An Inner Gaseous Disk around the Herbig Be Star MWC 147

We present high-spectral-resolution, optical spectra of the Herbig Be star MWC 147, in which we spectrally resolve several emission lines, including the [O I] lines at 6300 and 6363\deg. Their highly symmetric, double-peaked line profiles indicate that the emission originates in a rotating circumstellar disk. We deconvolve the Doppler-broadened [O I] emission lines to obtain a measure of emission as a function of distance from the central star. The resulting radial surface brightness profiles are in agreement with a disk structure consisting of a flat, inner, gaseous disk and a flared, outer, dust disk. The transition between these components at 2 to 3 AU corresponds to the estimated dust sublimation radius. The width of the double-peaked Mg II line at 4481\deg suggests that the inner disk extends to at least 0.10 AU, close to the corotation radius.Comment: accepted for ApJ Letters (Oct. 2010

Effects of sequence variations in innate immune response genes on infectious outcome in trauma patients: A comprehensive review

Infectious complications, sepsis, and multiple organ dysfunction syndrome (MODS) remain important causes for morbidity and mortality in patients who survive the initial trauma. Increasing evidence suggests that genetic variants, particularly single nucleotide polymorphisms (SNPs), are critical determinants for interindividual differences in both inflammatory responses and clinical outcome in sepsis patients. Although the effect of SNPs on sepsis and MODS has been studied in many populations and diseases, this review aimed to summarize the current knowledge on the effect of SNPs on infectious complication specifically in trauma patients. A review of available literature was performed in PubMed database. The following genes have been studied in populations of trauma patients: CD14, HMGB1, IFNG, IL1A, IL1B, IL1RN, IL4, IL6, IL8, IL10, IL17F, IL18, MBL2, MASP2, FCN2, TLR1, TLR2, TLR4, TLR9, TNF, LTA, GR, MYLK, NLRP3, PRDX6, RAGE, HSPA1B, HSPA1L, HSP90, SERPINE1, IRAK1, IRAK3, VEGFA, LY96, ANGPT2, LBP, MicroRNA, and mtDNA. In this review, we discuss the genes of the Pattern Recognition Receptors, Signal Transducing Adaptor Proteins, and Inflammatory Cytokines of the innate immune system. A number of genetic variations have so far been studied in cohorts of trauma patients. Studies are often unique and numbers sometimes small. No definitive conclusions can be reached at this time about the influence of specific sequence variations on outcome in trauma patients

Circulating antigen tests and urine reagent strips for diagnosis of active schistosomiasis in endemic areas

Background: Point-of-care (POC) tests for diagnosing schistosomiasis include tests based on circulating antigen detection and urine reagent strip tests. If they had sufficient diagnostic accuracy they could replace conventional microscopy as they provide a quicker answer and are easier to use. Objectives: To summarise the diagnostic accuracy of: a) urine reagent strip tests in detecting activeSchistosoma haematobium infection, with microscopy as the reference standard; and b) circulating antigen tests for detecting active Schistosoma infection in geographical regions endemic for Schistosoma mansoni or S. haematobium or both, with microscopy as the reference standard. Search methods: We searched the electronic databases MEDLINE, EMBASE, BIOSIS, MEDION, and Health Technology Assessment (HTA) without language restriction up to 30 June 2014. Selection criteria We included studies that used microscopy as the reference standard: for S. haematobium, microscopy of urine prepared by filtration, centrifugation, or sedimentation methods; and for S. mansoni, microscopy of stool by Kato-Katz thick smear. We included studies on participants residing in endemic areas only. Data collection and analysis: Two review authors independently extracted data, assessed quality of the data using QUADAS-2, and performed meta-analysis where appropriate. Using the variability of test thresholds, we used the hierarchical summary receiver operating characteristic (HSROC) model for all eligible tests (except the circulating cathodic antigen (CCA) POC for S. mansoni, where the bivariate random-effects model was more appropriate). We investigated heterogeneity, and carried out indirect comparisons where data were sufficient. Results for sensitivity and specificity are presented as percentages with 95% confidence intervals (CI). Main results; We included 90 studies; 88 from field settings in Africa. The median S. haematobiuminfection prevalence was 41% (range 1% to 89%) and 36% for S. mansoni (range 8% to 95%). Study design and conduct were poorly reported against current standards. Tests for S. haematobium Urine reagent test strips versus microscopy Compared to microscopy, the detection of microhaematuria on test strips had the highest sensitivity and specificity (sensitivity 75%, 95% CI 71% to 79%; specificity 87%, 95% CI 84% to 90%; 74 studies, 102,447 participants). For proteinuria, sensitivity was 61% and specificity was 82% (82,113 participants); and for leukocyturia, sensitivity was 58% and specificity 61% (1532 participants). However, the difference in overall test accuracy between the urine reagent strips for microhaematuria and proteinuria was not found to be different when we compared separate populations (P = 0.25), or when direct comparisons within the same individuals were performed (paired studies; P = 0.21). When tests were evaluated against the higher quality reference standard (when multiple samples were analysed), sensitivity was marginally lower for microhaematuria (71% vs 75%) and for proteinuria (49% vs 61%). The specificity of these tests was comparable. Antigen assay Compared to microscopy, the CCA test showed considerable heterogeneity; meta-analytic sensitivity estimate was 39%, 95% CI 6% to 73%; specificity 78%, 95% CI 55% to 100% (four studies, 901 participants). Tests for S. mansoni Compared to microscopy, the CCA test meta-analytic estimates for detecting S. mansoni at a single threshold of trace positive were: sensitivity 89% (95% CI 86% to 92%); and specificity 55% (95% CI 46% to 65%; 15 studies, 6091 participants) Against a higher quality reference standard, the sensitivity results were comparable (89% vs 88%) but specificity was higher (66% vs 55%). For the CAA test, sensitivity ranged from 47% to 94%, and specificity from 8% to 100% (four studies, 1583 participants). Authors' conclusions: Among the evaluated tests for S. haematobium infection, microhaematuria correctly detected the largest proportions of infections and non-infections identified by microscopy. The CCA POC test for S. mansoni detects a very large proportion of infections identified by microscopy, but it misclassifies a large proportion of microscopy negatives as positives in endemic areas with a moderate to high prevalence of infection, possibly because the test is potentially more sensitive than microscopy

Multiple Infectious Complications in a Severely Injured Patient with Single Nucleotide Polymorphisms in Important Innate Immune Response Genes

Abstract Trauma is a major public health problem worldwide. Infectious complications, sepsis, and multiple organ dysfunction syndrome (MODS) remain important causes for morbidity and mortality in patients who survive the initial trauma. There is increasing evidence for the role of genetic variation in the innate immune system on infectious complications in severe trauma patients. We describe a trauma patient with multiple infectious complications caused by multiple micro-organisms leading to prolonged hospital stay with numerous treatments. This patient had multiple single nucleotide polymorphisms (SNPs) in the MBL2, MASP2, FCN2 and TLR2 genes, most likely contributing to increased susceptibility and severity of infectious diseas

Botvervangende materialen

Abstract Bone substitutes – In trauma and orthopedic surgery the use of autograft is a first choice therapy for filling bone defects. Due to drawbacks in the use of autografts (for example donor site morbidity and limited amount of bone tissue) there is an increasing interest in the use of (artificial) bone substitutes. This article provides an overview of the basic science of bone substitution. For optimal ingrowth of bone a transplant should have osteogenic, osteoinductive and osteoconductive characteristics. Bone substitutes are mostly osteoconductive and provide a scaffold for bone regeneration. Osteoconductivity is mainly determined by pore size, porosity and cristallinity. Calcium phosphates represent a group of bone substitutes that is being used mostly, and this group of products has been extensively studied. In addition, calcium sulphates and bioactive glass are used also. New developments such as the addition of growth factors to bone substitutes are under extensive research

Reinsertion of an inverted osteochondral lesion of the talus: A case report

Osteochondral lesions of the talus (OLTs) occur infrequently and are missed at the initial presentation in up to 67% of cases. Probably more than 1500 OLTs have been reported in published studies, of which, thus far, only 5 cases have been an inverted anterolateral OLT. An anterolateral OLT results from a hypersupination trauma, in which the talar dome is caught behind the fibula. Apparently, if the forces are large enough a " flip of the coin" phenomenon occurs, causing the fragment to invert 180° upside down. We present the case of a young female patient with an inverted OLT that was treated with open reduction and internal fixation using bioabsorbable pins. Follow-up radiographs and computed tomography showed a congruent joint and complete healing of the osteochondral fragment. At the short-term follow-up visit, the functional outcome was promising

Emergency medicine training in the Netherlands, essential changes needed

Since 2008, training for emergency physicians (EPs) in the Netherlands has been based on a national 3-year curriculum. However, it has become increasingly evident that it needs to expand beyond its initial foundations. The training period does not comply with European regulations of a minimum of 5 years. Adjusting to this European standard is a logical step. Experience with the 3-year Dutch training scheme has led to the general conclusion that this training period is too short. Recommendations for essential changes and the basis for their development are presented

Plantar pressure analysis after percutaneous repair of displaced intra-articular calcaneal fractures

Background: Clinical results for the treatment of displaced intra-articular calcaneal fractures are mainly expressed using disease-specific outcome scores, physical examination and radiographs. We hypothesized that plantar pressure and foot position analysis is a valuable tool in assessing foot function in patients with a unilateral displaced intra-articular calcaneal fracture treated percutaneously. Materials and Methods: With a followup of at least one year, 21 patients with a unilateral displaced intra-articular calcaneal fracture treated percutaneously participated in the study. The pedobarographic measurements in the injured foot were compared with the contralateral control foot. Correlations between the ratios (injured/control) of plantar pressure and foot position variables and outcome scores, the physical exam items ratios, the fracture classification, and the radiological parameters were calculated. Results: Statistically significant differences between the injured and the control foot were f