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Daniels K, Frequin STFM, van de Garde EMW, Biesma DH, van der Wees PJ, van der Nat PB, Ben-Zacharia AB, Cohen E, Gonçalves PJC, Kragt JJ, Hynes SM, Marron FE. Development of an international, multidisciplinary, patient-centered Standard Outcome Set for Multiple Sclerosis: The S.O.S.MS project. Mult Scler Relat Disord 2023; 69:104461. [PMID: 36563595 DOI: 10.1016/j.msard.2022.104461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/15/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Currently, outcomes of Multiple Sclerosis (MS) are not standardized and it is unclear which outcomes matter most to people living with MS. A consensus between patients and healthcare professionals on which outcomes to measure and how, would facilitate a move towards value-based MS care. OBJECTIVE to develop an internationally accepted, patient-relevant Standard Outcome Set for MS (S.O.S.MS). METHODS A mixed-method design was used, including a systematic literature review, four patient focus groups (n=30) and a RAND-modified Delphi process with seventeen MS experts of five disciplines from seven countries (the Netherlands, United States of America, Portugal, Ireland, India, New Zealand, Switzerland and Turkey). RESULTS A standard outcome set for MS was defined, consisting of fourteen outcomes divided in four domains: disease activity (n=3), symptoms (n=4), functional status (n=6), and quality of life (n=1). For each outcome, an outcome measure was selected and the measurement protocol was defined. In addition, seven case-mix variables were selected. CONCLUSION This standard outcome set provides a guideline for measuring outcomes of MS in clinical practice and research. Using this set to monitor and (inter)nationally benchmark real-world outcomes of MS can support improvement of patient value and ultimately guide the transition towards value-based MS care.
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Affiliation(s)
- K Daniels
- Department of Value-Based Healthcare, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), the Netherlands.
| | - S T F M Frequin
- Department of Neurology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands
| | - E M W van de Garde
- Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - D H Biesma
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands; Department of Internal Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - P J van der Wees
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), the Netherlands
| | - P B van der Nat
- Department of Value-Based Healthcare, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), the Netherlands
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Hoffman TW, van Es HW, Biesma DH, Grutters JC. Potential interstitial lung abnormalities on chest X-rays prior to symptoms of idiopathic pulmonary fibrosis. BMC Pulm Med 2022; 22:329. [PMID: 36038862 PMCID: PMC9426013 DOI: 10.1186/s12890-022-02122-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) often has significant diagnostic delay. At present it is not well-known what factors associate with time to diagnosis and if this is associated with survival after the diagnosis. There has also been increasing attention for interstitial lung abnormalities on chest CT-scans. In this study we assessed what factors associate with time to diagnosis in patients with IPF, and whether early stages of pulmonary fibrosis can be seen on chest X-rays prior to the start of symptoms. Methods In this retrospective study, 409 Dutch patients with IPF were included. Clinical characteristics, including patient demographics, medical history, time of start of symptoms, time of first visit to pulmonologist, and any previous radiographic imaging reports were collected from patient records. Results In 96 patients (23%) a chest X-ray was available that had been made prior to the start of symptoms (median of 50.5 months (IQR 26.3–83.3 months)), and this showed potential interstitial lung abnormalities in 56 patients (58%). The median time from the start of symptoms to the final diagnosis was 24.0 months (interquartile range 9.0–48.0 months). In a multivariate model that corrected for diffusion capacity of the lung for carbon monoxide, forced vital capacity, sex, and age at diagnosis, time to diagnosis did not associate with survival (hazard ratio 1.051 (95% CI 0.800–1.380; p = 0.72)). Conclusions There is a significant diagnostic delay for patients with IPF, but longer time to diagnosis did not associate with survival. Interstitial lung abnormalities were seen in more than half of the patients in whom a chest X-ray had been made prior to the start of symptoms. This illustrates that a computed tomography scan should be strongly considered for analysis of unexplained abnormalities on a chest X-ray. This could facilitate early detection and possibly prevention of disease progression for patients with pulmonary fibrosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02122-8.
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Affiliation(s)
- T W Hoffman
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
| | - H W van Es
- Department of Radiology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - D H Biesma
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - J C Grutters
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.,Division of Heart and Lungs, University Medical Center, Utrecht, The Netherlands
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3
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Hoffman TW, van Moorsel CHM, Kazemier KM, Biesma DH, Grutters JC, van Kessel DA. Humoral Immune Status in Relation to Outcomes in Patients with Idiopathic Pulmonary Fibrosis. Lung 2021; 199:667-676. [PMID: 34714393 DOI: 10.1007/s00408-021-00488-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/22/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Idiopathic pulmonary fibrosis (IPF) is a severe fibrotic lung disease, in which inflammation is thought to only play a secondary role. Several factors associated with acute exacerbations of IPF (AE-IPF) have been identified, including infections. This study investigated whether humoral immunodeficiency or increased inflammatory markers at diagnosis were associated with AE-IPF and survival. METHODS Four-hundred-and-nine patients diagnosed with IPF between 2011 and 2017 were retrospectively included. Immune status investigations at diagnosis included measurement of serum immunoglobulins (available in 38%), leukocyte and lymphocyte subsets in blood and bronchoalveolar lavage (BAL) fluid (available in 58%), as well as response to pneumococcal vaccination (available in 64%). RESULTS Serum immunoglobulins or IgG subclass levels were below the lower limit of normal in 6%. The response to pneumococcal vaccination was severely impaired in 1%. Thirteen percent of patients developed an AE-IPF (4.7% per year). AE-IPF were associated with elevated lymphocytes in BAL fluid at diagnosis (p = 0.03). Higher serum IgA and IgG at diagnosis were associated with worse survival (p = 0.01; and p = 0.04), as were an increased BAL lymphocyte percentage (p = 0.005), and higher blood leukocytes and neutrophils (p = 0.01; and p = 0.0005). In a multivariate model, only BAL lymphocyte count retained statistical significance (p = 0.007). CONCLUSION The prevalence of humoral immunodeficiencies was low in patients with IPF and not associated with AE-IPF or survival. Elevated lymphocytes in BAL were associated with the development of AE-IPF and worse survival. Higher serum immunoglobulins and immune cells in blood were also associated with worse survival. The local immune response in the lungs may be a target for future therapies.
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Affiliation(s)
- T W Hoffman
- Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435CM, Nieuwegein, The Netherlands.
| | - C H M van Moorsel
- Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435CM, Nieuwegein, The Netherlands
- Division of Heart and Lungs, University Medical Centre, Utrecht, The Netherlands
| | - K M Kazemier
- Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435CM, Nieuwegein, The Netherlands
- Division of Heart and Lungs, University Medical Centre, Utrecht, The Netherlands
- Centre for Translational Immunology, University Medical Centre, Utrecht, The Netherlands
| | - D H Biesma
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J C Grutters
- Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435CM, Nieuwegein, The Netherlands
- Division of Heart and Lungs, University Medical Centre, Utrecht, The Netherlands
| | - D A van Kessel
- Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435CM, Nieuwegein, The Netherlands
- Division of Heart and Lungs, University Medical Centre, Utrecht, The Netherlands
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Fahim M, Dijksman LM, Derksen WJM, Bloemen JG, Biesma DH, Smits AB. Prospective multicentre study of a new bowel obstruction treatment in colorectal surgery: Reduced morbidity and mortality. Eur J Surg Oncol 2021; 47:2414-2420. [PMID: 34023165 DOI: 10.1016/j.ejso.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Bowel obstruction patients are at increased risk of emergency surgery and have poor nutritional and physical conditions. These patients could benefit from prehabilitation and prevention of emergency surgery. This study assessed the effect of a multimodal obstruction treatment for bowel obstruction patients in colorectal surgery on the risk of emergency surgery and postoperative morbidity and mortality. MATERIALS AND METHODS This multicenter observational cohort study included all consecutive bowel obstruction patients who received obstruction treatment (obstruction protocol) in the period 2019-2020 in two Dutch hospitals. Benign and malignant causes of bowel obstruction were included. Treatment consisted of 1. dietary adjustments, 2. postponing surgery for three weeks, 3. laxatives, and 4. prehabilitation. We compared emergency surgery and postoperative morbidity and mortality rates to known rates from the literature. RESULTS Eighty-nine patients were included: obstruction treatment was successful in 77 patients (87%) who underwent elective surgery and unsuccessful in 12 patients (13%) who underwent emergency surgery. Sixty-six (74%) had colorectal cancer, and 22 (25%) had benign disease. Thirty-day mortality of 0% in our study was significantly lower than the national average of 4% in colorectal cancer patients in the Netherlands (p = 0.049). Anastomotic leakage rate was 3%, severe complications (Clavien-Dindo ≥ III) 8%, and bowel perforation 0%. These rates did not differ significantly from rates reported in literature. CONCLUSION The obstruction treatment prevented emergency surgery in most patients with bowel obstruction and reduced postoperative morbidity and mortality. The obstruction treatment seems to be a safe and efficient alternative to emergency surgery.
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Affiliation(s)
- M Fahim
- Department of Surgery, St Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, the Netherlands; Department of Value-Based Healthcare, St. Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, the Netherlands.
| | - L M Dijksman
- Department of Value-Based Healthcare, St. Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, the Netherlands
| | - W J M Derksen
- Department of Surgery, St Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, the Netherlands
| | - J G Bloemen
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623, EJ Eindhoven, the Netherlands
| | - D H Biesma
- Department of Surgery, St Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, the Netherlands; Department of Value-Based Healthcare, St. Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, the Netherlands
| | - A B Smits
- Department of Surgery, St Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, the Netherlands
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Soeterik TFW, van Melick HHE, Dijksman LM, Biesma DH, Witjes JA, van Basten JPA. AUTHOR REPLY. Urology 2021; 147:211-212. [PMID: 33390204 DOI: 10.1016/j.urology.2020.08.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Timo F W Soeterik
- Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - H H E van Melick
- Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - L M Dijksman
- Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - D H Biesma
- Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J A Witjes
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J P A van Basten
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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6
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Fahim M, Dijksman LM, van der Nat P, Derksen WJM, Biesma DH, Smits AB. Increased long-term mortality after emergency colon resections. Colorectal Dis 2020; 22:1941-1948. [PMID: 32627889 DOI: 10.1111/codi.15238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/16/2020] [Indexed: 12/15/2022]
Abstract
AIM Emergency surgery is a known predictor for 30-day mortality. However, its relationship with long-term mortality is still a matter of debate. The aim of this study was to analyse the effect of emergency surgery compared with elective surgery on long-term survival. METHOD Data from the Dutch Colorectal Audit and the Dutch Cancer Centre registry of a large nonacademic teaching hospital were used to analyse outcomes of patients who underwent surgery for colon cancer from 2009 until 2017. Univariable and multivariable Cox regression were used to assess the effect of emergency surgery on long-term mortality with adjustment for patient, tumour and treatment characteristics. RESULTS A total of 1139 patients with a median follow-up of 40 months (interquartile range 23-65 months) were included. Emergency surgery was performed in 158 patients (14%). The 5-year survival after emergency surgery was 46% compared with 72% after elective surgery. After adjusting for baseline differences there was an independent and significant association between emergency surgery and increased long-term mortality (hazard ratio 1.79, 95% CI 1.28-2.51, P = 0.001). CONCLUSION Emergency surgery for colon cancer seems to lead to a significantly increased risk of long-term mortality compared with elective surgery. Detection and treatment of early symptoms that can lead to emergency surgery might be the way forward.
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Affiliation(s)
- M Fahim
- Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands.,Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - L M Dijksman
- Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands
| | - P van der Nat
- Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands.,Radboud Institute for Health Sciences, Scientific Centre for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - W J M Derksen
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - D H Biesma
- Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands
| | - A B Smits
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
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7
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Fahim M, Visser RA, Dijksman LM, Biesma DH, Noordzij PG, Smits AB. Routine postoperative intensive care unit admission after colorectal cancer surgery for the elderly patient reduces postoperative morbidity and mortality. Colorectal Dis 2020; 22:408-415. [PMID: 31696590 DOI: 10.1111/codi.14902] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/18/2019] [Indexed: 02/08/2023]
Abstract
AIM Older colorectal cancer (CRC) patients are at increased risk of postoperative morbidity and mortality. Routine postoperative overnight intensive care unit (ICU) admission might reduce this risk. This study aimed to examine the effect of routine overnight ICU admission after CRC surgery on postoperative adverse outcomes and costs in patients aged 80 years or older. METHODS Patients aged 80 years or older who underwent CRC surgery in our centre were included in this observational cohort study. All patients in the period 2014-2017 with routine overnight ICU admission were assigned to the ICU cohort; all patients in the period 2009-2013 were assigned to the non-ICU cohort. Multivariable logistic regression was performed to compare the primary composite end-point (30-day mortality, serious complications and readmission) between the groups. Cost data from the literature were used to perform a cost analysis. RESULTS A total of 242 patients were included, 125 in the ICU cohort and 117 in the non-ICU cohort. Routine overnight ICU admission was associated with a reduced risk of the composite end-point (OR 0.44, 95% CI 0.22-0.87, P = 0.02) after adjusting for important confounders. In the ICU cohort 28% of patients experienced ICU events requiring intervention; this was not associated with postoperative morbidity or mortality. The 9% reduction in the incidence of serious complications in the ICU cohort is sufficient to offset the additional costs of routine overnight ICU admission. CONCLUSION Routine overnight ICU admission after CRC surgery in patients aged 80 years and older is associated with reduced risk of postoperative mortality and morbidity and seems to be cost-effective.
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Affiliation(s)
- M Fahim
- Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands.,Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - R A Visser
- Department of Anesthesiology and Intensive Care, St Antonius Hospital, Nieuwegein, The Netherlands
| | - L M Dijksman
- Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands
| | - D H Biesma
- Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands
| | - P G Noordzij
- Department of Anesthesiology and Intensive Care, St Antonius Hospital, Nieuwegein, The Netherlands
| | - A B Smits
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
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Biesma DH. [Value-based healthcare: opportunities for better healthcare quality at a lower cost]. Ned Tijdschr Geneeskd 2018; 162:D2130. [PMID: 29600923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The introduction of 'value' as a goal in healthcare requires a change of thinking. Quality becomes a leading principle. Transparency will lead to better care in hospitals that compare their results with each other. Making quality visible together creates the group pressure this requires. Professional and patient organisations cannot stay behind when reducing costs. Physicians and patients should contribute to providing cheaper care. Concentrating care also helps to reduce costs. Hospital data will have to be processed to help patients select a treatment. This requires substantial investments in ICT. More attention should be given to the entire care chain. In science, the focus should shift from evidence-based to quality-based medicine. 'Value-based healthcare' turns the medical world on its head and requires time, patience and adjustment. This will repay itself in better quality, lower costs, higher satisfaction and more control for patients when making decisions about their treatment.
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Affiliation(s)
- D H Biesma
- St. Antonius Ziekenhuis, Raad van Bestuur, Utrecht/Nieuwegein
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9
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Haas FJLM, Wester-mann CJJ, Biesma DH, Mager JJ, Schutgens REG. The Early Course of D-dimer Concentration following Pulmonary Artery Embolisation. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1616766] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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10
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Wumkes ML, van der Velden AMT, de Bruin E, Meerveld-Eggink A, Koopmans MPG, Rimmelzwaan GF, Rijkers GT, Biesma DH. Microarray profile of the humoral immune response to influenza vaccination in breast cancer patients treated with chemotherapy. Vaccine 2017; 35:1299-1305. [PMID: 28169075 DOI: 10.1016/j.vaccine.2017.01.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/15/2017] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients treated with chemotherapy have an impaired response to influenza virus vaccination compared to healthy controls. Little is known about the broadness of the antibody response in these patients. METHODS Breast cancer patients on FEC (5-fluorouracil, epirubicin and cyclophosphamide) chemotherapy regimens were vaccinated with influenza virus vaccine. Sera were obtained before and three weeks after vaccination. In addition to the determination of virus-specific antibody titres by hemagglutination inhibition assay, the broadness of the response was assessed by the use of a protein microarray and baseline titres were compared with an age-matched reference group. RESULTS We included 38 breast cancer patients and found a wide variety in serum antibody response after vaccination. Patients with a history of influenza vaccination had higher pre-vaccination titres, which were comparable to the reference group. Increasing number of cycles of chemotherapy did not have a negative effect on influenza array antibody levels, nor on the HI antibody response. CONCLUSIONS Overall there was a broad serum antibody response to the influenza virus vaccine in patients treated with chemotherapy for breast cancer.
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Affiliation(s)
- M L Wumkes
- Department of Internal Medicine, Tergooi Hilversum/Blaricum, PO Box 10016, 1201 DA Hilversum, The Netherlands; Department of Internal Medicine, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - A M T van der Velden
- Department of Internal Medicine, Tergooi Hilversum/Blaricum, PO Box 10016, 1201 DA Hilversum, The Netherlands.
| | - E de Bruin
- Laboratory for Infectious Diseases and Screening, Centre for Infectious Disease Control (CIDC), National Institute of Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands; Department of Virology, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - A Meerveld-Eggink
- Department of Medical Oncology, Antoni van Leeuwenhoek, PO Box 90203, 1006 BE Amsterdam, The Netherlands; Department of Internal Medicine, St. Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, The Netherlands.
| | - M P G Koopmans
- Laboratory for Infectious Diseases and Screening, Centre for Infectious Disease Control (CIDC), National Institute of Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands; Department of Virology, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - G F Rimmelzwaan
- Department of Virology, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - G T Rijkers
- Department of Medical Microbiology and Immunology, St. Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, The Netherlands; Science Department, University College Roosevelt, PO Box 94, 4330 AB Middelburg, The Netherlands.
| | - D H Biesma
- Department of Internal Medicine, St. Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, The Netherlands; Department of Internal Medicine, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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Mol GC, van de Ree MA, Klok FA, Tegelberg MJAM, Sanders FBM, Koppen S, de Weerdt O, Koster T, Hovens MMC, Kaasjager HAH, Brouwer RE, Kragten E, Schaar CG, Spiering W, Arnold WP, Biesma DH, Huisman MV. One versus two years of elastic compression stockings for prevention of post-thrombotic syndrome (OCTAVIA study): randomised controlled trial. BMJ 2016; 353:i2691. [PMID: 27245485 PMCID: PMC4886508 DOI: 10.1136/bmj.i2691] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To study whether stopping elastic compression stockings (ECS) after 12 months is non-inferior to continuing them for 24 months after proximal deep venous thrombosis. DESIGN Multicentre single blind non-inferiority randomised controlled trial. SETTING Outpatient clinics in eight teaching hospitals in the Netherlands, including one university medical centre. PARTICIPANTS Patients compliant with compression therapy for 12 months after symptomatic, ultrasound proven proximal deep venous thrombosis of the leg. INTERVENTIONS Continuation or cessation of ECS 12 months after deep venous thrombosis. MAIN OUTCOME MEASURES The primary outcome was the incidence of post-thrombotic syndrome 24 months after diagnosis of deep venous thrombosis, as assessed by the standardised Villalta scale in an intention to treat analysis. The predefined non-inferiority margin was 10%. The main secondary outcome was quality of life (VEINES-QOL/Sym). RESULTS 518 patients compliant with ECS and free of post-thrombotic syndrome were randomised one year after diagnosis of deep venous thrombosis to stop or continue ECS therapy for another year. In the stop-ECS group, 51 of 256 patients developed post-thrombotic syndrome, with an incidence of 19.9% (95% confidence interval 16% to 24%). In the continue-ECS group, 34 of 262 patients developed post-thrombotic syndrome (incidence 13.0%, 9.9% to 17%), of whom 85% used ECS six or seven days a week during the study period, for an absolute difference of 6.9% (95% confidence interval upper limit 12.3%). Because the upper limit of the 95% confidence interval exceeds the predefined margin of 10%, non-inferiority was not reached. The number needed to treat to prevent one case of post-thrombotic syndrome by continuing ECS was 14 (95% confidence interval lower limit 8). Quality of life did not differ between the two groups. CONCLUSION Stopping ECS after one year in compliant patients with proximal deep venous thrombosis seemed not to be non-inferior to continuing ECS therapy for two years in this non-inferiority trial. TRIAL REGISTRATION Netherlands Trial Register NTR1442.
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Affiliation(s)
- G C Mol
- Department of Internal Medicine, Diakonessenhuis Hospital, Utrecht, Netherlands Department of Internal Medicine, University Medical Center, Utrecht, Netherlands Department of Vascular Medicine, University Medical Center, 3508 GA Utrecht, Netherlands
| | - M A van de Ree
- Department of Internal Medicine, Diakonessenhuis Hospital, Utrecht, Netherlands
| | - F A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands
| | - M J A M Tegelberg
- Department of Dermatology, Diakonessenhuis Hospital, Utrecht, Netherlands
| | - F B M Sanders
- Department of Radiology, Diakonessenhuis Hospital, Utrecht, Netherlands
| | - S Koppen
- Department of Dermatology, St Antonius Hospital, Nieuwegein, Netherlands
| | - O de Weerdt
- Department of Hematology, St Antonius Hospital, Nieuwegein, Netherlands
| | - T Koster
- Department of Internal Medicine, Groene Hart Hospital, Gouda, Netherlands
| | - M M C Hovens
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, Netherlands
| | - H A H Kaasjager
- Department of Internal Medicine, University Medical Center, Utrecht, Netherlands
| | - R E Brouwer
- Department of Hematology, Reinier de Graaf Group, Delft, Netherlands
| | - E Kragten
- Department of Hematology, Reinier de Graaf Group, Delft, Netherlands
| | - C G Schaar
- Department of Internal Medicine, Gelre Hospitals, Apeldoorn, Netherlands
| | - W Spiering
- Department of Vascular Medicine, University Medical Center, 3508 GA Utrecht, Netherlands
| | - W P Arnold
- Department of Dermatology, Gelderse Vallei Hospital, Ede, Netherlands
| | - D H Biesma
- Department of Hematology, St Antonius Hospital, Nieuwegein, Netherlands
| | - M V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands
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Nieuwenhuizen L, Schutgens REG, Coeleveld K, Mastbergen SC, Schiffelers RM, Roosendaal G, Biesma DH, Lafeber FPJG. Silencing of protease-activated receptors attenuates synovitis and cartilage damage following a joint bleed in haemophilic mice. Haemophilia 2015; 22:152-9. [DOI: 10.1111/hae.12770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- L. Nieuwenhuizen
- Rheumatology and Clinical Immunology; University Medical Center; Utrecht The Netherlands
- Hematology and Van Creveldkliniek; University Medical Center; Utrecht The Netherlands
| | - R. E. G. Schutgens
- Hematology and Van Creveldkliniek; University Medical Center; Utrecht The Netherlands
| | - K. Coeleveld
- Rheumatology and Clinical Immunology; University Medical Center; Utrecht The Netherlands
| | - S. C. Mastbergen
- Rheumatology and Clinical Immunology; University Medical Center; Utrecht The Netherlands
| | - R. M. Schiffelers
- Clinical Chemistry and Hematology; University Medical Center; Utrecht The Netherlands
| | - G. Roosendaal
- Hematology and Van Creveldkliniek; University Medical Center; Utrecht The Netherlands
| | - D. H. Biesma
- Hematology and Van Creveldkliniek; University Medical Center; Utrecht The Netherlands
- Internal Medicine; Sint Antonius Ziekenhuis; Nieuwegein The Netherlands
| | - F. P. J. G. Lafeber
- Rheumatology and Clinical Immunology; University Medical Center; Utrecht The Netherlands
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13
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Nieuwenhuizen L, Roosendaal G, Mastbergen SC, Coeleveld K, Biesma DH, Lafeber FPJG, Schutgens REG. Antiplasmin, but not amiloride, prevents synovitis and cartilage damage following hemarthrosis in hemophilic mice. J Thromb Haemost 2014; 12:237-45. [PMID: 24283895 DOI: 10.1111/jth.12467] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Blood-induced joint damage is characterized by synovitis and cartilage damage. Recently, we demonstrated that joint bleeding in hemophilic mice results in elevated synovial levels of urokinase plasminogen activator (u-PA) and plasmin, and in plasmin-mediated cartilage damage. OBJECTIVE To evaluate whether treatment with amiloride (an inhibitor of u-PA) or antiplasmin attenuates synovitis and cartilage damage following joint bleeding in hemophilic mice. METHODS Following the induction of joint bleeding, hemophilic mice were randomized between daily oral treatment with amiloride (1 mg kg⁻¹) or control, or weekly intra-articular treatment with amiloride (2.5 mg mL⁻¹), antiplasmin (2.5 mg mL⁻¹), or control. After 5 weeks of treatment, synovitis and cartilage damage were determined on hematoxylin and eosin-stained (Valentino score) and Safranin O-stained sections, respectively. RESULTS No effects of oral and intra-articular treatment with amiloride were found. In contrast, intra-articular treatment with antiplasmin resulted in significant (P < 0.01) reductions in both synovitis (score 1, 11.1% vs. 0%; score 2, 11.1% vs. 4.2%; score 3, 61.1% vs. 16.7%; score 4, 5.6% vs. 29.2%; score 5, 11.1% vs. 20.8%; score 6, 7.7% vs. 8.3%; score 7, 0% vs. 8.3%; and score 8, 0% vs. 12.5%) and cartilage damage (score 2, 10% vs. 8.3%; score 3, 50% vs. 12.5%; score 4, 30% vs. 33.3%; score 5, 10% vs. 33.3%; and score 6, 0% vs. 16.7%) as compared with controls. CONCLUSIONS Intra-articular treatment with antiplasmin (but not amiloride) following joint bleeding prevented synovitis and cartilage damage in hemophilic mice. These data offer promise for the use of antiplasmin as a new therapeutic intervention for patients who suffer from joint bleeds despite administration of clotting factor.
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Affiliation(s)
- L Nieuwenhuizen
- Rheumatology & Clinical Immunology, University Medical Center, Utrecht, The Netherlands; Hematology & Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
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14
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Wumkes ML, van der Velden AMT, van der Velden AWG, Stouthard JML, Nijziel MR, Westerman M, Beeker A, Meerveld-Eggink A, Rijkers GT, Biesma DH. Influenza vaccination coverage in patients treated with chemotherapy: current clinical practice. Neth J Med 2013; 71:472-477. [PMID: 24218421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Influenza virus vaccination is recommended for patients treated with chemotherapy. Little is known about vaccination coverage in these patients. METHODS Vaccination coverage in the Netherlands was analysed by questionnaires completed by general practitioners, within a catchment area of 1.3 million people, in the period 2010-2011. RESULTS Of 433 eligible adult patients treated with chemotherapy for breast or colorectal cancer, 144 patients gave permission for us to approach their general practitioner with a questionnaire. General practitioners were asked about vaccination coverage, awareness of recommendations and their opinion about the responsibility for vaccination. We received 114 (79%) completed questionnaires. Sixty-seven out of 114 patients (59%) were vaccinated against influenza. Forty-four (66%) of these patients also had an indication for vaccination based on age (age ≥60 years). According to 48% of the general practitioners, the responsibility for vaccination belongs to the competence of the treating medical oncologist. CONCLUSION Influenza vaccination coverage is limited to 59% of patients treated with chemotherapy. Guidelines for responsibility (general practitioner or medical oncologist) may increase the vaccination rate of cancer patients.
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Affiliation(s)
- M L Wumkes
- Department of Internal Medicine, Tergooi Hospitals Hilversum, the Netherlands
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15
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Nieuwenhuizen L, Falkenburg WJJ, Schutgens REG, Roosendaal G, van Veghel K, Biesma DH, Lafeber FPJG. Stimulation of naïve monocytes and PBMCs with coagulation proteases results in thrombin-mediated and PAR-1-dependent cytokine release and cell proliferation in PBMCs only. Scand J Immunol 2013; 77:339-49. [PMID: 23421536 DOI: 10.1111/sji.12033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/29/2013] [Indexed: 11/26/2022]
Abstract
Protease-activated receptors (PARs) are stimulated by proteolytic cleavage of their extracellular domain. Coagulation proteases, such as FVIIa, the binary TF-FVIIa complex, free FXa, the ternary TF-FVIIa-FXa complex and thrombin, are able to stimulate PARs. Whereas the role of PARs on platelets is well known, their function in naïve monocytes and peripheral blood mononuclear cells (PBMCs) is largely unknown. This is of interest because PAR-mediated interactions of coagulation proteases with monocytes and PBMCs in diseases with an increased activation of coagulation may promote inflammation. To evaluate PAR-mediated inflammatory reactions in naïve monocytes and PBMCs stimulated with coagulation proteases. For this, PAR expression at protein and RNA level on naïve monocytes and PBMCs was evaluated with flow cytometry and RT-PCR. In addition, cytokine release (IL-1β, IL-6, IL-8, IL-10, TNF-α) in stimulated naïve and PBMC cell cultures was determined. In this study, it is demonstrated that naïve monocytes express all four PARs at the mRNA level, and PAR-1, -3 and -4 at the protein level. Stimulation of naïve monocytes with coagulation proteases did not result in alterations in PAR expression or in the induction of inflammation involved cytokines like interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8, interleukin-10 or tumour necrosis factor-α. In contrast, stimulation of PBMCs with coagulation proteases resulted in thrombin-mediated induction of IL-1β and IL-6 cytokine production and PBMC cell proliferation in a PAR-1-dependent manner. These data demonstrate that naïve monocytes are not triggered by coagulation proteases, whereas thrombin is able to elicit pro-inflammatory events in a PAR-1-dependent manner in PBMCs.
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Affiliation(s)
- L Nieuwenhuizen
- Rheumatology & Clinical Immunology, University Medical Center, Utrecht, The Netherlands.
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16
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Nieuwenhuizen L, Schutgens RE, van Asbeck BS, Wenting MJ, van Veghel K, Roosendaal G, Biesma DH, Lafeber FP. Identification and expression of iron regulators in human synovium: evidence for upregulation in haemophilic arthropathy compared to rheumatoid arthritis, osteoarthritis, and healthy controls. Haemophilia 2013; 19:e218-27. [DOI: 10.1111/hae.12208] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2013] [Indexed: 01/29/2023]
Affiliation(s)
| | - R. E.G. Schutgens
- Hematology/Van Creveldkliniek; University Medical Center Utrecht; Utrecht; The Netherlands
| | - B. S. van Asbeck
- Internal Medicine; University Medical Center Utrecht; Utrecht; The Netherlands
| | - M. J. Wenting
- Rheumatology & Clinical Immunology; University Medical Center Utrecht; Utrecht; The Netherlands
| | - K. van Veghel
- Rheumatology & Clinical Immunology; University Medical Center Utrecht; Utrecht; The Netherlands
| | - G. Roosendaal
- Hematology/Van Creveldkliniek; University Medical Center Utrecht; Utrecht; The Netherlands
| | - D. H. Biesma
- Hematology/Van Creveldkliniek; University Medical Center Utrecht; Utrecht; The Netherlands
| | - F. P.J.G. Lafeber
- Rheumatology & Clinical Immunology; University Medical Center Utrecht; Utrecht; The Netherlands
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17
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Belle-van Meerkerk G, van de Graaf EA, Kwakkel-van Erp JM, van Kessel DA, Lammers JWJ, Biesma DH, de Valk HW. Diabetes before and after lung transplantation in patients with cystic fibrosis and other lung diseases. Diabet Med 2012; 29:e159-62. [PMID: 22486317 DOI: 10.1111/j.1464-5491.2012.03676.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIMS The aims of the study are to investigate the prevalence of diabetes in patients with cystic fibrosis compared with patients without cystic fibrosis, and its impact on the outcome after lung transplantation. METHODS Data were reviewed from 77 lung transplantation recipients in our centre between 2001 and 2010; 43 patients had cystic fibrosis and 34 patients had other lung diseases (no cystic fibrosis). To define diabetes, we used the American Diabetes Association definition. RESULTS Before lung transplantation, diabetes was diagnosed in 63% of patients with cystic fibrosis and 6% of patients without cystic fibrosis (P<0.001). In both groups, approximately 60% of the patients at risk developed new-onset diabetes after transplantation. The mortality in patients with cystic fibrosis was higher in patients with diabetes diagnosed before lung transplantation compared with those without (44 vs. 6%, P=0.04). Diabetes remained an independent factor in multivariate analyses. CONCLUSIONS Diabetes diagnosed before lung transplantation has a negative effect on survival after lung transplantation in patients with cystic fibrosis. Pre-existing diabetes is common in patients with cystic fibrosis, in contrast to patients without cystic fibrosis. Development of new-onset diabetes after transplantation is similar in both groups.
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Affiliation(s)
- G Belle-van Meerkerk
- Department of Internal Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands.
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18
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Kovaleva A, Remmelts HHF, Rijkers GT, Hoepelman AIM, Biesma DH, Oosterheert JJ. Immunomodulatory effects of macrolides during community-acquired pneumonia: a literature review. J Antimicrob Chemother 2011; 67:530-40. [DOI: 10.1093/jac/dkr520] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Fransen van de Putte DE, Fischer K, de Knegt RJ, Posthouwer D, van Erpecum KJ, Biesma DH, Mauser-Bunschoten EP. Beneficial effect of successful HCV treatment in patients with inherited bleeding disorders, assessed by liver stiffness measurements. Haemophilia 2011; 18:e266-72. [PMID: 22103568 DOI: 10.1111/j.1365-2516.2011.02697.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hepatitis C infection is a major comorbidity in patients with inherited bleeding disorders. Successful antiviral treatment leads to a reduction in liver fibrosis, as shown by liver biopsies. Liver stiffness measurement (LSM) is a non-invasive method of assessing liver fibrosis. The aim of this cohort study was to evaluate the long-term effect of successful antiviral treatment, using LSM, in HCV-infected patients with inherited bleeding disorders. The LSM were performed in 2005 (LSM 1) and 2009 (LSM 2) in 39 patients who were successfully treated for HCV. The change in liver fibrosis between LSM 1 and 2 was assessed. The median duration of HCV infection was 28.8 years. A total of 22 patients (56%) underwent successful antiviral treatment before LSM 1 (group 1), and 17 patients between LSM 1 and LSM 2 (group 2). The median time since antiviral treatment was 8.8 years in group 1 and 2.5 years in group 2. In group 1, the median results of LSM 1 and 2 were similar (6.0 vs. 5.6 kPa, P-value 0.36), so overall, patients remained stable. In three patients in this group, all treated more than 15 years ago, an increase of liver stiffness was shown. Group 2 showed a significant improvement in median LSM results (10.3 vs. 6.1 kPa, P-value <0.01), with decrease of liver stiffness in 82%. Even after a long HCV infection duration, successful antiviral treatment led to a significant improvement of fibrosis, measured by LSM, mainly in the first few years after completing treatment.
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Affiliation(s)
- D E Fransen van de Putte
- Van Creveldkliniek, Department of Haematology, University Medical Center Utrecht, Utrecht, The Netherlands.
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20
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Meijvis SCA, Cornips MCA, Voorn GP, Souverein PC, Endeman H, Biesma DH, Leufkens HGM, van de Garde EMW. Microbial evaluation of proton-pump inhibitors and the risk of pneumonia. Eur Respir J 2011; 38:1165-72. [PMID: 21478217 DOI: 10.1183/09031936.00020811] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recent initiation of proton-pump inhibitor (PPI) treatment may increase the risk of community-acquired pneumonia (CAP), hypothetically by allowing colonisation of the oropharynx by gastrointestinal bacteria. The aim of this study was to assess the causal pathway by considering microbial aetiology of pneumonia and indications for initiation of PPI treatment. This was a population-based, case-control study with 430 cases with pneumonia and 1,720 matched controls. An elaborate diagnostic protocol was used to identify the causative microorganism of pneumonia. For patients recently starting PPI treatment, indications for treatment were assessed. Recent initiation of PPI treatment (<30 days) was associated with an increased risk of CAP (adjusted OR 3.1, 95% CI 1.4-7.1). Oropharyngeal bacteria were evenly distributed among current users, past users and nonusers of PPIs (p=0.41). Gastrointestinal bacteria were identified in only five (1.2%) patients with pneumonia (two current users and three nonusers). Excluding patients who were possibly prescribed PPI treatment for early symptoms of pneumonia (protopathic bias) did not alter the study findings. This study reaffirmed that use of PPIs is associated with an increased risk of CAP, especially when treatment has recently been started. Neither protopathic bias nor shifts in microbial aetiology seem to explain the association.
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Affiliation(s)
- S C A Meijvis
- Dept of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.
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21
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Agterof MJ, Schutgens REG, Verzijlbergen JF, van Buul MMC, Tromp EAM, Eijkemans MJC, van der Griend R, Biesma DH. No firm association between N-terminal pro-brain natriuretic peptide and percentage of pulmonary vascular obstruction in patients with acute pulmonary embolism. Thromb Res 2011; 127:547-50. [PMID: 21421260 DOI: 10.1016/j.thromres.2011.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 02/10/2011] [Accepted: 02/20/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION High concentrations of N-terminal-pro-brain natriuretic peptide (NT-proBNP) are found in patients with right ventricular overload. Right ventricular overload may be the result of large perfusion defects in patients with pulmonary embolism (PE). NT-proBNP levels are associated with poorer outcome in patients with acute PE. Likewise, the percentage of pulmonary vascular obstruction (PVO) has shown to be a prognostic parameter for outcome in PE-patients. We postulated that NT-proBNP is associated with the amount of perfusion defects, expressed as the PVO, on perfusion scintigraphy. METHODS We included 85 consecutive patients in whom the diagnosis PE was confirmed by ventilation-perfusion scintigraphy. PVO was calculated in all patients. NT-proBNP concentrations were measured at presentation. We plotted the logarithm of NT-proBNP versus the PVO. The strength of the estimated association between NT-proBNP and the PVO was expressed by R2. RESULTS Eighteen percent of the variation in PVO could be explained by NT-proBNP. A positive association becomes apparent for NT-proBNP values above 200 pg/mL, with an increase in PVO of 6.3% (95% Confidence Interval 2.0 to 10.6), with every doubling of NT-proBNP. CONCLUSION There is an association between NT-proBNP concentrations and PVO, although this relation is quite weak. Some patients with low NT-proBNP values can have a high PVO, which might be relevant for outcome. Therefore, we advise caution in risk stratification and not to focus on NT-proBNP, without involving the clinical condition.
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Affiliation(s)
- M J Agterof
- Department of Internal Medicine, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
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22
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Meijvis SCA, Grutters JC, Thijsen SF, Rijkers GT, Biesma DH, Endeman H. Therapy in pneumonia: what is beyond antibiotics? Neth J Med 2011; 69:21-26. [PMID: 21325697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Community-acquired pneumonia (CAP) is a common and serious disease with significant mortality, morbidity and associated healthcare costs. Severity of pneumonia is related to the extent of the inflammatory response. Primary goal in the treatment of pneumonia is starting adequate antibiotic therapy as soon as possible. However, antimicrobial resistance among the most common bacteria causing pneumonia is increasing. For those two reasons, extended inflammatory response and increasing antibiotic resistance, it is interesting to look at adjunctive non-antibiotic therapeutic strategies aimed at modulation of the inflammatory response or at the micro-organism itself. In this review, we discuss the current knowledge regarding these therapies and their possible role in the future.
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Affiliation(s)
- S C A Meijvis
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, the Netherlands
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23
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Meerveld-Eggink A, de Weerdt O, de Voer RM, Berbers GAM, van Velzen-Blad H, Vlaminckx BJ, Biesma DH, Rijkers GT. Impaired antibody response to conjugated meningococcal serogroup C vaccine in asplenic patients. Eur J Clin Microbiol Infect Dis 2010; 30:611-8. [PMID: 21184126 DOI: 10.1007/s10096-010-1129-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Accepted: 12/06/2010] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to determine the quantity and quality of antibodies against the meningococcal serogroup C (MenC) conjugated vaccine in asplenic patients. In 116 asplenic patients, antibody concentrations (IgG) were measured against meningococcal serogroup C before and after immunisation. Of MenC-specific IgG, both antibody avidity and subclasses of IgG1 and IgG2 were determined. The mean MenC IgG concentration rose from 0.16 μg/mL prior to vaccination to 3.69 μg/mL 3 weeks post-vaccination, with 67% of patients reaching the threshold of ≥ 2.0 μg/mL. The mean IgG concentration at 35 weeks post-vaccination was 3.10 μg/mL. IgG2 concentrations increased more than IgG1. Marginal avidity maturation was seen. Hypo-responders to the first MenC vaccine (IgG anti-MenC ≤ 2.0 μg/mL) were offered a booster dose. After revaccination, 59% reached the chosen IgG threshold. The IgG concentration rose from 0.29 to 1.12 μg/mL, with an increase in the IgG1/IgG2 ratio. Avidity indices remained below 33%. In asplenic patients, the quantity and quality of antibodies produced after one dose of conjugated MenC vaccination is lower than that observed in previous studies in healthy adults. Booster vaccination does, indeed, lead to a rise in IgG geometric mean concentrations (GMCs), but does not lead to higher avidity of antibodies.
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Affiliation(s)
- A Meerveld-Eggink
- Department of Internal Medicine, St Antonius Hospital Nieuwegein, PO Box 2500, 3430 EM, Nieuwegein, The Netherlands.
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24
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Meerveld-Eggink A, de Weerdt O, van Velzen-Blad H, Biesma DH, Rijkers GT. Response to conjugate pneumococcal and Haemophilus influenzae type b vaccines in asplenic patients. Vaccine 2010; 29:675-80. [PMID: 21115060 DOI: 10.1016/j.vaccine.2010.11.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 11/12/2010] [Accepted: 11/14/2010] [Indexed: 11/28/2022]
Abstract
We determined the immunogenicity of conjugated Haemophilus influenzae type b and pneumococcal vaccines by quantitative analysis of the antibody response in asplenic patients. To that end, we vaccinated 92 patients with a conjugated Hib vaccine and 54 received two doses of conjugated pneumococcal vaccine (PCV7), followed at six months by a plain polysaccharide pneumococcal vaccine (PPV23). Antibody concentrations were measured before and three weeks after vaccination. After one dose of pneumococcal conjugate vaccine, 46% of the patients reached the antibody threshold of ≥ 1.0 μg/mL for all 7 tested vaccine serotypes. This percentage rose to 54% after the second dose of PCV7 and did not increase further after PPV23. Over 90% of patients had antibody concentrations ≥ 1.0 μg/mL for at least 5 out of the 7 conjugated pneumococcal serotypes after 2 doses of PCV7. For serotypes, included in the PPV23 vaccine only, 25% (PPS3)-100% (PPS19A) of the patients reached antibody concentrations ≥ 1.0 μg/mL after one dose of PPV23. For Hib, 97% of the patients reached the threshold concentration of ≥ 1.0 μg/mL after one dose of vaccine. It can be concluded that the majority of asplenic patients had a sufficient response to conjugated vaccines against Streptococcus pneumoniae and Hib, reflected by a ≥ 1.0 μg/mL antibody response. Inclusion of conjugated pneumococcal polysaccharide vaccines might be of additional value in the vaccination schedule for asplenic patients because of their high immunogenicity.
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Affiliation(s)
- A Meerveld-Eggink
- Department of Internal Medicine, St. Antonius Hospital Nieuwegein, The Netherlands.
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25
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Endeman H, Meijvis SCA, Rijkers GT, van Velzen-Blad H, van Moorsel CHM, Grutters JC, Biesma DH. Systemic cytokine response in patients with community-acquired pneumonia. Eur Respir J 2010; 37:1431-8. [PMID: 20884746 DOI: 10.1183/09031936.00074410] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The role of individual cytokines and polymorphisms in pneumonia has been described, but the relationship between different cytokines and polymorphisms in relation to causative microorganisms, antibiotics, corticosteroids and clinical course has not. This study questions the relationship between cytokines, polymorphisms and clinical characteristics of pneumonia. Patients diagnosed with pneumonia were included in the study. Serum cytokine levels were measured during hospital stay, genotyping was performed, causative microorganisms were identified and patients were monitored throughout the hospital stay. In 201 patients with pneumonia interleukin (IL)-1 receptor antagonist (IL-1RA), IL-6, IL-8 and IL-10 acted as acute phase proteins. After admission, the levels of these cytokines decreased rapidly. Single nucleotide polymorphisms did not influence cytokine production and were not associated with clinical outcome. Cytokine serum levels were significantly higher in patients with pneumococcal pneumonia. The decrease in levels of cytokines was independently influenced by the start of corticosteroid therapy. IL-1RA, IL-6, IL-8 and IL-10 are acute phase proteins, independent of genotype. Their levels are influenced by the nature of the causative microorganism and the start of corticosteroids therapy.
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Affiliation(s)
- H Endeman
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.
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26
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Beckers MMJ, Ruven HJT, Haas FJLM, Doevendans PA, ten Cate H, Prins MH, Biesma DH. Single nucleotide polymorphisms in inflammation-related genes are associated with venous thromboembolism. Eur J Intern Med 2010; 21:289-92. [PMID: 20603037 DOI: 10.1016/j.ejim.2010.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 03/08/2010] [Accepted: 04/05/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Various genetic risk factors are known to increase the risk of venous thromboembolism (VTE). Increasing evidence suggests a "cross-talk" between the coagulation and inflammatory cascade. Therefore, polymorphisms in genes involved in inflammation may influence susceptibility towards VTE. The aim of the study was to investigate the role of single nucleotide polymorphisms (SNPs) in inflammation genes for susceptibility towards VTE. METHODS The study group consisted of 108 (47 men and 61 women) Dutch patients with documented VTE and 325 healthy controls from the same geographical area (117 men and 208 women). Odds ratios (OR) and 95% confidence intervals (95% CI) for VTE separately and if indicated by gender were calculated to assess whether genotype and allele frequency were associated with thrombosis. RESULTS Heterozygosity for SNP -899C/T of the interleukin 1-alpha gene (IL1A -899C/T) was under-represented in VTE patients compared to the control group (OR=0.51, 95% CI 0.32-0.82). The IL6 -174 CC genotype was more frequent in male patients with VTE compared to male controls (OR=4.06, 95% CI 1.43-11.5). Female patients carried significantly more IL13 (intron3) TT genotype (OR=5.60, 95% CI 1.94-18.5) compared to female controls. The allelic frequency of IL4 -589 T allele was significantly increased in female patients (OR=1.72, 95% CI 1.05-2.81) in contrast to men where no differences were observed. CONCLUSION Four SNPs in inflammatory-related genes of IL1A, IL4, IL6, and IL13 may be associated with VTE. These results need to be confirmed in independent groups with larger number of patients.
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Affiliation(s)
- M M J Beckers
- Department of Internal Medicine, St. Antonius Hospital Nieuwegein, The Netherlands.
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Agterof MJ, Schutgens REG, Snijder RJ, Epping G, Peltenburg HG, Posthuma EFM, Hardeman JA, van der Griend R, Koster T, Prins MH, Biesma DH. Out of hospital treatment of acute pulmonary embolism in patients with a low NT-proBNP level. J Thromb Haemost 2010; 8:1235-41. [PMID: 20230418 DOI: 10.1111/j.1538-7836.2010.03831.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Low NT-proBNP levels are associated with an uncomplicated course in patients with pulmonary embolism (PE). The aim of this multicenter management study was to investigate the safety of home treatment of patients with PE with low (< 500 pg mL(-1)) NT-proBNP. METHODS AND RESULTS Hemodynamically stable outpatients with acute PE and NT-proBNP level < 500 pg mL(-1) were included. Patients were discharged immediately from the emergency room or within a maximum of 24 h after admission. The primary study objective was the absence of mortality during the first 10 days of treatment. Secondary objectives were the incidence of re-admission due to PE or its treatment and the patient's satisfaction during the first 10 days of treatment as well as the incidence of serious adverse events during the 3-month follow-up period. Of 351 patients, 152 (43%) fulfilled the inclusion criteria and were treated as outpatients. No deaths, major bleedings or recurrent venous thromboembolism occurred in the first 10 days of treatment or in the follow-up period of 3 months in these patients. Seven patients required readmission in the first 10 days: three because of complaints that could be related to PE and four due to an illness unrelated to PE. The HADS-A anxiety score did not change significantly between day 0 and day 10. The PSQ-18 showed a high score for satisfaction with home treatment. CONCLUSION Out of hospital treatment is safe in hemodynamically stable patients with PE with low (< 500 pg mL(-1)) NT-proBNP levels. Approximately 45% of patients with PE can be treated in an outpatient setting. Patients do not consider out of hospital treatment as inconvenient and have no increase in anxiety scores. CLINICAL TRIAL REGISTRATION INFORMATION http://clinicaltrials.gov/ct2/show/NCT00455819.
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Affiliation(s)
- M J Agterof
- Departments of Internal Medicine and Hematology/Van Creveldkliniek, University Medical Center, Utrecht, the Netherlands
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Beckers MMJ, Ruven HJT, Seldenrijk CA, Prins MH, Biesma DH. Risk of thrombosis and infections of central venous catheters and totally implanted access ports in patients treated for cancer. Thromb Res 2009; 125:318-21. [PMID: 19640573 DOI: 10.1016/j.thromres.2009.06.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 06/16/2009] [Accepted: 06/19/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Thrombosis and infections are well known complications of central venous catheters and totally implanted access ports. These complications lead to increased costs due to prolonged hospitalisation, increased antibiotics use and need for replacement. The objectives of the study were to document the occurrence of catheter related thrombosis and infections in patients with central venous catheters and totally implanted chest ports in cancer patients and to investigate whether factor V Leiden is a risk factor for catheter related thrombosis. MATERIALS AND METHODS Between February 2002 and November 2004, 43 patients with central venous catheter or totally implanted access port were followed up to document the occurrence of catheter related thrombosis and infections. Patients received chemotherapy either for haematological malignancy or for solid tumours. Factor V Leiden (R506Q) was determined by restriction fragment length polymorphism analysis. Follow-up period ended in April 2007. RESULTS Catheter related thrombosis occurred in 4 patients (4/43; 9.3%) with a totally implanted access port. None of the 3 patients with factor V Leiden had catheter related infection or thrombosis. Catheter related infections occurred in 15 patients: 10 patients (23.3%; 10/43) with central venous catheter and 5 patients (11.6%; 5/43) with totally implanted access ports. Time to infection was 32.5 days in the central venous catheter group compared to 88 days in the totally implanted access port group. CONCLUSION A higher incidence of catheter related infections was observed in patients with central venous catheters in contrast to patients with totally implanted access ports were venous thrombosis was more frequent.
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Affiliation(s)
- M M J Beckers
- Department of Internal Medicine, University of Maastricht, The Netherlands
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29
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Herpers BL, Endeman H, de Jong BAW, de Jongh BM, Grutters JC, Biesma DH, van Velzen-Blad H. Acute-phase responsiveness of mannose-binding lectin in community-acquired pneumonia is highly dependent upon MBL2 genotypes. Clin Exp Immunol 2009; 156:488-94. [PMID: 19438602 DOI: 10.1111/j.1365-2249.2009.03929.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Mannose-binding lectin (MBL) is a pattern recognition receptor of the complement system and plays an important role in innate immunity. Whether or not MBL acts as an acute-phase response protein in infection has been an issue of extensive debate, because MBL responses have shown a high degree of heterogeneity. Single nucleotide polymorphisms (SNPs) in the promoter (wild-type Y versus X) and exon 1 (A versus 0) of the MBL2 gene can lead to MBL deficiency. This study investigated the influence of SNPs in the promoter and exon 1 of the MBL2 gene on the acute-phase responsiveness of MBL in 143 patients with community-acquired pneumonia. Acute-phase reactivity was observed only in MBL-sufficient genotypes (YA/YA, XA/YA, XA/XA and YA/0). In patients with wild-type exon 1 genotype A/A, positive acute-phase responses were associated with the presence of the YA haplotype and negative responses with its absence. Genotypes YA/0 and XA/XA produced equal levels of MBL in convalescence. In the acute phase, however, patients with genotype XA/XA displayed negative acute-phase responses more often than those with genotype YA/0. Correlation of MBL and C-reactive protein levels in the acute phase of pneumonia also depended upon the MBL2 genotype. In conclusion, acute-phase responsiveness of MBL was highly dependent upon the MBL2 genotype. These data suggest that heterogeneity in protein responses in the acute phase of disease should always be viewed in the light of possible influences of genetic differences in both structural and regulatory parts of the gene.
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Affiliation(s)
- B L Herpers
- Department of Medical Microbiology and Immunology, Antonius Hospital, Nieuwgein, The Netherlands.
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30
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Abstract
Mortality due to ischemic heart disease in hemophilia patients is lower as compared to the general male population. Differences in the prevalence of cardiovascular risk factors cannot explain this finding. The hypocoagulable state of hemophilia patients might have a protective effect on thrombus formation, which precipitates infarction. It remains unclear whether the deficiency of coagulation factor VIII or IX exerts a protective effect on the development of atherosclerosis. Despite the relative protection against cardiovascular events, the incidence of ischemic cardiovascular disease in hemophilia patients is increasing, because life expectancy of these patients now approaches that of the general population. This review focuses on what is currently known about cardiovascular risk factors, atherosclerosis, arterial thrombosis and ischemic cardiovascular disease in hemophilia patients.
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Affiliation(s)
- A Tuinenburg
- Van Creveldkliniek/Department of Haematology, University Medical Center Utrecht, The Netherlands.
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31
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Beckers MMJ, Verzijlbergen JF, van Buul MMC, Prins MH, Biesma DH. The potential role of positron emission tomography in the detection of occult cancer in 25 patients with venous thromboembolism. Ann Oncol 2008; 19:1203-4. [PMID: 18385199 DOI: 10.1093/annonc/mdn156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bredenoord AJ, Onaca MG, van Ramshorst B, Biesma DH. [Sigmoid carcinoma as a long-term complication following ureterosigmoidostomy]. Ned Tijdschr Geneeskd 2008; 152:213-215. [PMID: 18320948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 45-year-old woman, known to have a congenital exstrophy ofthe bladder, for which she underwent a ureterosigmoidostomy in her infancy, presented with fever. This was due to pyelonephritis, from which she recovered with antibiotic therapy. During colonoscopy a carcinoma of the sigmoid was found at the level of the anastomosis of the ureters. Patients with a ureterosigmoidostomy have a one hundred-fold increased risk of colon carcinoma compared to the general population. The development of malignant tumours as a long-term complication of this procedure is linked with the frequent contact between intestinal tissue and urine. Periodical colonoscopy of these patients is advised.
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Affiliation(s)
- A J Bredenoord
- St. Antonius Ziekenhuis, Postbus 2500, 3430 EM Nieuwegein.
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33
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van der Velden AMT, Claessen AME, van Velzen-Blad H, de Groot MR, Kramer MHH, Biesma DH, Rijkers GT. Vaccination responses and lymphocyte subsets after autologous stem cell transplantation. Vaccine 2007; 25:8512-7. [PMID: 17996989 DOI: 10.1016/j.vaccine.2007.10.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 08/26/2007] [Accepted: 10/07/2007] [Indexed: 11/19/2022]
Abstract
Twenty autologous stem cell transplant recipients were vaccinated with three doses of Diphtheria-Tetanus-Poliomyelitis vaccine and conjugated Haemophilus influenzae type b (Hib) vaccine. Pneumococcal vaccination consisted of two doses of conjugated vaccine followed by a single dose of polysaccharide vaccine, at 6, 8 and 14 months after transplantation, respectively. Mean anti-tetanus, anti-Hib and anti-pneumococcal IgG antibodies significantly increased after each vaccination. Response rates after the full vaccination schedule were 94%, 78% and 61% for Hib, conjugated 7-valent pneumococcal vaccine and non-conjugated 23-valent pneumococcal vaccine, respectively. Three months after transplantation, CD16(+)CD56(+) NK cells were in the normal range and remained so. The total number of T lymphocytes at 3 months was and remained in the normal range. The mean CD4/CD8 ratio was 0.43 at 3 months post aSCT and, while gradually increasing, remained subnormal. The mean number of CD19(+) B lymphocytes significantly increased during the study period. Patients with CD19 counts <0.10 x 10(9)L(-1) required at least two Hib vaccinations to show a response, while the majority of patients with CD19 counts > or = 0.20 x 10(9)L(-1) showed a response to Hib after one vaccination only. Thus, a minimum threshold level of CD19(+) cells appears to be required for adequate responses to vaccination.
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Affiliation(s)
- A M T van der Velden
- Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, The Netherlands.
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34
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van der Velden AMT, Claessen AME, van Velzen-Blad H, Biesma DH, Rijkers GT. Development of T cell-mediated immunity after autologous stem cell transplantation: prolonged impairment of antigen-stimulated production of gamma-interferon. Bone Marrow Transplant 2007; 40:261-6. [PMID: 17563737 DOI: 10.1038/sj.bmt.1705706] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The conditioning regimens for autologous SCT (auto-SCT) lead to impairment of the immune system and concomitant increase in susceptibility to infections. We studied the recovery of cellular immunity by in vitro analysis of T-cell proliferation and cytokine production profiles during the first 15 months after auto-SCT in patients with multiple myeloma and non-Hodgkin's lymphoma. PBMC were collected at 6, 9 and 15 months after transplantation and stimulated with a combination of CD2 and CD28 monoclonal antibodies, with PHA or with tetanus toxoid as recall antigen. A multiplex enzyme linked immunoassay was used to determine levels of Th1 cytokines IL-2, IFN-gamma and tumour-necrosis factor-alpha (TNF-alpha), Th2 cytokines IL-4, IL-5 and IL-13, the regulatory cytokine IL-10 and the proinflammatory cytokines IL-1alpha, IL-1beta, IL-6 and the chemokine IL-8. T-cell proliferation progressively increased from 6 to 15 months after auto-SCT. Overall, cytokine production increased after auto-SCT. Production of Th2 cytokines IL-5 and IL-13 was superior to production of Th1 cytokines IFN-gamma and TNF-alpha. We hypothesize that prolonged impairment of IFN-gamma production might contribute to the relatively high incidence of viral infections after auto-SCT.
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Affiliation(s)
- A M T van der Velden
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.
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35
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Agterof MJ, van der Bruggen T, Tersmette M, ter Borg EJ, van den Bosch JMM, Biesma DH. Nocardiosis: a case series and a mini review of clinical and microbiological features. Neth J Med 2007; 65:199-202. [PMID: 17587645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Infections caused by Nocardia species are uncommon and have a wide variety of clinical manifestations in immunocompetent and immunocompromised patients. The diagnosis of nocardiosis can easily be missed because there are no characteristic symptoms. We present one case of a Nocardia infection in detail and give a brief description of eight other cases, including a relatively unique type of Nocardia veterana, diagnosed in our hospital during a five-year period. The diversity of clinical manifestations, microbiological identification and general principles of treatment of nocardiosis are reviewed.
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Affiliation(s)
- M J Agterof
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, the Netherlands.
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36
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Ten Heuvel A, Schramel FMMH, Biesma DH. Fondaparinux in the management of recurrent venous thromboembolic events in a patient with active lung cancer. Thromb Res 2007; 120:635-7. [PMID: 17257658 DOI: 10.1016/j.thromres.2006.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 12/04/2006] [Accepted: 12/05/2006] [Indexed: 11/20/2022]
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38
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Wasowicz-Kemps DK, Biesma DH, Schagen van Leeuwen J, van Ramshorst B. [Thromboprophylaxis in general surgical practices in the year 2004]. Ned Tijdschr Geneeskd 2006; 150:220; author reply 220-1. [PMID: 16471240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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39
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Wasowicz-Kemps DK, Biesma DH, Schagen van Leeuwen J, Van Ramshorst B. Prophylaxis of venous thromboembolism in general and gynecologic day surgery in The Netherlands. J Thromb Haemost 2006; 4:269-71. [PMID: 16409484 DOI: 10.1111/j.1538-7836.2005.01673.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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40
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van der Lee I, Zanen P, Biesma DH, van den Bosch JMM. The Effect of Red Cell Transfusion on Nitric Oxide Diffusing Capacity. Respiration 2005; 72:512-6. [PMID: 16210891 DOI: 10.1159/000087676] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2004] [Accepted: 12/02/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The diffusion capacity of the lung for nitric oxide (DLNO) is supposed to reflect the properties of the alveolocapillary membrane better than the diffusion capacity of the lung for carbon monoxide (DLCO), due to a much stronger binding of NO to haemoglobin (Hb). OBJECTIVES The aim of this study was to investigate the effect of Hb concentration on the DLNO. METHODS The DLNO and DLCO (single-breath method) were measured in 10 anaemic patients before and shortly after red cell transfusion. RESULTS The mean increase in Hb concentration was 2.6 g/dl. Whereas DLCO increased as predicted by the reference equations, the DLNO did not change: mean DLCO rose from 13.6 to 16.5 ml/min/mm Hg (increase of 122%), mean DLCO corrected for Hb rose from 18.8 to 19.3 ml/min/mm Hg (103%) and mean DLNO rose from 75.6 to 77.8 ml/min/mm Hg (103%). CONCLUSION The DLNO is not influenced by Hb concentration.
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Affiliation(s)
- I van der Lee
- Department of Pulmonary Diseases, Heart Lung Centre Utrecht, Nieuwegein, The Netherlands.
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41
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Schreinemakers JMJ, van Dam PS, Seldenrijk CA, Biesma DH, Borel Rinkes IHM. [The adrenocortical carcinoma, a tumour of wide clinical diversity]. Ned Tijdschr Geneeskd 2004; 148:2109-13. [PMID: 15553352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Over the course of a few years, an obese 52-year-old woman with a 23-year history of hypertension developed a number of abdominal complaints including gall stones. Her blood pressure became increasingly difficult to control and she developed diabetes mellitus and suffered palpitations and headaches. It became noticeable that she had a moon face. Laboratory tests revealed hypercortisolism. CT-scan showed a large inhomogeneous mass of nine centimetres in her left adrenal gland, which was subsequently removed surgically. The histopathological diagnosis was consistent with an adenoma. After a number of months the patient developed bone and liver metastases and the diagnosis was amended to carcinoma of the adrenal cortex. She then underwent radiotherapy and chemotherapy treatment. One year after surgery she developed a pancytopenia and died. Adrenocortical carcinomas are rare tumours with an incidence of about 1-2 cases per million of the population. Symptoms are heterogeneous since both functional (hormonal overproduction) and non-functional (mass effect) tumours exist. Surgical resection is the only curative therapy. It may be difficult to distinguish between benign and malignant cortical tumours.
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42
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Schutgens RE, Biesma DH. [Simplified diagnosis of deep venous thrombosis by applying clinical score and D-dimer concentration]. Ned Tijdschr Geneeskd 2003; 147:1721-6. [PMID: 14520796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Serial compression ultrasonography of the leg is a safe but inefficient method of diagnosing deep venous thrombosis (DVT). The introduction of the clinical score and the D-dimer test heralds a change in the diagnostics of DVT. It is now safe to withhold anticoagulation from patients following one single normal ultrasonography in combination with a low clinical score or a normal D-dimer concentration. Recent studies show that DVT can safely be excluded on the basis of the combination of a normal D-dimer concentration and a low clinical score alone.
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Affiliation(s)
- R E Schutgens
- Universitair Medisch Centrum Utrecht, afd. Hematologie, Heidelberglaan 100, 3584 CX Utrecht.
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43
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Schutgens REG, Haas FJLM, Gerritsen WBM, van der Horst F, Nieuwenhuis HK, Biesma DH. The usefulness of five D-dimer assays in the exclusion of deep venous thrombosis. J Thromb Haemost 2003; 1:976-81. [PMID: 12871364 DOI: 10.1046/j.1538-7836.2003.00148.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
D-Dimer measurement is a promising tool in the exclusion of venous thrombosis. New d-dimer assays have been introduced, but need clinical validation. Our objective was to evaluate the clinical usefulness of four relatively new d-dimer assays and a classical ELISA in outpatients suspected for deep venous thrombosis. In 537 patients, participants in a large prospective management study using a clinical probability score and a d-dimer measurement (Tina-quant), additional samples were taken for d-dimer measurement using the Asserachrom ELISA, the VIDAS New, the STA-LIA and the Miniquant assay. Performances of each test were calculated using clinical data during a 3-month follow-up. Thrombosis was detected in 224 patients (42%). The area under the ROC curve was significantly higher for the Tina-quant as compared to the other assays. Using standard cut-off values, sensitivity, negative predictive value (NPV) and specificity of the Asserachrom were 97, 94 and 33%, respectively. For the VIDAS New, values were 100, 96 and 8%, respectively. The Tina-quant showed values of 99, 98 and 41%, respectively, and the STA-LIA 98, 95 and 32%. Values for the Miniquant were 95, 94 and 52%. The d-dimer assays in our study all show a high sensitivity and negative predictive value, but none of the assays reached an NPV of > 98% at standard cut-off values. d-Dimer assays with a low specificity still necessitate additional diagnostic tests in the majority of the patients.
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Affiliation(s)
- R E G Schutgens
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, the Netherlands.
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Schutgens REG, Ackermark P, Haas FJLM, Nieuwenhuis HK, Peltenburg HG, Pijlman AH, Pruijm M, Oltmans R, Kelder JC, Biesma DH. Combination of a normal D-dimer concentration and a non-high pretest clinical probability score is a safe strategy to exclude deep venous thrombosis. Circulation 2003; 107:593-7. [PMID: 12566372 DOI: 10.1161/01.cir.0000045670.12988.1e] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Serial ultrasonography is reliable for the diagnosis of deep venous thrombosis in symptomatic patients, but the low prevalence of thrombosis in this group renders the approach costly and inconvenient to patients. We studied the clinical validity of the combination of a pretest clinical probability score and a D-dimer test in the initial evaluation of patients suspected of deep venous thrombosis. METHODS AND RESULTS Patients with a normal D-dimer concentration (<500 fibrin equivalent units [FEU] microg/L) and a non-high probability score (<3) had no further testing. Patients with a normal D-dimer concentration and a high probability score (> or =3) underwent one ultrasonogram. Serial ultrasonography was performed in patients with an abnormal D-dimer concentration. Patients were followed for 3 months. A total of 812 patients were evaluable for efficacy. Only 1 of 176 patients (0.6%; 95% CI, 0.02% to 3.1%) with a normal D-dimer concentration and a non-high probability score developed thrombosis during follow-up. A normal D-dimer concentration and a high probability score were found in 39 patients; 3 of them (7.7%; 95% CI, 1.6% to 20.9%) had thrombosis at presentation, and one (2.8%; 95% CI, 0.07% to 14. 5%) developed pulmonary embolism during follow-up. In 306 of 597 patients (51.3%) with an abnormal D-dimer concentration, thrombosis was detected by serial ultrasonography. Six patients (2.1%; 95% CI, 0.8% to 4. 4%) developed thrombosis during follow-up. No deaths due to thromboembolism occurred during follow-up. The total need for ultrasonography was reduced by 29%. CONCLUSION The combination of a non-high pretest clinical probability score and a normal D-dimer concentration is a safe strategy to rule out deep venous thrombosis and to withhold anticoagulation.
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Affiliation(s)
- R E G Schutgens
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.
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Affiliation(s)
- D A C Duyndam
- Department of Radiology, St. Antonius Hospital Nieuwegein, Postbus 2500, 3430, The Netherlands
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46
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Biesma DH, Westerhof PW. Paradoxical thromboembolism. Neth Heart J 2002; 10:207. [PMID: 25696092 PMCID: PMC2499742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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Mager JJ, Schutgens RE, Haas FJ, Westermann CJ, Biesma DH. The early course of D-dimer concentration following pulmonary artery embolisation. Thromb Haemost 2001; 86:1578-9. [PMID: 11776330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Biesma DH, Hannema AJ, van Velzen-Blad H, Mulder L, van Zwieten R, Kluijt I, Roos D. A family with complement factor D deficiency. J Clin Invest 2001; 108:233-40. [PMID: 11457876 PMCID: PMC203023 DOI: 10.1172/jci12023] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A complement factor D deficiency was found in a young woman who had experienced a serious Neisseria meningitidis infection, in a deceased family member with a history of meningitis, and in three relatives without a history of serious infections. The patient and these three relatives showed a normal activity of the classical complement pathway, but a very low activity of the alternative complement pathway and a very low capacity to opsonize Escherichia coli and N. meningitidis (isolated from the patient) for phagocytosis by normal human neutrophils. The alternative pathway-dependent hemolytic activity and the opsonizing capacity of these sera were restored by addition of purified factor D. The family had a high degree of consanguinity, and several other family members exhibited decreased levels of factor D. The gene encoding factor D was found to contain a point mutation that changed the TCG codon for serine 42 into a TAG stop codon. This mutation was found in both alleles of the five completely factor D-deficient family members and in one allele of 21 other members of the same family who had decreased or low-normal factor D levels in their serum. The gene sequence of the signal peptide of human factor D was also identified. Our report is the first, to our knowledge, to document a Factor D gene mutation. The mode of inheritance of factor D deficiency is autosomal recessive, in accordance with the localization of the Factor D gene on chromosome 19. Increased susceptibility for infections in individuals with a partial factor D deficiency is unlikely.
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Affiliation(s)
- D H Biesma
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.
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49
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Collen A, Maas A, Kooistra T, Lupu F, Grimbergen J, Haas FJ, Biesma DH, Koolwijk P, Koopman J, van Hinsbergh VW. Aberrant fibrin formation and cross-linking of fibrinogen Nieuwegein, a variant with a shortened Aalpha-chain, alters endothelial capillary tube formation. Blood 2001; 97:973-80. [PMID: 11159525 DOI: 10.1182/blood.v97.4.973] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A congenital dysfibrinogenemia, fibrinogen(Nieuwegein), was discovered in a young man without any thromboembolic complications or bleeding. A homozygous insertion of a single nucleotide (C) in codon Aalpha 453 (Pro) introduced a stop codon at position 454, which resulted in the deletion of the carboxyl-terminal segment Aalpha 454-610. The ensuing unpaired cysteine at Aalpha 442 generated fibrinogen-albumin complexes of different molecular weights. The molecular abnormalities of fibrinogen(Nieuwegein) led to a delayed clotting and a fibrin network with a low turbidity. Electron microscopy confirmed that thin fibrin bundles were organized in a fine network. The use of fibrinogen(Nieuwegein)-derived fibrin (fibrin(Nieuwegein)) in an in vitro angiogenesis model resulted in a strong reduction of tube formation. The ingrowth of human microvascular endothelial cells (hMVEC) was independent of alpha(v)beta(3), indicating that the reduced ingrowth is not due to the absence of the RGD-adhesion site at position Aalpha 572-574. Rather, the altered structure of fibrin(Nieuwegein) is the cause, since partial normalization of the fibrin network by lowering the pH during polymerization resulted in an increased tube formation. Whereas factor XIIIa further decreased the ingrowth of hMVEC in fibrin(Nieuwegein), tissue transglutaminase (TG), which is released in areas of vessel injury, did not. This is in line with the absence of the cross-linking site for TG in the alpha-chains of fibrinogen(Nieuwegein). In conclusion, this newly discovered congenital dysfibrinogenemia has a delayed clotting time and leads to the formation of an altered fibrin structure, which could not be cross-linked by TG and which is less supportive for ingrowth of endothelial cells.
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MESH Headings
- Adult
- Afibrinogenemia/genetics
- Afibrinogenemia/pathology
- Biopolymers
- Capillaries/pathology
- Cells, Cultured
- Codon, Terminator
- Endothelium, Vascular/ultrastructure
- Exons/genetics
- Fibrin/biosynthesis
- Fibrin/chemistry
- Fibrin/ultrastructure
- Fibrinogens, Abnormal/chemistry
- Fibrinogens, Abnormal/genetics
- Humans
- Male
- Microscopy, Electron
- Molecular Weight
- Mutagenesis, Insertional
- Neovascularization, Physiologic/genetics
- Oligopeptides/physiology
- Partial Thromboplastin Time
- Receptors, Vitronectin/immunology
- Receptors, Vitronectin/physiology
- Sequence Deletion
- Structure-Activity Relationship
- Transglutaminases/metabolism
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Affiliation(s)
- A Collen
- Gaubius Laboratory, TNO-PG, Leiden, The Netherlands
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Hartkamp A, Mulder AH, Rijkers GT, van Velzen-Blad H, Biesma DH. Antibody responses to pneumococcal and haemophilus vaccinations in patients with B-cell chronic lymphocytic leukaemia. Vaccine 2001; 19:1671-7. [PMID: 11166890 DOI: 10.1016/s0264-410x(00)00409-6] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although vaccination against Streptococcus pneumoniae (S. pneumoniae) and Haemophilus influenzae type b (Hib) is recommended for immunocompromised patients, such as patients with B-cell chronic lymphocytic leukaemia (B-CLL), its protective effect is questionable. We studied antibody responses to pneumococcal polysaccharide vaccine (Pneumovax-23) and to conjugated H. influenzae type b-vaccine (Act-Hib) in 25 patients with B-CLL. After vaccination, the number of patients with antibody levels in the protective range against pneumococcal serotypes and H. influenzae b increased from 9 (38%) to 12 (50%) of 24 patients and from 8 (35%) to 11 (48%) of 23 patients, respectively. The patients with adequate antibody response to Pneumovax-23 and Act-Hib had significantly less advanced stages of B-CLL, higher gammaglobulin levels, total IgG-levels and IgG-subclasses 2 and 4 levels, and lower levels of soluble CD23. Consequently, vaccination with these vaccines should be given as soon as the diagnosis of B-CLL is made, early in the course of the disease with determination of post-vaccination antibody levels.
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Affiliation(s)
- A Hartkamp
- Department of Internal Medicine, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
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