Chronic Q fever associated with systemic sclerosis

Contains fulltext : 205462.pdf (publisher's version ) (Open Access)BACKGROUND: After the Q fever outbreak in the Netherlands between 2007 and 2010, more than 300 patients with chronic Q fever have been identified. Some patients were also diagnosed with systemic sclerosis, a rare immune-mediated disease. We aimed to increase awareness of concomitant chronic Q fever infection and systemic sclerosis and to give insight into the course of systemic sclerosis during persistent Q fever infection. MATERIALS AND METHODS: Chronic Q fever patients were identified after the Dutch Q fever outbreak in 2007-2010. Systemic sclerosis was diagnosed by a scleroderma expert and patients fulfilled the 2013 Classification Criteria for Systemic Sclerosis. RESULTS: Four cases presented with chronic Q fever, persistent Coxiella burnetii infection, shortly preceded or followed by the diagnosis of limited cutaneous systemic sclerosis. The three male patients of 60 years or older developed a relatively mild systemic sclerosis, which did not require immunosuppressive therapy during adequate treatment of the chronic Q fever infection. The 58-year-old female patient used immunosuppressives for her newly diagnosed systemic sclerosis at the time she likely developed a chronic Q fever infection. CONCLUSIONS: In this case series, chronic Q fever preceding systemic sclerosis was associated with a mild course of systemic sclerosis without the necessity of immunosuppressive drugs, while chronic Q fever development due to immunocompromised state was associated with a more deteriorating course of systemic sclerosis

The influence of induced parturition and the moment of vaccination against Swine erysipelas during lactation on the weaning-to-oestrus interval in sows

This experiment was carried out to investigate the effect of vaccination during lactation with PorciW Ery+Parvo on the weaning-to-oestrus interval and the reproduction in sows. An exploratory study had indicated that vaccination during particularly the first few days of lactation might lead to a longer weaning-to-oestrus interval. To find out whether vaccination during lactation and/orthe moment of vaccination actually affects the weaning-to-oestrus interval, sows were vaccinated the first, second or last weeks of lactation with either Porcilis@ Ery+Parvo or a placebo. In the same experiment the combination with induced parturition on the weaning-to-oestrus interval was examined. Also the influence of the treatments on the use of PGGOO@ was considered, as was pregnancy rate from first insemination and litter size, and the number of stillborn piglets or born alive in the subsequent litter. The main results and conclusions are: 1- Vaccination of sows during the first week of lactation (with PorciW Ery+Parvo) against Swine erysipelas and Parvo has no significant adverse effect on reproductive performance. 2- Induced parturition causes earlier parturition, which results in lighter piglets. Induced parturition has no effect on percentage of piglets born alive; the percentage of piglets with splay leg is significantly highe

Platelet- derived growth factor receptor-beta and epidermal growth factor receptor in pulmonary vasculature of systemic sclerosis-associated pulmonary arterial hypertension versus idiopathic pulmonary arterial hypertension and pulmonary veno-occlusive disease: a case-control study

INTRODUCTION: Systemic sclerosis (SSc) complicated by pulmonary arterial hypertension (PAH) carries a poor prognosis, despite pulmonary vascular dilating therapy. Platelet-derived growth factor receptor-beta (PDGFR-beta) and epidermal growth factor receptor (EGFR) are potential therapeutic targets for PAH because of their proliferative effects on vessel remodelling. To explore their role in SScPAH, we compared PDGFR- and EGFR-mmunoreactivity in lung tissue specimens from SScPAH. We compared staining patterns with idiopathic PAH (IPAH) and pulmonary veno-occlusive disease (PVOD), as SScPAH vasculopathy differs from IPAH and sometimes displays features of PVOD. Immunoreactivity patterns of phosphorylated PDGFR-beta (pPDGFR-beta) and the ligand PDGF-B were evaluated to provide more insight into the patterns of PDGFR-b activation. METHODS: Lung tissue specimens from five SScPAH, nine IPAH, six PVOD patients and five controls were examined. Immunoreactivity was scored for presence, distribution and intensity. RESULTS: All SScPAH and three of nine IPAH cases (P = 0.03) showed PDGFR-beta-immunoreactivity in small vessels (arterioles/venules); of five SScPAH vs. two of nine IPAH cases (P = 0.02) showed venous immunoreactivity. In small vessels, intensity was stronger in SScPAH vs. IPAH. No differences were found between SScPAH and PVOD. One of five normal controls demonstrated focally mild immunoreactivity. There were no differences in PDGF-ligand and pPDGFR-b-immunoreactivity between patient groups; however, pPDGFR-b-immunoreactivity tended to be more prevalent in SScPAH small vasculature compared to IPAH. Vascular EGFR-immunoreactivity was limited to arterial and arteriolar walls, without differences between groups. No immunoreactivity was observed in vasculature of normals. CONCLUSIONS: PDGFR-beta-immunoreactivity in SScPAH is more common and intense in small- and post-capillary vessels than in IPAH and does not differ from PVOD, fitting in with histomorphological distribution of vasculopathy. PDGFR-beta immunoreactivity pattern is not paralleled by pPDGFR-beta or PDGF-B patterns. PDGFR-beta- and EGFR-immunoreactivity of pulmonary vessels distinguishes PAH patients from controls

Kraamhoktype en uitmestfrequentie bij scharrelvarkens: technische resultaten, arbeid en ammoniakemissie

De scharrelvarkensvleesproductie is een deelmarkt waar extra aandacht wordt geschonken aan de wijze van huisvesten en verzorgen van varkens. De technische resultaten van zeugen onder scharrelomstandigheden blijven achter bij de resultaten van zeugen die op de gangbare wijze (regulier) gehouden worden. Knelpunten in de zoogperiode zijn: te hoge uitval van biggen door doodliggen, te hoge uitval van biggen door diarree, slechte hygiëne van het kraamhok, slechte arbeidsomstandigheden en naar verwachting een hogere milieubelasting door onder meer ammoniakemissie. Deze knelpunten zijn in belangrijke mate paradoxaal met de maatschappelijke wensen achter deze productiewijze en leiden samen met de hoge arbeidsbehoefte en extra huisvestingskosten tot een verhoogde kostprijs. Dit was aanleiding om de invloed van de vormgeving van het kraamhok en de invloed van de uitmestfrequentie op de resultaten te onderzoeke

Toxicity of sediment-bound lufenuron to benthic arthropods in laboratory bioassays

This paper deals with species sensitivity distributions (SSDs) for the lipophilic insecticide lufenuron and benthic arthropods based on sediment-spiked laboratory toxicity tests. This compound that inhibits chitin synthesis and moulting of arthropods persists in sediment. Using field-collected sediment, toxicity tests were conducted with three macro-crustaceans and six insects. The Hazardous Concentration to 5% of the tested species, the HC5 (and 95% confidence limit), derived from an SSD constructed with 10d-LC50′s was 2.2 (1.2–5.7) μg/g organic carbon (OC) in dry sediment. In addition, HC5 values derived from SSDs constructed with 28d-LC10 and 28-d LC50 values were 0.13 (0.02–1.50) μg/g OC and 2.0 (1.3–5.5) μg/g OC, respectively. In 28d toxicity tests with Chironomus riparius and Hyalella azteca, a higher sensitivity was observed when using lufenuron-spiked field-collected sediment than in lufenuron-spiked artificial sediment. Overall, the non-biting midge C. riparius appeared to be a representative and sensitive standard test species to assess effects of lufenuron exposure in sediment. The Tier-1 (based on standard test species), Tier-2 (based on standard and additional test species) and Tier-3 (model ecosystem approach) regulatory acceptable concentrations (RACs) for sediment-spiked lufenuron did not differ substantially. The Tier-2 RAC was the lowest. Since to our knowledge this study is the first in the open literature that evaluates the tiered approach in the sediment effect assessment procedure for pesticides, we advocate that similar evaluations should be conducted for pesticides that differ in toxic mode-of-action

From "being at war" to "getting back on your feet": a qualitative study on experiences of patients with systemic sclerosis treated with hematopoietic stem cell transplantation

Objectives:To gain insight into the experiences of patients with diffuse cutaneous systemic sclerosis during and after autologous hematopoietic stem cell transplantation.Methods:Semi-structured interviews were conducted with patients who underwent hematopoietic stem cell transplantation in four university hospitals in the Netherlands. Interviews were transcribed verbatim and thematically analyzed.Results:Nine male and seven female patients were interviewed, median age 47 years (range: 27-68). Patients mentioned their life was severely disrupted before hematopoietic stem cell transplantation and remained unsettled a long time after treatment. Uncertainty because of disease progression, loss of control over health and the sense of time and fear of treatment-related adverse events were common during hospitalization. After hematopoietic stem cell transplantation, patients experienced more physical limitations than they had expected, and recovery took longer and was mentally taxing. Going back to work and finding a new balance in personal relations and social life was complicated. Patients described various strategies to deal with challenges. Family and friends provided essential support, although many experienced a dwindling social circle. Most patients also appreciated peer support. All patients were satisfied with the low threshold for contact with physicians and nurses during hospitalization. However, aftercare focused on medical aspects rather than on psychological well-being and social issues. Moreover, patients would have preferred to be better prepared on what to expect after discharge, and lacked information about self-management, prognosis, optimal recovery, work, sexuality, and family planning.Conclusion:Hematopoietic stem cell transplantation has a major physical and psychological impact on patients with diffuse cutaneous systemic sclerosis. The course of recovery after this intensive therapy was unexpectedly long for some patients and offer of support was far less pro-active post-HSCT compared to pre-HSCT and during HSCT.Analysis and support of clinical decision makin

Treatment decision-making in diffuse cutaneous systemic sclerosis: a patient's perspective

Objectives. To examine the treatment decision-making process of patients with dcSSc in the context of haematopoietic stem cell transplantation (HSCT).Methods. A qualitative semi-structured interview study was done in patients before or after HSCT, or patients who chose another treatment than HSCT. Thematic analysis was used. Shared decision-making (SDM) was assessed with the 9-item Shared Decision Making Questionnaire (SDM-Q-9).Results. Twenty-five patients [16 male/nine female, median age 47 (range 27-68) years] were interviewed: five pre-HSCT, 16 post-HSCT and four following other treatment. Whereas the SDM-Q-9 showed the decision-making process was perceived as shared [median score 81/100 (range 49-100)], we learned from the interviews that the decision was predominantly made by the rheumatologist, and patients were often steered towards a treatment option. Strong guidance of the rheumatologist was appreciated because of a lack of accessible, reliable and SSc-specific information, due to the approach of the decision-making process of the rheumatologist, the large consequence of the decision and the trust in their doctor. Expectations of outcomes and risks also differed between patients. Furthermore, more than half of patients felt they had no choice but to go for HSCT, due to rapid deterioration of health and the perception of HSCT as 'the holy grail'.Conclusion. This is the first study that provides insight into the decision-making process in dcSSc. This process is negatively impacted by a lack of disease-specific education about treatment options. Additionally, we recommend exploring patients' preferences and understanding of the illness to optimally guide decision-making and to provide tailor-made information.Analysis and support of clinical decision makin