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1.
2.
Feike J. Loots Daan Smulders Paul Giesen Rogier M. Hopstaken Marleen Smits 《The European journal of general practice》2021,27(1):83
BackgroundSigns of the systemic inflammatory response syndrome (SIRS) – fever (or hypothermia), tachycardia and tachypnoea – are used in the hospital setting to identify patients with possible sepsis.ObjectivesTo determine how frequently abnormalities in the vital signs of SIRS are present in adult out-of-hours (OOH) primary care patients with suspected infections and assess the association with acute hospital referral.MethodsWe conducted a cross-sectional study at the OOH GP cooperative in Nijmegen, the Netherlands, between August and October 2015. GPs were instructed to record the body temperature, heart rate and respiratory rate of all patients with suspected acute infections. Vital signs of SIRS, other relevant signs and symptoms, and referral state were extracted from the electronic registration system of the OOH GP cooperative retrospectively. Logistic regression analysis was used to evaluate the association between clinical signs and hospital referral.ResultsA total of 558 patients with suspected infections were included. At least two SIRS vital signs were abnormal in 35/409 (8.6%) of the clinic consultations and 60/149 (40.3%) of the home visits. Referral rate increased from 13% when no SIRS vital sign was abnormal to 68% when all three SIRS vital signs were abnormal. Independent associations for referral were found for decreased oxygen saturation, hypotension and rapid illness progression, but not for individual SIRS vital signs.ConclusionAlthough patients with abnormal vital signs of SIRS were referred more often, decreased oxygen saturation, hypotension and rapid illness progression seem to be most important for GPs to guide further management. 相似文献
3.
J. Ø. Odland V. P. Tchachtchine V. Bykov P. E. Fiskebeck E. Lund Y. Thomassen E. Nieboer 《International archives of occupational and environmental health》1999,72(3):151-160
Background: The feasibility study described herein was prompted by a report in 1992 of possible reproductive and developmental health
concerns among female workers in a Russian nickel refinery. Objective: The primary goal was to ascertain whether medical, statistical, and occupational data bases could be accessed for information
about the pregnancy histories, occupational histories, and life-style factors of the women affected. Methods: The project was facilitated by construction of a registry of all births in three towns with a nickel refinery and verification
of its contents against patients' records obtained from hospital delivery and gynecology departments and community polyclinics.
Municipal Registration Board, Regional Health Statistics Board, and nickel company records were also reviewed. Results: Reproductive/developmental outcome information and workplace histories were acceptable. Sample-size calculations indicated
that a cohort or cross-sectional study would be amenable and suitable for the detection of an excess risk for spontaneous
abortion with adequate statistical significance and power. Such investigations would need to be supplemented by workplace
environmental/biological monitoring assessments for evaluation of exposure to occupational hazardous factors and a worker's
questionnaire to obtain information about life-style factors. A case-control design is recommended for the study of congenital
defects. Conclusions: A well-designed, comprehensive epidemiology study is technically feasible because of the availability of a favorable pool
of study subjects, reproductive/developmental outcome data, information to control for major confounders, and suitable occupational
records.
Received: 13 July 1998 / Accepted: 7 February 1999 相似文献
4.
Corine C Visser Sanja Stevanovi? L Heleen Voorwinden Louis van Bloois Pieter J Gaillard Meindert Danhof Daan J A Crommelin Albertus G de Boer 《European journal of pharmaceutical sciences》2005,25(2-3):299-305
In this study, we aim to target pegylated liposomes loaded with horseradish peroxidase (HRP) and tagged with transferrin (Tf) to the BBB in vitro. Liposomes were prepared with the post-insertion technique: micelles of polyethylene glycol (PEG) and PEG-Tf were inserted into pre-formed liposomes containing HRP. Tf was measured indirectly by measuring iron via atomic absorption spectroscopy. All liposomes were around 100 nm in diameter, contained 5-13 microg HRP per mumol phospholipid and 63-74 Tf molecules per liposome (lipo Tf) or no Tf (lipo C). Brain capillary endothelial cells (BCEC) were incubated with liposomes at 4 degrees C (to determine binding) or at 37 degrees C (to determine association, i.e. binding+endocytosis) and the HRP activity, rather than the HRP amount was determined in cell lysates. Association of lipo Tf was two- to three-fold higher than association of lipo C. Surprisingly, the binding of lipo Tf at 4 degrees C was four-fold higher than the association of at 37 degrees C. Most likely this high binding and low endocytosis is explained by intracellular degradation of endocytosed HRP. In conclusion, we have shown targeting of liposomes loaded with protein or peptide drugs to the BCEC and more specifically to the lysosomes. This is an advantage for the treatment of lysosomal storage disease. However, drug targeting to other intracellular targets also results in intracellular degradation of the drug. Our experiments suggest that liposomes release some of their content within the BBB, making targeting of liposomes to the TfR on BCEC an attractive approach for brain drug delivery. 相似文献
5.
Daan P Livestro Alona Muzikansky Emily M Kaine Thomas J Flotte Arthur J Sober Martin C Mihm James S Michaelson A Benedict Cosimi Kenneth K Tanabe 《Journal of clinical oncology》2005,23(27):6739-6746
PURPOSE: Previous studies have established that patients with desmoplastic melanoma (DM) have thicker primary tumors. Consequently, comparisons with other forms of melanoma have been strongly biased by differences in Breslow stage. This is the first case-matched control study comparing DM with other forms of melanoma. PATIENTS AND METHODS: From a database of 3,202 melanoma patients treated at one institution, 89 patients with DM and 178 case-matched control patients (2:1) were identified by matching for tumor thickness, age, sex, and year of diagnosis. Clinical, pathologic, and outcome information was obtained from chart review. RESULTS: Controls were matched successfully to patients for tumor thickness, age, sex, and year of diagnosis. Presentation with American Joint Committee on Cancer stage III or IV disease is less common in patients with DM compared to case-matched control patients (5% v 21%; P < .001). Re-excisions to obtain clear surgical margins are required more often in patients with DM compared to case-matched control patients (21% v 6%; P < .001). Risk of positive sentinel nodes is lower in patients with DM compared to case-matched control patients (8% v 34%; P = .013). Despite these differences, survival rates of patients with DM are the same as case-matched control patients. CONCLUSION: Use of case-matched control patients matched for tumor thickness avoids biases introduced by the advanced Breslow stage of DMs. DMs are more locally aggressive than thickness-matched controls, and positive sentinel nodes are limited to patients with thick primary tumors. Importantly, patients with DM have survival rates similar to patients with other melanomas of similar thickness. 相似文献
6.
Peter Nieboer Ciska Buijs Sjoerd Rodenhuis Caroline Seynaeve Louk V A M Beex Elsken van der Wall Dick J Richel Marianne A Nooij Emile E Voest Pierre Hupperets Nanno H Mulder Winette T A van der Graaf Els M TenVergert Harm van Tinteren Elisabeth G E de Vries 《Journal of clinical oncology》2005,23(33):8296-8304
PURPOSE: Determine whether standard or high-dose chemotherapy leads to changes in fatigue, hemoglobin (Hb), mental health, muscle and joint pain, and menopausal status from pre- to post-treatment and to evaluate whether fatigue is associated with these factors in disease-free breast cancer patients. PATIENTS AND METHODS: Eight hundred eighty-five patients were randomly assigned between two chemotherapy regimens both followed by radiotherapy and tamoxifen. Fatigue was assessed using vitality scale (score < or = 46 defined as fatigue), poor mental health using mental health scale (score < or = 56 defined as poor mental health) both of Short-Form 36, muscle and joint pain with Rotterdam Symptom Checklist, and Hb levels were assessed before and 1, 2, and 3 years after chemotherapy. RESULTS: Fatigue was reported in 20% of 430 assessable patients (202 standard-dose, 228 high-dose) with at least a 3-year follow-up, without change over time or difference between treatment arms. Mean Hb levels were lower following high-dose chemotherapy. Only 5% of patients experienced fatigue and anemia. Mental health score was the strongest fatigue predictor at all assessment moments. Menopausal status had no effect on fatigue. Linear mixed effect models showed that the higher the Hb level (P = .0006) and mental health score (P < .0001), the less fatigue was experienced. Joint (P < .0001) and muscle pain (P = .0283) were associated with more fatigue. CONCLUSION: In 3 years after treatment, no significant differences in fatigue were found between standard and high-dose chemotherapy. Fatigue did not change over time. The strongest fatigue predictor was poor mental health. 相似文献
7.
Immunogenicity of meningococcal PorA formulations encapsulated in biodegradable microspheres. 总被引:1,自引:0,他引:1
Carmen Arigita Joost van den Berg Karin Wensink Mies van Steenbergen Wim E Hennink Daan J A Crommelin Gideon F A Kersten Wim Jiskoot 《European journal of pharmaceutical sciences》2004,21(2-3):131-141
The purpose of our study was to investigate the possibility to microencapsulate liposomes and meningococcal outer membrane vesicles (OMV), both containing neisserial pore protein A (PorA), in biodegradable dextran- and mannan-based microspheres and to study the immunogenicity of the encapsulated PorA formulations. PorA-liposomes and OMV were encapsulated in dextran- or mannan-based microspheres by using an aqueous two-phase system consisting of a polyethylene glycol solution and a methacrylated dextran or mannan solution. The formulations were characterized for size distribution, PorA structure and antigen recovery after release. Calcein-containing model liposomes were used to establish the encapsulation efficiency and release profiles from both types of microspheres. The immunogenicity of the PorA-containing formulations was determined in mice after subcutaneous immunization. Liposomes were encapsulated in dextran and mannan microspheres with a high efficiency (70-90%). Calcein liposomes, after a 5-day lag period, exhibited apparent zero-order release kinetics from both types of microspheres between Days 5 and 10 of incubation in vitro. The total release was 80 and 100% from mannan and dextran microspheres, respectively. The trimeric PorA conformation was preserved in the released liposomes and OMV and the antigen was partly recovered. The immunogenicity of PorA-liposomes and OMV encapsulated in dextran or mannan microspheres was preserved. In conclusion, PorA-liposomes and OMV could be encapsulated in dextran- and mannan-based microspheres with high efficiency. The immunogenicity of encapsulated antigen was preserved. 相似文献
8.
Romy D Zwittink Cornelia CH Wielders Daan W Notermans Nelianne J Verkaik Annelot F Schoffelen Sandra Witteveen Varisha A Ganesh Angela de Haan Jeroen Bos Jacinta Bakker Caroline Schneeberger-van der Linden Ed J Kuijper Sabine C de Greeff Antoni PA Hendrickx 《Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin》2022,27(50)
Since March 2022, there has been an emergence of multidrug-resistant organisms (MDRO) in the Netherlands in patients originating from Ukraine (58 patients, 75 isolates). For about half of these patients, recent hospitalisation in Ukraine was reported. Genomic surveillance revealed that the majority of the MDRO represent globally spread epidemic lineages and that 60% contain New Delhi metallo-β-lactamase (NDM) genes. Professionals should be aware of an increase in such MDRO associated with migration and medical evacuation of people from Ukraine. 相似文献
9.
Rajeesh Kumar Pazhavelikkakath Purushothaman Gijs van Erven Daan S. van Es Lon Rohrbach Augustinus E. Frissen Jacco van Haveren Richard J. A. Gosselink 《RSC advances》2023,13(8):4898
A first systematic approach on the base catalyzed depolymerization (BCD) of five technical lignins derived from various botanical origins (herbaceous, hardwood and softwood) and covering the main three industrial pulping methods (soda, kraft and organosolv) is reported. This study provides a first of its kind in-depth quantification and structural characterization of two main BCD fractions namely lignin oil and lignin residue, describing the influence of the BCD process conditions. Depolymerization is evaluated in terms of lignin conversion, lignin oil yield, phenolic monomer selectivity and the production of lignin residue and char. Lignin oils were extensively characterized by size exclusion chromatography (SEC), GC-MS, GC-FID, 13C-NMR, HSQC NMR and elemental analysis. GC × GC-FID was used to identify and quantify distinct groups of monomeric compounds (methoxy phenols, phenols, dihydroxy-benzenes) in the lignin oil. The lignin oil yields (w/w) ranged from 20–31% with total monomer contents ranging from 48 to 57% w/w. SEC analysis indicated the presence of dimers/oligomers in the lignin oil, which through HSQC NMR analysis were confirmed to contain new, non-native interunit linkages. 13C NMR analyses of the lignin oils suggest the presence of diaryl type linkages (i.e. aryl–aryl, aryl C–O) evidencing deconstruction and recombination of lignin fragments during BCD. Irrespective of the lignin source, a residue, often regarded as ‘unreacted’ residual lignin was the main product of BCD (43 to 70% w/w). Our study highlights that this residue has different structural properties and should not be considered as unreacted lignin, but rather as an alkali soluble condensed aromatic material. HSQC, DEPT-135, 13C, and 31P NMR and SEC analyses confirm that the BCD residues are indeed more condensed, with increased phenolic hydroxyl content and lower molecular weights compared to all feed lignins. Subsequent BCD of solid residual fractions produced only low oil yields (6–9% w/w) with lower phenolic monomer yields (4% w/w) compared to original lignin, confirming the significantly more recalcitrant structure. Our study improves the overall understanding of the BCD process, highlights important feedstock-dependent outcomes and ultimately contributes to the complete valorization of BCD-derived lignin streams.Towards a lignin BCD biorefinery! Overall understanding of the BCD process, feedstock-dependent fractionation results, complete valorization of BCD-derived lignin streams. 相似文献
10.
Anne‐Grete Mrtson Anette Veringa Edwin R. van den Heuvel Martijn Bakker Daan J. Touw Tjip S. van der Werf Lambert F. R. Span Jan‐Willem C. Alffenaar 《Mycoses》2019,62(8):698-705
Posaconazole is indicated for prophylaxis and treatment of invasive aspergillosis. Therapeutic drug monitoring (TDM) of posaconazole is used to optimise drug exposure. The aim of this study was to analyse and describe the TDM practices and exposure of posaconazole tablets. Patients who received posaconazole for treatment or prophylaxis of fungal infections were included in the study. The following therapeutic window was defined: if concentration was low (<0.7 mg/L for prophylaxis or < 1.5 mg/L for treatment) or high (>3.75 mg/L), the hospital pharmacist provided the physician with dosage advice, which implementation to patient care was analysed. A longitudinal analysis was performed to analyse if different confounding variables had an effect on posaconazole concentrations. Forty‐seven patients were enrolled resulting in 217 posaconazole trough concentrations. A median of 3 (IQR 1‐7) samples was measured per patient. The median concentration was 1.7 mg/L (IQR 0.8‐2.7) for prophylaxis and 1.76 mg/L (IQR 1.3‐2.3) for treatment. Overall, 78 posaconazole concentrations were out of the therapeutic window. For 45 (54%) of these concentrations, a dosage change was recommended. In the longitudinal analysis, the laboratory markers and patient baseline variables did not have an effect on posaconazole concentrations. Adequate posaconazole exposure was shown in 64% (affected 28 patients) of the measured concentrations. TDM practice of posaconazole can be improved by increasing the implementation rate of dose recommendation by a multidisciplinary antifungal stewardship team. 相似文献