Prehospitale triage bij traumapatiënten

The prehospital trauma triage system consisting of regional ambulance services and overarching availability of mobile medical teams, the level criteria for trauma centres and in-hospital care for trauma patients are well-organised in the Netherlands.- However, the quality of prehospital triage in the Netherlands is inadequate at the moment, with an average under-triage rate of more than 30%. There is, thus, much room for improvement in the quality of prehospital triage.- Research in this area is now taking off, partly because of the arrival of a new quality indicator from the Netherlands National Health Care Institute, which states that at least 90% of multiple-trauma patients should be primarily taken to a level 1 trauma centre

Thermoelectric properties of Ba8Ga16Ge30 with TiO2 nanoinclusions

The effects on thermal and electrical properties of adding small amounts of TiO2 nanoinclusions to bulk Ba8Ga16Ge30 clathrate have been investigated. The thermal properties were analysed using the transient plane source technique and the analysis showed a significant decrease in thermal conductivity as the volume fraction of TiO2 increased from 0 vol. % to 1.2 vol. %. The introduction of TiO2 nanoparticles caused a shift in the peak value of the Seebeck coefficient towards lower temperatures. The maximum value of the Seebeck coefficient was, however, only little affected. The introduction of TiO2 nanoparticles into the bulk Ba8Ga16Ge30 resulted in an increased electrical resistivity of the sample, thus simultaneously reducing the charge carrier contribution to the thermal conductivity, partly explaining the decrease in total thermal conductivity. Due to the large increase in resistivity of the samples, ZT was only somewhat improved for the material with 0.4 vol. % TiO2 while the ZT values of the other materials were lower than for the reference Ba8Ga16Ge30 material without TiO2 nanoparticles. The combined results are consistent with a scenario where the nanoparticle introduction causes a light doping of the semiconductor matrix and an increased concentration of phonon scattering centres

Subfractions of enamel matrix derivative differentially influence cytokine secretion from human oral fibroblasts.

Enamel matrix derivative is used to promote periodontal regeneration during the corrective phase of the treatment of periodontal defects. Our main goal was to analyze the bioactivity of different molecular weight fractions of enamel matrix derivative. Enamel matrix derivative, a complex mixture of proteins, was separated into 13 fractions using size-exclusion chromatography and characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and liquid chromatography-electrospray ionization-tandem mass spectrometry. Human periodontal ligament fibroblasts were treated with either enamel matrix derivative or the different fractions. Proliferation and cytokine secretion to the cell culture medium were measured and compared to untreated cells. The liquid chromatography-electrospray ionization-tandem mass spectrometry analyses revealed that the most abundant peptides were amelogenin and leucine-rich amelogenin peptide related. The fractions containing proteins above 20 kDa induced an increase in vascular endothelial growth factor and interleukin-6 secretion, whereas lower molecular weight fractions enhanced proliferation and secretion of interleukin-8 and monocyte chemoattractant protein-1 and reduced interleukin-4 release. The various molecular components in the enamel matrix derivative formulation might contribute to reported effects on tissue regeneration through their influence on vascularization, the immune response, and chemotaxis

Are practical recommendations practiced? A national multi-centre cross-sectional study on frequency of visual field testing in glaucoma

Aim: To estimate current clinical practice for frequency of visual field (VF) monitoring in glaucoma in England. Methods: A cross-sectional review of all patients with chronic open angle glaucoma (COAG) attending specialist glaucoma clinics at six hospitals in England was performed. The number of VF tests undertaken prior to the study date and during the first 2 years since diagnosis were recorded and compared with European Glaucoma Society (EGS) guidelines for newly-diagnosed patients. Clinician-requested monitoring intervals were compared with intervals from the National Institute of Clinical Excellence (NICE) guidelines, and the relationships with disease severity, intraocular pressure (IOP) and glaucoma progression status were reviewed. Results: One-hundred and four patients with COAG were included. 73 patients had at least 2 years of follow-up. Median (IQR) total number of VF tests and in the first 2 years of diagnosis were 4 (2–7) and 2 (2–3), respectively. No patients met EGS guidelines, but 87% of patients had their monitoring intervals requested in accordance with NICE guidelines. These intervals were not related to disease severity or VF stability (Kruskal–Wallis test, p=0.25) but shortened significantly when IOP control was inadequate or when the overall clinical impression was disease progression (p<0.001). Conclusions Most newly-diagnosed COAG patients receive less than three VFs in the first 2 years following diagnosis and an average of 0.7 VF per year over the duration of follow-up

New insights into measurement variability in glaucomatous visual fields from computer modelling.

To develop a model to simulate visual fields (VFs) in glaucoma patients, and to characterize variability of the Mean Deviation (MD) VF summary measurement using real VFs and simulations

Long-term follow-up of patients with ANCA-associated vasculitis

This thesis is based on long-term follow-up results from two cohorts of patients with ANCA-associated vasculitis; one cohort with 535 patients originally included in 4 European randomized clinical trials (papers I and II) and one Swedish population-based cohort including 195 patients (papers III and IV). Two areas are covered in the two cohorts, respectively; the assessment of mortality, prognostic factors and causes of death in the two cohorts (paper I and III) and the assessment of malignancy risk compared with a matched general population (papers II and IV).ResultsPaper I: 1-, 2-, and 5-year survival was 88%, 85% and 78%. Predictors of death were age, gender, kidney function and disease activity at presentation. Main causes of death were active vasculitis and infection during the first year, and after the first year, malignancy and cardiovascular disease. Paper II: Higher risk for malignancy at all sites and non-melanoma skin cancer. Paper III: 1-, 2-, 5-, and 10-year survival was 87%, 82%, 70% and 55%, respectively. Predictors of death were age, gender, kidney function and organ involvement at diagnosis. Main causes of death were active vasculitis and infection during the first year, and after the first year, malignancy and cardiovascular disease. Paper IV: Higher risk for malignancy at all sites, non-melanoma skin cancer, bladder cancer and pancreatic cancer.Conclusions: The mortality and malignancy risks in patients treated for AAV with current treatment protocols are higher than in the general population. However, the mortality in the group of patients with AAV without gastrointestinal, cardiovascular, or renal involvement at presentation is not significantly increased compared with the general population

Therapeutic approaches to gastroesophageal junction adenocarcinomas

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108681/1/nyas12532.pd

Predictive genetic testing in minors for Myocilin juvenile onset open angle glaucoma

Author manuscript made available following 12 month embargo from date of publication (28 Jan 2015) in accordance with publisher copyright policy.Myocilin glaucoma is an autosomal dominant disorder leading to irreversible blindness, but early intervention can minimize vision loss and delay disease progression. The purpose of this study was to discuss the benefits of predictive genetic testing in minors for Myocilin mutations associated with childhood onset glaucoma. Three families with Myocilin mutations associated with an age of onset before 18 years and six unaffected at-risk children were identified. Predictive genetic testing was discussed with the parents and offered for at-risk minors. Parents opted for genetic testing in half of the cases. None carried the familial mutation. The age of disease onset in the family, the severity of the condition, and the age of the child are all factors that appear to influence the decision of the parent to test their children. Predictive genetic testing for early onset Myocilin glaucoma can facilitate early detection of disease or discharge from routine ophthalmic examinations

Operative Treatment of Intra-Articular Distal Radius Fractures With versus Without Arthroscopy

__Background:__ In the past several years, an increase in open reduction and internal fixation (ORIF) for intra-articular distal radius fractures has been observed. This technique leads to a quicker recovery of function compared to non-operative treatment. However, some patients continue to have a painful and stiff wrist postoperatively. Arthroscopically assisted removal of intra-articular fracture haematoma and debris may improve the functional outcomes following operative treatment of intra-articular distal radius fractures. The purpose of this randomised controlled trial is to determine the difference in functional outcome, assessed with the Patient-Rated Wrist Evaluation (PRWE) score, after ORIF with and without an additional wrist arthroscopy in adult patients with displaced complete articular distal radius fractures. __Methods:__ In this multicentre trial, adult patients with a displaced complete articular distal radius fracture are randomised between ORIF with an additional wrist arthroscopy to remove fracture haematoma and debris (intervention group) and conventional fluoroscopic-assisted ORIF (control group). The primary outcome is functional outcome assessed with the PRWE score after three months. Secondary outcomes are wrist function assessed with the Disability of the Arm, Shoulder and Hand (DASH) score, postoperative pain, range of motion, grip strength, complications and cost-effectiveness. Additionally, in the intervention group, the quality of reduction, associated ligamentous injuries and cartilage damage will be assessed. A total of 50 patients will be included in this study. __Discussion:___ Although ORIF of intra-articular distal radi

Diurnal IOP fluctuation: not an independent risk factor for glaucomatous visual field loss in high-risk ocular hypertension.

Purpose: To establish whether intraocular pressure (IOP) fluctuations contribute to the risk of developing glaucoma in patients with high-risk ocular hypertension. Methods: Ninety patients included in the Malmo Ocular Hypertension Study were examined every 3 months with office-hours diurnal tension curves and computerised perimetry. Patients were followed up prospectively for 10 years or until glaucomatous visual field loss could be demonstrated. Poststudy data were included in the analyses, extending maximum follow-up to 17 years. Results: After 17 years, 37 patients had developed glaucomatous visual field defects. When applying univariate Cox regression analyses, mean IOP of all measurements during the prospective part of the study was a significant risk factor for developing glaucoma (95% confidence interval [CI] 1.08 - 1.39), while IOP fluctuations were almost significant ( 95% CI 0.98 - 1.93). When separating effects of mean IOP level and mean IOP fluctuation using Cox multiple regression analysis, only IOP level came out as significant ( 95% CI 1.09 - 1.38), and IOP fluctuations did not contribute to the risk ( 95% CI 0.80 - 1.60). IOP fluctuation depended linearly on IOP level ( p< 0.0001), i.e. IOP fluctuation was larger in eyes with higher IOP levels. Conclusion: IOP fluctuations were not an independent risk factor for the incidence of glaucomatous visual field loss in subjects with ocular hypertension