Prediction of disease progression, treatment response and dropout in chronic obstructive pulmonary disease (COPD).

Drug development in chronic obstructive pulmonary disease (COPD) has been characterised by unacceptably high failure rates. In addition to the poor sensitivity in forced expiratory volume in one second (FEV1), numerous causes are known to contribute to this phenomenon, which can be clustered into drug-, disease- and design-related factors. Here we present a model-based approach to describe disease progression, treatment response and dropout in clinical trials with COPD patients

Zoonotic Diseases Report 2013

De Staat van zoönosen 2013 geeft een overzicht van de mate waarin zoönosen in Nederland voorkomen en ontwikkelingen daarin op de lange termijn. Zoönosen zijn infectieziekten die van dier op mens overgaan. Net als in voorgaande jaren waren er in 2013 geen uitgesproken veranderingen te zien in de mate waarin zoönosen in Nederland voorkomen. Zoals ieder jaar deden zich ook in 2013 enkele opmerkelijke voorvallen voor, zoals een geval van hazenpest. In deze jaarlijkse uitgave van het RIVM en de NVWA is het thema 'huis-, tuin- en keukenzoönosen': zoönosen die mensen kunnen oplopen in en om het huis. Opmerkelijke voorvallen Bij een haas afkomstig uit Noord-Limburg werd in mei 2013 hazenpest (tularemie) vastgesteld. Vervolgens werd ook bij een jongeman tularemie vastgesteld, die de infectie waarschijnlijk via een dazenbeet in een natuurgebied in Limburg had opgelopen. In 2011 is er mogelijk ook een in Nederland opgelopen geval van tularemie geweest, terwijl in de jaren daarvoor alleen sporadisch gevallen gemeld werden die in het buitenland waren opgelopen. Een andere opmerkelijke gebeurtenis betrof een uitbraak van Campylobacter onder bezoekers van een pluimveeslachthuis die waarschijnlijk via de lucht aan de ziekteverwekker waren blootgesteld. Negen mensen werden ziek. Ook blijkt uit een onderzoek naar de vossenlintworm (Echinococcus multilocularis) onder vossen en honden, dat deze lintworm bij vossen in Zuid-Limburg veel vaker voorkomt dan in voorgaande jaren. Thema: huis-, tuin- en keukenzoönosen Juist in en om het huis kunnen mensen worden blootgesteld aan allerlei zoönoseverwekkers. Duizenden mensen krijgen jaarlijks via hun huisdieren ringworm, een schimmelinfectie. Ook kunnen zoönosen afkomstig zijn van huisdieren of dieren die hun behoefte doen in de tuin. Verder komen voedselgerelateerde zoönosen aan de orde, waarbij aandacht is voor het feit dat zoönosen ook via groenten kunnen worden opgelopen.The Zoonotic Diseases Report is an annual publication of the Dutch National Institute for Public Health and the Environment (RIVM) and the Netherlands Food and Consumer Product Safety Authority (NVWA). The report provides an overview of the incidence of zoonotic diseases in the Netherlands, as well as the associated long-term trends. Zoonotic diseases or zoonoses are infectious diseases that can be transmitted from animals to humans. As in previous years, no marked changes were observed in 2013 in the incidence of zoonotic diseases in the Netherlands. Every year a number of notable incidents occurres. In 2013 this included a case of rabbit fever (tularemia). This year's edition of the Zoonotic Diseases Report focuses in particular on 'zoonoses close to home', i.e. the risk of contracting a zoonotic disease in or around the house. Notable incidents In May 2013, rabbit fever (tularemia) was discovered in a hare originating from the north of the province of Limburg. Tularemia was later also diagnosed in a young man, who had probably contracted the infection after having been bitten by a horse fly in a nature reserve in Limburg. Another person possibly contracted tularemia in the Netherlands in 2011. In previous years only incidental cases were reported, with the disease being contracted abroad. Another notable incident concerned an outbreak of Campylobacter infection among visitors to a poultry slaughterhouse who had probably been exposed to airborne pathogens. Nine people fell ill as a result of this outbreak. An investigation into the incidence of Echinococcus multilocularis in foxes and dogs showed that this tapeworm was much more common in foxes in the south of Limburg province than in previous years. 'Zoonoses close to home' Humans can be exposed to various zoonotic disease pathogens in or around the house. Every year, thousands of people contract dermatophytosis (a fungal infection commonly known in the Netherlands as 'ringworm') from their pets. Zoonotic diseases can also be contracted from pets or from animals defecating in the garden. The report also devotes attention to food-related zoonotic diseases, with a particular focus on the risk of contracting zoonoses through the consumption or handling of vegetables.NVW

Features of the popliteal lymph nodes seen on musculoskeletal MRI in a Western population

To asses the features and explore the clinical relevance of popliteal lymph nodes (PLNs) detected on MRI examination for different pathologies of the knee. A total of 150 knee MRIs, which were conducted for various indications, were retrospectively collected from the Picture Archiving and Communication System. Imaging planes in at least two orthogonal planes were mandatory, with a field of view extending 15 cm cranial from the joint space. The localization of the PLN was determined by measuring the distance of the lowest border of the PLN to the lowest border of the lateral femoral condyle. Clinical diagnosis was obtained from radiology reports and a statistician performed the statistical analysis. The patients were 70 males [mean age 36.6 years (range: 5-72 years)] and 80 females [mean age 41.1 years (range: 9-76 years)]. In 36.7% of the patients, a PLN was visible. The number of PLNs was negatively associated with age (p < 0.001). The mean number of PLNs was 0.5 PLN per patient. The mean length, height, and width were respectively: 0.57 cm (SD = 0.15), 0.84 cm (SD = 0.26), and 0.71 cm (SD = 0.23). The mean location was 5.8 cm (SD = 1.61). No association was found between the presence of PLNs and internal derangement, inflammation, or cancer (p = 0.368). PLNs appearance is age related, with a higher frequency at a young age. The presence of the PLNs showed no relation to a specific clinical situatio

Het Rijksvaccinatieprogramma in Nederland. Ontwikkelingen in 2006

In 2006 several changes were made in the Dutch National Immunisation Programme (NIP): Hepatitis B vaccination at birth was added for children born to mothers positive for hepatitis B surface antigen; a new vaccine for diphtheria, tetanus, pertussis (a-cellular), poliomyelitis and Haemophilus influenzae (DTaP-IPV/Hib) was introduced; vaccination against pneumococcal disease was added at two, three, four and eleven months; risk groups for hepatitis B receive a combined vaccine for DTaP-IPV/Hib and HBV at the same ages; DT-IPV and aP at the age of four years were combined in one vaccine; and new MMR vaccines were introduced. As new information became available in 2006, the desirability to introduce vaccinations in the NIP for the following diseases could be (re)considered: hepatitis B (universal vaccination), rotavirus, varicella and human papillomavirus. For respiratory syncytial virus and meningococcal serogroup B disease no candidate vaccines are available yet. Extension of the programme with available vaccines for hepatitis A, influenza and tuberculosis is not (yet) recommended. The NIP in the Netherlands is effective and safe. However, continued monitoring of the effectiveness and safety of the NIP is important as changes are made regularly. Maintaining high vaccine uptake is vital to prevent (re)emergence of diseases. Furthermore, the programme should be regularly reviewed as new vaccines become available.In 2006 traden verschillende veranderingen op in het Rijksvaccinatieprogramma (RVP) in Nederland: kinderen die geboren worden uit moeders die chronisch geinfecteerd zijn met hepatitis B krijgen vlak na de geboorte een hepatitis B vaccinatie; er is een ander vaccin geintroduceerd voor difterie, kinkhoest (a-cellulair), tetanus, poliomyelitis en Haemophilus influenzae (DaKTP/Hib); vaccinatie tegen pneumokokken is toegevoegd op de leeftijd van 2, drie, vier en elf maanden; risicogroepen voor hepatitis B krijgen op diezelfde leeftijden een combinatievaccin voor DaKTP/Hib en hepatitis B; DTP en aK zijn gecombineerd in een vaccin op vierjarige leeftijd; en er zijn nieuwe BMR vaccins geintroduceerd. Op basis van informatie die in 2006 beschikbaar is gekomen wordt geadviseerd de introductie van vaccinaties voor de volgende ziekten te overwegen: hepatitis B (universele vaccinatie), rotavirus, waterpokken en humaan papillomavirus. Voor respiratoir syncytieel virus en meningokokken B zijn nog geen kandidaatvaccins beschikbaar en uitbreiding van het RVP met beschikbare vaccins voor hepatitis A, influenza en tuberculose wordt nog niet aanbevolen. Het RVP is effectief en veilig, maar voortdurende bewaking hiervan is groot belang, omdat er regelmatig veranderingen optreden. Handhaven van de hoge vaccinatiegraad is essentieel om terugkeer van ziekten te voorkomen. Verder moet regelmatig bekeken worden of het RVP aangepast moet worden aangezien er steeds nieuwe vaccins beschikbaar komen

Why pharmacokinetic differences among oral triptans have little clinical importance: a comment

Triptans, selective 5-HT1B/1D receptor agonists, are specific drugs for the acute treatment of migraine that have the same mechanism of action. Here, it is discussed why the differences among kinetic parameters of oral triptans have proved not to be very important in clinical practice. There are three main reasons: (1) the differences among the kinetic parameters of oral triptans are smaller than what appears from their average values; (2) there is a large inter-subject, gender-dependent, and intra-subject (outside/during the attack) variability of kinetic parameters related to the rate and extent of absorption, i.e., those which are considered as critical for the response; (3) no dose-concentration–response curves have been defined and it is, therefore, impossible both to compare the kinetics of triptans, and to verify the objective importance of kinetic differences; (4) the importance of kinetic differences is outweighed by non-kinetic factors of variability of response to triptans. If no oral formulations are found that can allow more predictable pharmacokinetics, the same problems will probably also arise with new classes of drugs for the acute treatment of migraine