Responders to Exercise Therapy in Patients with Osteoarthritis of the Hip: A Systematic Review and Meta-Analysis.

The Outcome Measures in Rheumatology workgroup (OMERACT), together with the Osteoarthritis Research Society International (OARSI) developed the OMERACT-OARSI responder criteria. These criteria are used to determine if a patient with osteoarthritis (OA) 'responds' to therapy, meaning experiences a clinically relevant effect of therapy. Recently, more clinical OA trials report on this outcome and most OA trials have data to calculate the number of responders according to these criteria. A systematic review and meta-analysis were performed on the response to exercise therapy, compared to no or minimal intervention in patients with hip OA using the OMERACT-OARSI responder criteria. The literature was searched for relevant randomized trials. If a trial fit the inclusion criteria, but number of responders was not reported, the first author was contacted. This way the numbers of responders of 14 trials were collected and a meta-analysis on short term (directly after treatment, 12 trials n = 1178) and long term (6-8 months after treatment, six trials n = 519) outcomes was performed. At short term, the risk difference (RD) was 0.14 (95% confidence interval (CI) 0.06-0.22) and number needed to treat (NNT) 7.1 (95% CI 4.5-17); at long term RD was 0.14 (95% CI 0.07-0.20) and NNT 7.1 (95% CI 5.0-14.3). Quality of evidence was moderate for the short term and high for the long term. In conclusion, 14% more hip OA patients responded to exercise therapy than to no therapy

Do we need another trial on exercise in patients with knee osteoarthritis?: No new trials on exercise in knee OA

© 2019 Osteoarthritis Research Society International Objective: We aim to investigate if we need additional trials on exercise in knee osteoarthritis (OA) to accept a certain effect size to be a ‘true’ effect size, and new studies are not needed anymore. Design: We performed a secondary analyses of a meta-analysis of studies on patients with knee osteoarthritis, on pain immediately post treatment. We performed five different analysis: a) we evaluated publication bias, b) we performed subgroup analysis, c) a sensitivity analysis based on the overall risk of bias (RoB) score, d) a cumulative meta-analysis and e) we developed an extended funnel plot to explore the potential impact of a new study on the summary effect estimate. Results: We included 42 studies with in total 6863 patients. The analyses showed that a) there is no clear publication bias, b) subgrouping did not affect the overall effect estimate, c) the effect estimate of exercise is more consistent (no heterogeneity) in the studies of low RoB, d) the benefit of exercise was clear since 2010 and e) the extended funnel plot suggests that an additional study has a none or very limited impact to change the current effect estimate. Conclusion: Exercise is effective and clinically worthwhile in reducing pain immediately post treatment compared to no or minimal interventions in patients with knee OA and adding new data will unlikely change this conclusion

Annual report on surveillance of respiratory infectious diseases 2013, the Netherlands

Het griepseizoen (influenza) 2013/2014 was erg mild, na de uitzonderlijk langdurende epidemie in het seizoen 2012/2013. Ook was het een mild seizoen wat betreft het aantal mensen dat een longontsteking (pneumonie) opliep. In 2013 waren er geen grote uitbraken van de meldingsplichtige luchtweginfectieziekten legionellose (308 meldingen), papegaaienziekte (psittacose; 51 meldingen), Q-koorts (19 meldingen) en tuberculose (848 meldingen). Deze aantallen waren in het verslagjaar vergelijkbaar of lager dan het aantal meldingen in voorgaande jaren. Dit blijkt uit de jaarlijkse surveillance luchtweginfectieziekten 2013 van het RIVM. Griep en longontsteking leiden tot veel ziekenhuisopnames en sterfte in Nederland, waardoor het RIVM ze actief volgt. In vergelijking met griep komen de meldingsplichtige luchtweginfecties in Nederlands maar weinig voor. Ze zijn meldingsplichtig, omdat tijdige maatregelen, zoals de besmettingsbron opsporen, belangrijk kunnen zijn om uitbraken of verdere verspreiding van de ziekte te voorkomen. Het RIVM volgt ook potentieel gevaarlijke nieuwe luchtweginfecties die elders in de wereld voorkomen. In mei 2014 werden voor het eerst in Nederland twee patiënten gediagnostiseerd met het MERS coronavirus. In het seizoen 2013/2014 lag het aantal mensen dat met griepachtige klachten bij de huisarts kwam begin 2014 gedurende vier weken boven de grens waarmee een griepepidemie wordt geduid. Bij de patiënten met griepachtige klachten kwam naast influenzavirus vaak RSV (respiratoir syncytieel virus) en neusverkoudheid (rhinovirus) voor. Er kwamen minder mensen met een longontsteking bij de huisarts dan voorgaande seizoenen, maar het aantal longontstekingpatiënten in verpleeghuizen bleef gelijk.The 2013/2014 influenza season was extremely mild in the Netherlands, compared to the exceptionally long-lasting epidemic in 2012/2013. In addition, the number of pneumonia patients and overall mortality, possible complications of influenza, were low. In 2013, no major outbreaks of the notifiable respiratory infectious diseases legionellosis (308 notifications), psittacosis (51 notifications), Q-fever (19 notifications) and tuberculosis (848 notifications) occurred. These incidences are either comparable to or lower than preceding years. These are the outcomes of the annual report: 'Surveillance of respiratory infectious diseases 2013, the Netherlands', published by the Dutch National Institute for Public Health and the Environment (RIVM). Influenza and pneumonia are an important cause of hospital admissions and death in the Netherlands, a reason for the RIVM to actively monitor these diseases. In comparison to influenza, notifiable respiratory infectious diseases only rarely occur. These diseases are notifiable, as timely measures like source finding, are important for preventing outbreaks and/ or ongoing transmission of the disease. The RIVM also monitors potential threats to public health from new (worldwide) respiratory infections. In May 2014, the first two cases of MERS coronavirus were diagnosed in the Netherlands. During the 2013/2014 influenza-season, the number of patients with influenza-like illness (ILI) consulting a general practitioner, was above the threshold set for an influenza epidemic for four weeks at the beginning of 2014. In nose and throat samples of ILI-patients, RSV (respiratory syncytial virus) and rhinovirus were found in addition to the influenza virus. During the 2013/2014 influenza-season, fewer patients consulted the general practitioner for pneumonia than in previous years, however the number of pneumonia patients in nursing homes was similar.Ministerie van VW

Steiner t-designs for large t

One of the most central and long-standing open questions in combinatorial design theory concerns the existence of Steiner t-designs for large values of t. Although in his classical 1987 paper, L. Teirlinck has shown that non-trivial t-designs exist for all values of t, no non-trivial Steiner t-design with t > 5 has been constructed until now. Understandingly, the case t = 6 has received considerable attention. There has been recent progress concerning the existence of highly symmetric Steiner 6-designs: It is shown in [M. Huber, J. Algebr. Comb. 26 (2007), pp. 453-476] that no non-trivial flag-transitive Steiner 6-design can exist. In this paper, we announce that essentially also no block-transitive Steiner 6-design can exist.Comment: 9 pages; to appear in: Mathematical Methods in Computer Science 2008, ed. by J.Calmet, W.Geiselmann, J.Mueller-Quade, Springer Lecture Notes in Computer Scienc

Standard decomposition of expansive ergodically supported dynamics

In this work we introduce the notion of weak quasigroups, that are quasigroup operations defined almost everywhere on some set. Then we prove that the topological entropy and the ergodic period of an invertible expansive ergodically supported dynamical system $(X,T)$ with the shadowing property establishes a sufficient criterion for the existence of quasigroup operations defined almost everywhere outside of universally null sets and for which $T$ is an automorphism. Furthermore, we find a decomposition of the dynamics of $T$ in terms of $T$-invariant weak topological subquasigroups.Comment: 18 pages, the conditions on the entropy in Theorem 3.5 was improved. Some small changes in the text, by adding more explanation

Perfect Secrecy Systems Immune to Spoofing Attacks

We present novel perfect secrecy systems that provide immunity to spoofing attacks under equiprobable source probability distributions. On the theoretical side, relying on an existence result for $t$-designs by Teirlinck, our construction method constructively generates systems that can reach an arbitrary high level of security. On the practical side, we obtain, via cyclic difference families, very efficient constructions of new optimal systems that are onefold secure against spoofing. Moreover, we construct, by means of $t$-designs for large values of $t$, the first near-optimal systems that are 5- and 6-fold secure as well as further systems with a feasible number of keys that are 7-fold secure against spoofing. We apply our results furthermore to a recently extended authentication model, where the opponent has access to a verification oracle. We obtain this way novel perfect secrecy systems with immunity to spoofing in the verification oracle model.Comment: 10 pages (double-column); to appear in "International Journal of Information Security

Expression profile of human Fc receptors in mucosal tissue: implications for antibody-dependent cellular effector functions targeting HIV-1 transmission

The majority of new Human Immunodeficiency Virus (HIV)-1 infections are acquired via sexual transmission at mucosal surfaces. Partial efficacy (31.2%) of the Thai RV144 HIV-1 vaccine trial has been correlated with Antibody-dependent Cellular Cytotoxicity (ADCC) mediated by non-neutralizing antibodies targeting the V1V2 region of the HIV-1 envelope. This has led to speculation that ADCC and other antibody-dependent cellular effector functions might provide an important defense against mucosal acquisition of HIV-1 infection. However, the ability of antibody-dependent cellular effector mechanisms to impact on early mucosal transmission events will depend on a variety of parameters including effector cell type, frequency, the class of Fc-Receptor (FcR) expressed, the number of FcR per cell and the glycoslyation pattern of the induced antibodies. In this study, we characterize and compare the frequency and phenotype of IgG (CD16 [FcγRIII], CD32 [FcγRII] and CD64 [FcγRI]) and IgA (CD89 [FcαR]) receptor expression on effector cells within male and female genital mucosal tissue, colorectal tissue and red blood cell-lysed whole blood. The frequency of FcR expression on CD14+ monocytic cells, myeloid dendritic cells and natural killer cells were similar across the three mucosal tissue compartments, but significantly lower when compared to the FcR expression profile of effector cells isolated from whole blood, with many cells negative for all FcRs. Of the three tissues tested, penile tissue had the highest percentage of FcR positive effector cells. Immunofluorescent staining was used to determine the location of CD14+, CD11c+ and CD56+ cells within the three mucosal tissues. We show that the majority of effector cells across the different mucosal locations reside within the subepithelial lamina propria. The potential implication of the observed FcR expression patterns on the effectiveness of FcR-dependent cellular effector functions to impact on the initial events in mucosal transmission and dissemination warrants further mechanistic studies

Wall shear stress as measured in vivo: consequences for the design of the arterial system

Based upon theory, wall shear stress (WSS), an important determinant of endothelial function and gene expression, has been assumed to be constant along the arterial tree and the same in a particular artery across species. In vivo measurements of WSS, however, have shown that these assumptions are far from valid. In this survey we will discuss the assessment of WSS in the arterial system in vivo and present the results obtained in large arteries and arterioles. In vivo WSS can be estimated from wall shear rate, as derived from non-invasively recorded velocity profiles, and whole blood viscosity in large arteries and plasma viscosity in arterioles, avoiding theoretical assumptions. In large arteries velocity profiles can be recorded by means of a specially designed ultrasound system and in arterioles via optical techniques using fluorescent flow velocity tracers. It is shown that in humans mean WSS is substantially higher in the carotid artery (1.1–1.3 Pa) than in the brachial (0.4–0.5 Pa) and femoral (0.3–0.5 Pa) arteries. Also in animals mean WSS varies substantially along the arterial tree. Mean WSS in arterioles varies between about 1.0 and 5.0 Pa in the various studies and is dependent on the site of measurement in these vessels. Across species mean WSS in a particular artery decreases linearly with body mass, e.g., in the infra-renal aorta from 8.8 Pa in mice to 0.5 Pa in humans. The observation that mean WSS is far from constant along the arterial tree implies that Murray’s cube law on flow-diameter relations cannot be applied to the whole arterial system. Because blood flow velocity is not constant along the arterial tree either, a square law also does not hold. The exponent in the power law likely varies along the arterial system, probably from 2 in large arteries near the heart to 3 in arterioles. The in vivo findings also imply that in in vitro studies no average shear stress value can be taken to study effects on endothelial cells derived from different vascular areas or from the same artery in different species. The cells have to be studied under the shear stress conditions they are exposed to in real life

Longevity and Composition of Cellular Immune Responses Following Experimental Plasmodium falciparum Malaria Infection in Humans

Cellular responses to Plasmodium falciparum parasites, in particular interferon-gamma (IFNγ) production, play an important role in anti-malarial immunity. However, clinical immunity to malaria develops slowly amongst naturally exposed populations, the dynamics of cellular responses in relation to exposure are difficult to study and data about the persistence of such responses are controversial. Here we assess the longevity and composition of cellular immune responses following experimental malaria infection in human volunteers. We conducted a longitudinal study of cellular immunological responses to sporozoites (PfSpz) and asexual blood-stage (PfRBC) malaria parasites in naïve human volunteers undergoing single (n = 5) or multiple (n = 10) experimental P. falciparum infections under highly controlled conditions. IFNγ and interleukin-2 (IL-2) responses following in vitro re-stimulation were measured by flow-cytometry prior to, during and more than one year post infection. We show that cellular responses to both PfSpz and PfRBC are induced and remain almost undiminished up to 14 months after even a single malaria episode. Remarkably, not only ‘adaptive’ but also ‘innate’ lymphocyte subsets contribute to the increased IFNγ response, including αβT cells, γδT cells and NK cells. Furthermore, results from depletion and autologous recombination experiments of lymphocyte subsets suggest that immunological memory for PfRBC is carried within both the αβT cells and γδT compartments. Indeed, the majority of cytokine producing T lymphocytes express an CD45RO+ CD62L- effector memory (EM) phenotype both early and late post infection. Finally, we demonstrate that malaria infection induces and maintains polyfunctional (IFNγ+IL-2+) EM responses against both PfRBC and PfSpz, previously found to be associated with protection. These data demonstrate that cellular responses can be readily induced and are long-lived following infection with P. falciparum, with a persisting contribution by not only adaptive but also (semi-)innate lymphocyte subsets. The implications hereof are positive for malaria vaccine development, but focus attention on those factors potentially inhibiting such responses in the field