Structure and function of the digestive tract of the grasscarp

CONCLUSIONS1. The grasscarp is a stomachless teleost. The intestine does not contain multicellular glands.2. The relative length of the grasscarp intestine increases from 0,7 x body length in young larvae to 2 x body length in adults. The gut length is the only morphological characteristic to change when the grasscarp turns from carnivorous to herbivorous feeding.3. After feeding the grasscarp with vegetable food, the increase in gut length is higher than in fishes fed with animal food.4. Animal food stimulates rapid growth in the grasscarp, also after they are able to ingest plant material. Grasscarp may represent a serious threat to other species as a predator as well as a competitor for food.5. The intestine of the grasscarp shows a similar regional differentiation as found in other Cyprinids, with a proximo-distal gradient in alkaline phosphatase activity.6. The anterior gut segment is involved in the absorption of lipids and proteins (and probably also of sugars), which are absorbed in enterocytes after hydrolysis in the lumen. Also in regard to the morphological characteristics of lipid absorption, the epithelium shows resemblance with the epithelium in the small intestine of mammals.7. A "second gut segment", running from ± 60-85 % of gut length, is characterized by enterocytes with a high pinocytotic activity. These cells are capable of absorbing protein macromolecules like horseradish peroxidase and ferritin.8. Protein digestion is efficient despite the absence of a stomach. Quantitatively relevant amounts of protein are not absorbed by the "second segment".9. The "second segment" is not related to the lack of peptic activity in stomachless fishes, since it is also present in Clarias lazera after the stomach has developed and has become functionally active.10. The stomach of Clarias lazera contains only one type of corpus glandular cells with the morphological characteristics of chief- as well as parietal cells.11. The intestinal epithelium of the grasscarp represents a cell renewal system and is completely renewed within 10-15 days.12. In contrast to mammals the proliferative pool of cells consists of functional cells ingrasscarp larvae and juveniles and in Clarias lazera larvae

Towards clinical phenotyping of COPD : effects of inhaled corticosteroide in the GLUCOLD study

Patients with Chronic Obstructive Pulmonary Disease (COPD) have a lung disorder that limits daily activities and contributes considerably to physical limitations and emotional distress. Taking into account the large heterogeneity of the disease, it can be expected that specific subtypes of the disease (phenotypes) may benefit from a given treatment. This thesis is based on analyses from the Groningen Leiden Universities Corticosteroids in Obstructive Lung Disease (GLUCOLD) study. The effects of long-term maintenance therapy with inhaled corticosteroids with or without long-acting bronchodilators, and discontinuation were examined on 1) clinical parameters: symptoms, lung function decline, airway hyperreactivity and hyperinflation; and 2) pathological parameters: inflammatory cell counts in bronchial biopsies and induced sputum. The current thesis focused on health status, chronic bronchitis, long-term therapy with inhaled corticosteroids and specific phenotypes that benefit from treatment. By showing that certain subgroups of COPD such as patients with less advanced disease or a subphenotype with less emphysema can benefit from inhaled corticosteroids, our results may offer an indication for a promising perspective for particular, individual patients with COPD towards the potential of slowing down the progression of the disease in the future.Netherlands Organization for Scientific Research (NWO), Netherlands Asthma Foundation (NAF), GlaxoSmithKline (GSK NL), Leiden University Medical Center (LUMC), University Medical Center Groningen (UMCG)UBL - phd migration 201

MyAirCoach: The use of home-monitoring and mHealth systems to predict deterioration in asthma control and the occurrence of asthma exacerbations; Study protocol of an observational study

© Published by the BMJ Publishing Group Limited. Introduction Asthma is a variable lung condition whereby patients experience periods of controlled and uncontrolled asthma symptoms. Patients who experience prolonged periods of uncontrolled asthma have a higher incidence of exacerbations and increased morbidity and mortality rates. The ability to determine and to predict levels of asthma control and the occurrence of exacerbations is crucial in asthma management. Therefore, we aimed to determine to what extent physiological, behavioural and environmental data, obtained by mobile healthcare (mHealth) and home-monitoring sensors, as well as patient characteristics, can be used to predict episodes of uncontrolled asthma and the onset of asthma exacerbations. Methods and analysis In an 1-year observational study, patients will be provided with mHealth and home-monitoring systems to record daily measurements for the first-month (phase I) and weekly measurements during a follow-up period of 11 months (phase II). Our study population consists of 150 patients, aged ≥18 years, with a clinician's diagnosis of asthma, currently on controller medication, with uncontrolled asthma and/or minimally one exacerbation in the past 12 months. They will be enrolled over three participating centres, including Leiden, London and Manchester. Our main outcomes are the association between physiological, behavioural and environmental data and (1) the loss of asthma control and (2) the occurrence of asthma exacerbations. Ethics This study was approved by the Medical Ethics Committee of the Leiden University Medical Center in the Netherlands and by the NHS ethics service in the UK. Trial registration number NCT02774772

Perspectives of patients and healthcare professionals on mHealth for asthma self-management

Copyright ©ERS 2017. Mobile healthcare (mHealth) has the potential to revolutionise the self-management of long-term medical conditions such as asthma. A user-centred design is integral if mHealth is to be embraced by patients and healthcare professionals. The aim of this study was to determine the perspectives of individuals with asthma and healthcare professionals on the use of mHealth for asthma self-management. We used a sequential exploratory mixed methods design; focus groups informed the development of questionnaires, which were disseminated to individuals with asthma and healthcare professionals. Focus group participants (18 asthma patients and five healthcare professionals) identified 12 potential uses of mHealth. Questionnaire results showed that individuals with asthma (n=186) most frequently requested an mHealth system to monitor asthma over time (72%) and to collect data to present to healthcare teams (70%). In contrast, healthcare professionals (n=63) most frequently selected a system alerting patients to deteriorating asthma control (86%) and advising them when to seek medical attention (87%). Individuals with asthma were less likely than healthcare professionals (p < 0.001) to believe that assessing medication adherence and inhaler technique could improve asthma control. Our data provide strong support for mHealth for asthma self-management, but highlight fundamental differences between the perspectives of patients and healthcare professionals

MyAirCoach: the use of home-monitoring and mHealth systems to predict deterioration in asthma control and the occurrence of asthma exacerbations; study protocol of an observational study.

INTRODUCTION: Asthma is a variable lung condition whereby patients experience periods of controlled and uncontrolled asthma symptoms. Patients who experience prolonged periods of uncontrolled asthma have a higher incidence of exacerbations and increased morbidity and mortality rates. The ability to determine and to predict levels of asthma control and the occurrence of exacerbations is crucial in asthma management. Therefore, we aimed to determine to what extent physiological, behavioural and environmental data, obtained by mobile healthcare (mHealth) and home-monitoring sensors, as well as patient characteristics, can be used to predict episodes of uncontrolled asthma and the onset of asthma exacerbations. METHODS AND ANALYSIS: In an 1-year observational study, patients will be provided with mHealth and home-monitoring systems to record daily measurements for the first-month (phase I) and weekly measurements during a follow-up period of 11 months (phase II). Our study population consists of 150 patients, aged ≥18 years, with a clinician's diagnosis of asthma, currently on controller medication, with uncontrolled asthma and/or minimally one exacerbation in the past 12 months. They will be enrolled over three participating centres, including Leiden, London and Manchester. Our main outcomes are the association between physiological, behavioural and environmental data and (1) the loss of asthma control and (2) the occurrence of asthma exacerbations. ETHICS: This study was approved by the Medical Ethics Committee of the Leiden University Medical Center in the Netherlands and by the NHS ethics service in the UK. TRIAL REGISTRATION NUMBER: NCT02774772

Asthma control cost-utility randomized trial evaluation (ACCURATE): the goals of asthma treatment

Contains fulltext : 97659.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: Despite the availability of effective therapies, asthma remains a source of significant morbidity and use of health care resources. The central research question of the ACCURATE trial is whether maximal doses of (combination) therapy should be used for long periods in an attempt to achieve complete control of all features of asthma. An additional question is whether patients and society value the potential incremental benefit, if any, sufficiently to concur with such a treatment approach. We assessed patient preferences and cost-effectiveness of three treatment strategies aimed at achieving different levels of clinical control: 1. sufficiently controlled asthma 2. strictly controlled asthma 3. strictly controlled asthma based on exhaled nitric oxide as an additional disease marker DESIGN: 720 Patients with mild to moderate persistent asthma from general practices with a practice nurse, age 18-50 yr, daily treatment with inhaled corticosteroids (more then 3 months usage of inhaled corticosteroids in the previous year), will be identified via patient registries of general practices in the Leiden, Nijmegen, and Amsterdam areas in The Netherlands. The design is a 12-month cluster-randomised parallel trial with 40 general practices in each of the three arms. The patients will visit the general practice at baseline, 3, 6, 9, and 12 months. At each planned and unplanned visit to the general practice treatment will be adjusted with support of an internet-based asthma monitoring system supervised by a central coordinating specialist nurse. Patient preferences and utilities will be assessed by questionnaire and interview. Data on asthma control, treatment step, adherence to treatment, utilities and costs will be obtained every 3 months and at each unplanned visit. Differences in societal costs (medication, other (health) care and productivity) will be compared to differences in the number of limited activity days and in quality adjusted life years (Dutch EQ5D, SF6D, e-TTO, VAS). This is the first study to assess patient preferences and cost-effectiveness of asthma treatment strategies driven by different target levels of asthma control. Trial registration: Netherlands Trial Registration NTR1756