ViroSpot microneutralization assay for antigenic characterization of human influenza viruses

The hemagglutination inhibition (HI) assay has been used for the antigenic characterization of influenza viruses for decades. However, the majority of recent seasonal influenza A viruses of the H3N2 subtype has lost the capacity to agglutinate erythrocytes of various species. The hemagglutination (HA) activity of other A(H3N2) strains is generally sensitive to the action of the neuraminidase inhibitor oseltamivir, which indicates that the neuraminidase and not the hemagglutinin is responsible for the HA activity. These findings complicate the antigenic characterization and selection of A(H3N2) vaccine strains, calling for alternative antigenic characterization assays. Here we describe the development and use of the ViroSpot microneutralization (MN) assay as a reliable and robust alternative for the HI assay. Serum neutralization of influenza A(H3N2) reference virus strains and epidemic isolates was determined by automated readout of immunostained cell monolayers, in a format designed to minimize the influence of infectious virus doses on serum neutralization titers. Neutralization of infection was largely independent from rates of viral replication and cell-to-cell transmission, facilitating the comparison of different virus isolates. Other advantages of the ViroSpot MN assay include its relative insensitivity to variation in test dose of infectious virus, automated capture and analyses of residual infection patterns, and compatibility with standardized large scale analyses. Using this assay, a number of epidemic influenza A(H3N2) strains that failed to agglutinate erythrocytes, were readily characterized antigenically

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

In patients undergoing fast track total knee arthroplasty, addition of buprenorphine to a femoral nerve block has no clinical advantage A prospective, double-blinded, randomized, placebo controlled trial

Background: Several adjuvants have been proposed to prolong the effect of peripheral nerve blocks, one of which is buprenorphine. In this randomized double blinded placebo controlled trial we studied whether the addition of buprenorphine to a femoral nerve block prolongs analgesia in patients undergoing total knee arthroplasty in a fast track surgery protocol. Methods: The treatment group (B) was given an ultrasound-guided femoral nerve block with ropivacaine 0.2% and 0.3mg buprenorphine. We choose to use 2 control groups. Group R was given a femoral nerve block with ropivacaine 0.2% only. Group S also received 0.3mg buprenorphine subcutaneously. Only patients with a successful block were enrolled in the study. Results: We found no difference in our primary outcome parameter of time to first rescue analgesic. We found lower opioid use and better sleep quality the first postoperative night in patients receiving buprenorphine perineurally or subcutaneously. Buprenorphine did not lead to any significant change in pain or mobilization. We found a high overall incidence of nausea and vomiting. Conclusion: In patients undergoing total knee arthroplasty, in the setting of a fast track surgery protocol, the addition of buprenorphine to a femoral nerve block did not prolong analgesi

Naamlijst en verspreidingsgegevens van de Nederlandse bramen (Rubus L. subgenus Rubus)

In Noordwest-Europa is de taxonomie van bramen (Rubus L. subgenus Rubus) goed op orde en de verspreiding van bramen in de verschillende landen goed bekend dankzij herbarium- en veldonderzoek vanaf de jaren 1970. De meeste soorten zijn gestabileerde apomicten die zonder bevruchting zaad vormen. De nakomelingen van een zich apomictisch voortplantende braam zijn hierdoor genetisch gelijk aan de moederplant. In Nederland dateert onderzoek aan bramen pas van na 1900 met een actieve periode na de Tweede Wereldoorlog. Dit resulteerde in 1956 in de Rubi Neerlandici door W. Beijerinck, een overzicht gebaseerd op de kunstmatig soortsopvatting van H. Sudre (Rubi Europae; 1908–1913). Het moderne, op typemateriaal en veldwerk gebaseerde onderzoek startte begin jaren 1970 en resulteerde in de decennia erna tot de herkenning en beschrijving van tal van nieuwe regionale soorten en nieuwe namen voor verkeerd geïnterpreteerde soorten. Door de meeste Europese bramendeskundigen wordt een soortsopvatting gehanteerd die inhoudt dat taxa met een areaaldiameter kleiner dan 50 km niet worden beschreven als soort. Deze opvatting wordt ook door ons gehanteerd. Op de naamlijst van Nederlandse bramen van het subgenus Rubus staan 191 soorten verdeeld over 4 secties: Rubus (Zwarte braam; ‘Rubus fruticosus agg.’; 147 soorten), Corylifolii Lindl. (Wasbraam; ‘Rubus corylifolius agg.’; 34 soorten), Caesii Lej. & Courtois (Dauwbraam; 2 soorten) en Subidaei (Focke) A.Beek (Purperbraam; 8 soorten). De laatste sectie omvat gestabiliseerde soorten met R. idaeus L. (Framboos) als voorouder. Nomenclatorische aspecten van de Nederlandse taxa en de beschrijving van enkele nieuwe wasbramen zijn in begeleidende artikelen ondergebracht. Alle taxa – secties, subsecties, series en soorten – zijn voorzien van Nederlandse namen. Aangezien areaalgrootte een belangrijke rol speelt in de taxonomie, is elke soort toegekend aan een areaalcategorie: W1 (zeer wijdverbreid; areaaldiameter >1500 km), W2 (wijdverbreid; idem 500–1500 km), R1 (bovenregionaal; idem 250–500 km) of R2 (regionaal; idem 50–250 km). Van de Nederlandse bramen hebben 97 soorten (51%) een regionale verspreiding; slechts 32 soorten (17%) zijn zeer wijdverbreid. Alle digitaal beschikbare verspreidingsgegevens van soorten uit het subgenus Rubus (excl. R. caesius L.) zijn samengebracht in een database, in totaal ruim 43.000 records waarvan 37.000 met een nauwkeurigheid op km-hokniveau of beter. Van alle soorten (excl. Rubus caesius) is de landelijke zeldzaamheid bepaald op grond van Rode Lijst-criteria. Bijna 80 soorten zijn landelijk zeer zeldzaam, 60 zeldzaam, 25 vrij zeldzaam en ongeveer 20 vrij algemeen of algemeen. Zeer algemene soorten ontbreken, wat niet alleen heeft te maken met het hoge aandeel regionale soorten, maar ook met het feit dat in de klei- en veengebieden zeer weinig bramen voorkomen. De regionale verspreiding wordt per soort gegeven als percentage van het aantal uurhokken per floradistrict. Hotspots van soortenrijkdom met meer dan 40 soorten per uurhok liggen in oude boslandschappen in het Rijk van Nijmegen, de Liemers, de Oude IJsselstreek en aangrenzende Veluwezoom en de omgeving van Winterswijk (Achterhoek), Epen-Vijlen (Zuid Limburg) en Oldenzaal (Twente). De regionale soorten dragen sterk bij aan de identiteit van de regio’s. De relatief grote landelijke soortenrijkdom met regionale hotspots onderstreept de ligging van ons land in het centrum van de (sub)atlantische bramendiversiteit in Europa. The taxonomy and distribution of brambles (Rubus L. subgenus Rubus) are well-known in northwestern Europe due to herbarium studies and extensive field work from the 1970s onwards. Most brambles are stabilized apomictic species that form fruits without prior fertilization. Therefore, offspring is genetically identical with the mother plant. In the Netherlands, the study of brambles did not start until 1900, with a relatively active period occuring after World War II. This resulted in the publication of Rubi Neerlandici by W. Beijerinck in 1956, an overview based on the artificial species circumscription of H. Sudre (Rubi Europae; 1908–1913). Modern research, based on the study of type material supplemented with field work began in the 1970s and lead to the recognition of several newly described regional species as well as new names for misapplied species. Most bramble experts in Europe agree on a species circumscription that includes a geographic constraint: taxa with a range less than 50 km in diameter are not described as species. We adhere to this view as well. The Dutch checklist of subgenus Rubus comprises 191 species in 4 sections: Rubus (‘Rubus fruticosus agg.’; 147 species), Corylifolii Lindl. (‘Rubus corylifolius agg.’; 34 species), Caesii Lej. & Courtois (2 species) and Subidaei (Focke) A.Beek (8 species). The latter section includes stabilized species with Rubus idaeus L. as an ancestor. Nomenclatural aspects of the Dutch taxa and the description of some new Corylifolii taxa are dealt with in accompanying papers. All taxa on the checklist are provided with Dutch names, including sections, subsections and series. Since range size is taxonomically important, this feature has been classified and assigned to each species as W1 (very widespread; range diameter >1500 km), W2 (widespread; 500–1500 km), R1 (supraregional; 250–500 km) or R2 (regional; 50–250 km). The Dutch checklist contains 97 regional species (51%); only 32 species (17%) are very widespread. All digitally available distribution data for species of Rubus subgenus Rubus (excluding Rubus caesius L.) have been merged into a database, currently comprising about 43,000 records, including 37,000 with an accuracy of one kilometer or better. National rarity of species (Rubus caesius excluded) has been coded according to Dutch Red List criteria based on the number of occupied 5×5 km-squares. Almost 80 species are nationally very rare, 60 rare, 25 rather rare and about 20 rather common or common. Very common species are absent from the section Rubus, which is not only caused by the large proportion of regional species, but also by the low frequency of brambles on clay and peat soils in the western and northern parts of the country. Regional occurrence is expressed as percentage occupied relative to the total number of 5×5 km-squares for each flora district. Hotspots of species richness with more than 40 species per 5×5 km-square occur in old woodland landscapes in physiogeographic gradients with sandy and loamy soils. The national species richness in a European context, the high numbers of regional species, and the occurrence of hotspots of bramble diversity emphasize the central position of the Netherlands within the (sub) atlantic range of brambles in Europe

The Effectiveness of Adductor Canal Block Compared to Femoral Nerve Block on Readiness for Discharge in Patients Undergoing Outpatient Anterior Cruciate Ligament Reconstruction: A Multi-Center Randomized Clinical Trial

This study evaluated the effect of adductor canal block (ACB) versus femoral nerve block (FNB) on readiness for discharge in patients undergoing outpatient anterior cruciate ligament (ACL) reconstruction. We hypothesized that ACB would provide sufficient pain relief while maintaining motor strength and safety, thus allowing for earlier discharge. This was a randomized, multi-center, superiority trial. From March 2014 to July 2017, patients undergoing ACL reconstruction were enrolled. The primary outcome was the difference in readiness for discharge, defined as Post-Anesthetic Discharge Scoring System score ≥ 9. Twenty-six patients were allocated to FNB and twenty-seven to ACB. No difference in readiness for discharge was found (FNB median 1.8 (95% CI 1.0 to 3.5) vs. ACB 2.9 (1.5 to 4.7) hours, p = 0.3). Motor blocks and (near) falls were more frequently reported in patients with FNB vs. ACB (20 (76.9%) vs. 1 (3.7%), p p = 0.023. However, less opioids were consumed in the post-anesthesia care unit for FNB (median 3 [0, 21] vs. 15 [12, 42.5] oral morphine milligram equivalents, p = 0.004) for ACB. Between patients with FNB or ACB, no difference concerning readiness for discharge was found. Despite a slight reduction in opioid consumption immediately after surgery, FNB demonstrates a less favorable safety profile compared to ACB, with more motor blocks and (near) falls

Optical pumping of metastable nh radicals into the paramagnetic ground state

Contains fulltext : 98909.pdf (publisher's version ) (Open Access

LOFIT (Lifestyle front Office For Integrating lifestyle medicine in the Treatment of patients): a novel care model towards community-based options for lifestyle change-study protocol

BACKGROUND: A healthy lifestyle is indispensable for the prevention of noncommunicable diseases. However, lifestyle medicine is hampered by time constraints and competing priorities of treating physicians. A dedicated lifestyle front office (LFO) in secondary/tertiary care may provide an important contribution to optimize patient-centred lifestyle care and connect to lifestyle initiatives from the community. The LOFIT study aims to gain insight into the (cost-)effectiveness of the LFO. METHODS: Two parallel pragmatic randomized controlled trials will be conducted for (cardio)vascular disorders (i.e. (at risk of) (cardio)vascular disease, diabetes) and musculoskeletal disorders (i.e. osteoarthritis, hip or knee prosthesis). Patients from three outpatient clinics in the Netherlands will be invited to participate in the study. Inclusion criteria are body mass index (BMI) ≥25 (kg/m 2) and/or smoking. Participants will be randomly allocated to either the intervention group or a usual care control group. In total, we aim to include 552 patients, 276 in each trial divided over both treatment arms. Patients allocated to the intervention group will participate in a face-to-face motivational interviewing (MI) coaching session with a so-called lifestyle broker. The patient will be supported and guided towards suitable community-based lifestyle initiatives. A network communication platform will be used to communicate between the lifestyle broker, patient, referred community-based lifestyle initiative and/or other relevant stakeholders (e.g. general practitioner). The primary outcome measure is the adapted Fuster-BEWAT, a composite health risk and lifestyle score consisting of resting systolic and diastolic blood pressure, objectively measured physical activity and sitting time, BMI, fruit and vegetable consumption and smoking behaviour. Secondary outcomes include cardiometabolic markers, anthropometrics, health behaviours, psychological factors, patient-reported outcome measures (PROMs), cost-effectiveness measures and a mixed-method process evaluation. Data collection will be conducted at baseline, 3, 6, 9 and 12 months follow-up. DISCUSSION: This study will gain insight into the (cost-)effectiveness of a novel care model in which patients under treatment in secondary or tertiary care are referred to community-based lifestyle initiatives to change their lifestyle. TRIAL REGISTRATION: ISRCTN ISRCTN13046877 . Registered 21 April 2022

Severe Fatigue in the First Year Following SARS-CoV-2 Infection: A Prospective Cohort Study

Background: Severe fatigue can persist for months after coronavirus disease 2019 (COVID-19) onset. This longitudinal study describes fatigue severity and its determinants up to 12 months after illness onset across the full spectrum of COVID-19 severity. Methods: RECoVERED, a prospective cohort study in Amsterdam, the Netherlands, enrolled participants aged≥16 years after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis. Fatigue was measured using the validated Short Fatigue Questionnaire (SFQ; range 4-28) at months 1, 3, 6, 9, and 12 of follow-up. Fatigue severity was modeled over time using mixed-effects linear regression. Determinants of severe fatigue (SFQ≥18) at 6 months since illness onset (ie, persistent fatigue) were identified using logistic regression. Results: Between May 2020 and July 2021, 303 participants completed at least 1 fatigue questionnaire. Twelve months after illness onset, 17.4% (95% CI, 6.7% to 38.3%), 21.6% (95% CI, 11.2% to 37.7%), and 44.8% (95% CI, 28.0% to 62.9%) of participants with mild, moderate, and severe/critical COVID-19 (World Health Organization definition), respectively, experienced severe fatigue. When adjusting for age and sex, having≥3 comorbidities (P=.007), severe/critical COVID-19 (P=.002), low mood (P<.001), and dyspnea in the first 2 weeks of illness (P=.001) were associated with more severe fatigue over time. Severe/critical COVID-19 (adjusted odds ratio [aOR], 3.37; 95% CI, 1.28 to 8.93) and low mood at enrollment (aOR, 2.43; 95% CI, 1.11 to 5.29) were associated with persistent fatigue. Recovery rarely occurred beyond 6 months after illness onset, regardless of COVID-19 severity. Conclusions: The occurrence of severe fatigue in our cohort was high, especially among those with initially severe/critical COVID-19, with little recovery beyond 6 months after illness onset. Our findings highlight an urgent need for improved understanding of persistent severe fatigue following COVID-19 to help inform prevention and intervention

LOFIT (Lifestyle front Office For Integrating lifestyle medicine in the Treatment of patients): a novel care model towards community-based options for lifestyle change—study protocol

A healthy lifestyle is indispensable for the prevention of noncommunicable diseases. However, lifestyle medicine is hampered by time constraints and competing priorities of treating physicians. A dedicated lifestyle front office (LFO) in secondary/tertiary care may provide an important contribution to optimize patient-centred lifestyle care and connect to lifestyle initiatives from the community. The LOFIT study aims to gain insight into the (cost-)effectiveness of the LFO