De diagnotische accuratesse van de anticitrullinebepaling voor het vaststellen van reumatoïde artritis door de huisarts

Doel. Vaststellen of het meten van antistoffen tegen citrulline toegevoegde waarde heeft bij het stellenvan de diagnose ‘reumatoïde artritis’ (‘RA’) in de huisartsenpraktijk. Opzet. Retrospectief. Methoden. Gedurende een halfjaar (mei-december 2004) werden alle sera die naar het laboratorium waren ingezonden voor een reumafactorbepaling (RF-IgM) ook onderzocht op de aanwezigheid van antistoffen die binden aan gecitrullineerd fibrinogeen (anticitrulline). Met behulp van deze zelf ontwikkelde test werden in totaal 691 sera van huisartspatiënten gemeten. Om de classificerende diagnose van deze personen te achterhalen, werden de huisartsen benaderd om informatie te verstrekken over hun patiënten met betrekking tot de criteria van het American College of Rheumatology. De respons was 97,6%. Indien de patiënt de afgelopen twee jaar (december 2004-december 2006) werd verwezen naar een reumatoloog, was diens diagnose echter meegenomen in de analyse. Resultaten. In totaal kon de classificerende diagnose ‘RA’ bij 28 huisartspatiënten (4%) worden gesteld. Bij slechts 25% van de bijbehorende sera werd anticitrulline aangetoond. Ook RF-IgM werd in slechts 25% van de sera aangetoond. Deze twee groepen overlapten elkaar slechts gedeeltelijk. De bijbehorende positief en negatief voorspellende waarden van anticitrulline waren respectievelijk 36 en 96%. Conclusie. Het aantonen van anticitrulline had geen toegevoegde waarde ten opzichte van de reumafactorbepaling voor de diagnostiek van RA in de huisartsenpraktijk

Neonatal screening for congenital hypothyroidism in the Netherlands: Cognitive and motor outcome at 10 years of age

Contains fulltext : 35300.pdf (publisher's version ) (Open Access)CONTEXT: Patients with thyroidal congenital hypothyroidism (CH-T) born in The Netherlands in 1981-1982 showed persistent intellectual and motor deficits during childhood and adulthood, despite initiation of T(4) supplementation at a median age of 28 d after birth. OBJECTIVE: The present study examined whether advancement of treatment initiation to 20 d had resulted in improved cognitive and motor outcome. DESIGN/SETTING/PATIENTS: In 82 Dutch CH-T patients, born in 1992 to 1993 and treated at a median age of 20 d (mean, 22 d; range, 2-73 d), cognitive and motor outcome was assessed (mean age, 10.5 yr; range, 9.6-11.4 yr). Severity of CH-T was classified according to pretreatment free T(4) concentration. MAIN OUTCOME MEASURE: Cognitive and motor outcome of the 1992-1993 cohort in comparison to the 1981 to 1982 cohort was the main outcome measure. RESULTS: Patients with severe CH-T had lower full-scale (93.7), verbal (94.9), and performance (93.9) IQ scores than the normative population (P < 0.05), whereas IQ scores of patients with moderate and mild CH-T were comparable to those of the normative population. In all three severity subgroups, significant motor problems were observed, most pronounced in the severe CH-T group. No correlations were found between starting day of treatment and IQ or motor outcome. CONCLUSIONS: Essentially, findings from the 1992-1993 cohort were similar to those of the 1981-1982 cohort. Apparently, advancing initiation of T(4) supplementation from 28 to 20 d after birth did not result in improved cognitive or motor outcome in CH-T patients

Evaluation and Modification of a Radioimmunoassay for Pregnancy-specific β1-Glycoprotein

Peer Reviewe

A Time-Resolved Fluoroimmuno Assay of the IgM-Rheumatoid Factor

Peer Reviewe

Temperature-responsive release of thyroxine and its environmental adaptation in Australians

The hormone thyroxine that regulates mammalian metabolism is carried and stored in the blood by thyroxine-binding globulin (TBG). We demonstrate here that the release of thyroxine from TBG occurs by a temperature-sensitive mechanism and show how this will provide a homoeostatic adjustment of the concentration of thyroxine to match metabolic needs, as with the hypothermia and torpor of small animals. In humans, a rise in temperature, as in infections, will trigger an accelerated release of thyroxine, resulting in a predictable 23% increase in the concentration of free thyroxine at 39°C. The in vivo relevance of this fever-response is affirmed in an environmental adaptation in aboriginal Australians. We show how two mutations incorporated in their TBG interact in a way that will halve the surge in thyroxine release, and hence the boost in metabolic rate that would otherwise occur as body temperatures exceed 37°C. The overall findings open insights into physiological changes that accompany variations in body temperature, as notably in fevers

A novel time resolved fluorometric assay of anoikis using Europium-labelled Annexin V in cultured adherent cells

Background: Adherent cells undergo apoptosis when detached from their home ground, a process called anoikis (homelessness).\ud Methods: We developed a new and sensitive method to analyse apoptosis and anoikis of adherent cell types using a time resolved fluorometric assay with Europium-labelled Annexin V. Anoikis was induced with tumor necrosis factor-agr /cycloheximide and three cell fractions of the cell cultures were prepared and analysed. Fraction 1 consisted of adherent cells, analysed while growing on their support (without detachment by trypsinisation). Fraction 2 contained detached cells due to anoikis (floating cells) and fraction 3 contained apoptotic bodies. Both fractions 2 and 3 were present in the culture medium and were isolated by differential centrifugation.\ud Results: TNF-agr treatment of three different types of adherent cell cultures induced a significant increase of the amount of floating cells (anoikis) and apoptotic bodies compared to control cell cultures. Also in the adherent cell fractions a small amount of apoptosis was observed.\ud Conclusions: The novel time resolved assay provides the ability to analyse the cell death cascade in adherent cell cultures of the same sample at the same time in a sensitive and reproducible way

Prevalence and side effects of pediatric home tube feeding

Tube feeding ensures growth, but can have negative effects on health and psychosocial functioning, resulting in health related costs. The aims of this study were to determine the prevalence of pediatric home tube feeding in the Netherlands and to assess the clinical characteristics of tube fed children and side effects of tube feeding. The prevalence of pediatric home tube feeding was calculated using data (2010-2014) of both the Medicines and Devices Information Project of the National Health Care Institute, and Statistics Netherlands. Subsequently, a cross-sectional parental online questionnaire was used to obtain data regarding clinical characteristics of tube fed children and side effects of tube feeding. Children aged ≤17 years receiving tube feeding ≥2 weeks were included. The prevalence of pediatric home tube feeding was 83-92:100,000 children/year. Parents of 279 children (53% boys) completed the questionnaire. Most children (88%) had ≥1 medical diagnosis, of which congenital abnormalities (42%), perinatal problems (38%) and neurologic diseases (16%) were most common. They had gastrostomy (60%), nasogastric (33%), or other tube types (7%). Parents of most children (74%) mentioned ≥1 side effect due to tube feeding. Vomiting (37%), lack of appetite (29%), and gagging (29%) were reported most frequently. Nasogastric tube placement resolved in negative experiences (94%). The prevalence of pediatric home tube feeding varies between 83 and 92:100,000 children/year in the Netherlands. These children are characterized by various underlying medical diagnoses. Side effects of tube feeding are frequently reported by parents. Further studies should focus on methods reducing side effect