamin K antagonists, we measured the INR (international normalized ratio) on admission and prior to surgery, along with the frequency of PCC administration. Finally, we compared in-hospital mortality and complications between patient groups.Results
A total of 62 (15%) patients received phenprocoumon prior to their fractures. Surgery was delayed in these patients compared to controls (27 h; 95%CI 23–31 vs. 16 h; 95%CI 19–19; p = 0.001), but surgery delay > 48 h (n = 5; 8%) was not due to a failure of INR reversal. The main reason for these delays was a lack of capacity for surgery. The average INR on admission was 2.1 (± 0.7; range 1.0-3.5) in patients taking phenprocoumon, which decreased to 1.3 (± 0.3; range 1.0-1.6) until surgery. PCCs were administered to 19% of patients. We found no differences in the in-hospital mortality (6.2% vs. 8.1%, p = 0.575) or complication rates (12.9% vs. 9.4%, p = 0.364).Conclusion
The use of vitamin K seemed to be sufficient for anticoagulation reversal in geriatric hip fracture patients, and it generally led to timely surgery; despite this success, PCCs were sometimes administered for logistical reasons. 相似文献40.