A hinged external fixator for complex elbow dislocations: A multicenter prospective cohort study

Background: Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures of the radial head, olecranon, or coronoid process. The majority of patients with these complex dislocations are treated with open reduction and internal fixation (ORIF), or arthroplasty in case of a non-reconstructable radial head fracture. If the elbow joint remains unstable after fracture fixation, a hinged elbow fixator can be applied. The fixator provides stability to the elbow joint, and allows for early mobilization. The latter may be important for preventing stiffness of the joint. The aim of this study is to determine the effect of early mobilization with a hinged external elbow fixator on clinical outcome in patients with complex elbow dislocations with residual instability following fracture fixation. Methods/Design. The design of the study will be a multicenter prospective cohort study of 30 patients who have sustained a complex elbow dislocation and are treated with a hinged elbow fixator following fracture fixation because of residual instability. Early active motion exercises within the limits of pain will be started immediately after surgery under supervision of a physical therapist. Outcome will be evaluated at regular intervals over the subsequent 12 months. The primary outcome is the Quick Disabilities of the Arm, Shoulder, and Hand score. The secondary outcome measures are the Mayo Elbow Performance Index, Oxford Elbow Score, pain level at both sides, range of motion of the elbow joint at both sides, radiographic healing of the fractures and formation of periarticular ossifications, rate of secondary interventions and complications, and health-related quality of life (Short-Form 36). Discussion. The outcome of this study will yield quantitative data on the functional outcome in patients with a complex elbow dislocation and who are treated with ORIF and additional stabilization with a hinged elbow fixator. Trial Registration. The trial is registered at the Netherlands Trial Register (NTR1996)

Functional treatment versus plaster for simple elbow dislocations (FuncSiE): a randomized trial

Background. Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures. After reduction of a simple dislocation, treatment options include immobilization in a static plaster for different periods of time or so-called functional treatment. Functional treatment is characterized by early active motion within the limits of pain with or without the use of a sling or hinged brace. Theoretically, functional treatment should prevent stiffness without introducing increased joint instability. The primary aim of this randomized controlled trial is to compare early functional treatment versus plaster immobilization following simple dislocations of the elbow. Methods/Design. The design of the study will be a multicenter randomized controlled trial of 100 patients who have sustained a simple elbow dislocation. After reduction of the dislocation, patients are randomized between a pressure bandage for 5-7 days and early functional treatment or a plaster in 90 degrees flexion, neutral position for pro-supination for a period of three weeks. In the functional group, treatment is started with early active motion within the limits of pain. Function, pain, and radiographic recovery will be evaluated at regular intervals over the subsequent 12 months. The primary outcome measure is the Quick Disabilities of the Arm, Shoulder, and Hand score. The secondary outcome measures are the Mayo Elbow Performance Index, Oxford elbow score, pain level at both sides, range of motion of the elbow joint at both sides, rate of secondary interventions and complication rates in both groups (secondary dislocation, instability, relaxation), health-related quality of life (Short-Form 36 and EuroQol-5D), radiographic appearance of the elbow joint (degenerative changes and heterotopic ossifications), costs, and cost-effectiveness. Discussion. The successful completion of this trial will provide evidence on the effectiveness of a functional treatment for the management of simple elbow dislocations. Trial Registration. The trial is registered at the Netherlands Trial Register (NTR2025)

The activation of the adaptive immune system: Cross-talk between antigen-presenting cells, T cells and B cells

The adaptive immune system consists of T and B cells that express clonally distributed antigen receptors. To achieve functional adaptive immune responses, antigen-specific T cell populations are stimulated by professional antigen-presenting cells like dendritic cells (DCs), which provide crucial stimulatory signals for efficient expansion and development of effector functions. Antigen-specific B cells receive costimulatory signals from helper T cells to stimulate affinity maturation and isotype switching. Here we elaborate on the interactions between DCs, T cells and B cells, and on the important signals for efficient induction of adaptive immune responses. (C) 2014 Elsevier B.V. All rights reserved

Optimization of Liposomes for Antigen Targeting to Splenic CD169+ Macrophages

Despite promising progress in cancer vaccination, therapeutic effectiveness is often insufficient. Cancer vaccine effectiveness could be enhanced by targeting vaccine antigens to antigen-presenting cells, thereby increasing T-cell activation. CD169-expressing splenic macrophages efficiently capture particulate antigens from the blood and transfer these antigens to dendritic cells for the activation of CD8+ T cells. In this study, we incorporated a physiological ligand for CD169, the ganglioside GM3, into liposomes to enhance liposome uptake by CD169+ macrophages. We assessed how variation in the amount of GM3, surface-attached PEG and liposomal size affected the binding to, and uptake by, CD169+ macrophages in vitro and in vivo. As a proof of concept, we prepared GM3-targeted liposomes containing a long synthetic ovalbumin peptide and tested the capacity of these liposomes to induce CD8+ and CD4+ T-cell responses compared to control liposomes or soluble peptide. The data indicate that the delivery of liposomes to splenic CD169+ macrophages can be optimized by the selection of liposomal constituents and liposomal size. Moreover, optimized GM3-mediated liposomal targeting to CD169+ macrophages induces potent immune responses and therefore presents as an interesting delivery strategy for cancer vaccination

Reliability of environmental information: analysis of a nitrogen-chain

This report discusses the reliability of environmental indicators obtained from calculations, used by RIVM in the composition of reports on the state of the environment. The considered calculation chain (for the Netherlands) starts at the emission of nitrogen compounds in 1992 and ends with forecasts of the nitrate concentration in untreated water in 2100. To this end the notion of reliability is specified in terms of a reliability factor and a confidence interval. The structure of the chain is depicted with flow diagrams. It is composed of measurement data, registration data, model operations and GIS operations. The primary data with respect to the nitrogen load are obtained from sources outside RIVM. They are based on registrated data, for example agricultural surveys. For the nitrogen emissions a reliability was postulated. The applied RIVM models are respectively OPS (atmospheric transport), DEADM (atmospheric deposition), NLOAD (nitrate leaching from agricultural soils), BOSMODEL (nitrate leaching from forest soils and heathland) and FLOPZ1 (groundwater streamlines and residence times). The measurement data are obtained from the National Monitoring Networks for Air Quality (LML, wind velocities and NOy concentrations) and Groundwater Quality (LMG, nitrate concentration in deep groundwater). Applying uncertainty analyses on models and using statistical techniques, uncertainties in the various indicators are determined, where uncertainties are propagated through the chain. The reliability of the indicators, as reported for 1992, is calculated on the basis of the resulting uncertainties. Most of the calculations are performed on three different scales, 5 x 5 km blocks, Acidification Areas (20 areas in the Netherlands) and on national scale. The reliability of nitrate concentration in untreated water is assessed for two different drinking water stations. Results of the project are presented in the form of tables and graphics, such as histograms and geographical plots of indicators and reliability factors. Table 7.1 on page 73 summarizes the reliability of the investigated indicators. A subsequent goal of this report is to contribute to a (discussion about a) generally applicable method to determine the reliability in the calculation of environmental indicators.Dit rapport behandelt de betrouwbaarheid van milieu-indicatoren van een van de berekeningsketens, die door het RIVM gehanteerd worden bij het opstellen van de milieubalans en milieuverkenningen (MB/MV). Het betreft de keten (voor Nederland) van stikstof-emissies in 1992 tot de nitraat-concentratie in ruw water in 2100. Hiertoe wordt het begrip betrouwbaarheid gespecificeerd in termen van een betrouwbaarheidsfactor en een betrouwbaarheidsinterval. De behandelde keten, door middel van stroomdiagrammen in kaart gebracht, is opgebouwd uit metingen, registraties, modelberekeningen en GIS-operaties. De primaire gegevens m.b.t. de stikstofbelasting zijn afkomstig van bronnen buiten het RIVM. Ze zijn gebaseerd op registraties, zoals bijvoorbeeld de landbouwtellingen. Voor de stikstofbelasting is een betrouwbaarheid gepostuleerd. De toegepaste RIVM modellen zijn respectievelijk OPS (atmosferisch transport), DEADM (atmosferische depositie), NLOAD (nitraat-uitspoeling vanaf bouw- en weilanden), BOSMODEL (nitraat-uitspoeling vanaf bos- en heidegrond) en FLOPZ1 (grondwater- stroombanen en verblijftijden). Meetnet-data zijn afkomstig van de Landelijke Meetnetten Luchtkwaliteit (LML, windsnelheden en NOy concentraties) en Grondwaterkwaliteit (LMG, nitraat-concentratie in het diepe grondwater). Door toepassing van onzekerheidsanalyses op modellen en met behulp van statistische methoden worden de onzekerheden in de diverse indicatoren bepaald, waarbij onzekerheden zich door de keten heen voortplanten. Op basis van deze gegevens wordt de betrouwbaarheid van de voor 1992 gerapporteerde milieu-indicatoren vastgesteld. Bij de berekeningen wordt veelal een ruimtelijke schaal van 5 x 5 km gehanteerd. Daarnaast worden ook de betrouwbaarheden voor verzurings-gebieden en voor geheel Nederland gegeven. Voor de nitraat-concentratie in ruw water wordt de betrouwbaarheid bepaald voor twee winputten in Nederland. De resultaten van het onderzoek worden gepresenteerd in de vorm van tabellen en figuren, waaronder histogrammen en geografische weergaves van de indicatoren en de betrouwbaarheidsfactoren. Tabel 7.1 op bladzijde 73 geeft een overzicht van de betrouwbaarheid van de in dit rapport onderzochte indicatoren. Dit rapport heeft mede tot doel een aanzet te geven tot een (discussie over een) algemeen bruikbare methodiek voor het bepalen van de betrouwbaarheid in de berekeningen van milieu-indicatoren