Bovine natural antibodies in antibody-dependent bactericidal activity against Escherichia coli and Salmonella Typhimurium and risk of mastitis.

Natural antibodies (NAbs) are mostly IgM antibodies produced without antigenic stimulation and serve as a first line of defence of the immune system. As both natural and specific antibodies are present in animals, NAbs are studied by determining the IgM response to naïve antigens like keyhole limpet hemocyanin (KLH). In this study, we selected cows based on high and low anti-KLH IgM titers, reflecting high and low NAb titers, and determined if the anti-KLH IgM titers were indicative for the recognition of common microbial structures (lipopolysaccharide, lipoteichoic acid and peptidoglycan) and intact bacteria (Escherichia coli and Salmonella Typhimurium). Sera with high NAbs titers showed more IgM and IgG binding to common microbial structures and S. Typhimurium bacteria than sera with low NAbs titers. The same association was observed for IgM binding to E. coli, but not for IgG binding to E. coli. Antibody-mediated complement killing of E. coli and S. Typhimurium in a newly developed bactericidal test was equal between high and low NAb cows. However, relating the outcome of the bactericidal test to the development of mastitis within one and even four years after sampling showed a significant negative correlation implying cows that were less potent in bacterial killing had a higher chance on developing mastitis. In conclusion, sera with high NAbs titers had more antibodies binding to common microbial structures and intact bacteria. Furthermore, the bactericidal test might provide a useful prognostic tool for the development of mastitis.

Nucleophilic substitution with two reactive centers: The CN(-) + CH3I case.

The nucleophilic substitution reaction CN(-) + CH3I allows for two possible reactive approaches of the reactant ion onto the methyl halide, which lead to two different product isomers. Stationary point calculations predict a similar shape of the potential and a dominant collinear approach for both attacks. In addition, an H-bonded pre-reaction complex is identified as a possible intermediate structure. Submerged potential energy barriers hint at a statistical formation process of both CNCH3 and NCCH3 isomers at the experimental collision energies. Experimental angle- and energy differential cross sections show dominant direct rebound dynamics and high internal excitation of the neutral product. No distinct bimodal distributions can be extracted from the velocity images, which impedes the indication of a specific preference towards any of the product isomers. A forward scattering simulation based on the experimental parameters describes accurately the experimental outcome and shows how the possibility to discriminate between the two isomers is mainly hindered by the large product internal excitation.

Lip-reading abilities in a subject with congenital prosopagnosia.

We present the case of an individual with congenital prosopagnosia or "face blindness", a disorder where the ability to recognize faces is impaired. We studied the lip-reading ability and audiovisual perception of this subject using a DVD with four conditions (audiovisual congruent, auditory, visual, and audiovisual incongruent) and compared results with a normal patient cohort. The patient had no correct responses in the visual lip-reading task; whereas, he improved in the audiovisual congruent task. In the audiovisual incongruent task, the patient provided one response; thus, he was able to lip-read. (He was able to use lip-reading/to use labial informations) This patient perceived only global dynamic facial movements, not the fine ones. He had a sufficient complementary use of lip-reading in audiovisual tasks, but not visual ones. These data are consistent with abnormal development of the pathways used for visual speech perception and associated with second-order face processing disorders and normal development of the audiovisual network for speech perception.

[Recognizing and preventing disturbances in eruption]. / Herkennen en voorkomen van eruptiestoornissen.

Disturbances in eruption and related problems are quite common in permanent dentition but rare in deciduous dentition. For the timely recognition of disturbances in eruption, knowledge of the normal development of dentition is essential. Disturbances in eruption comprise disturbances in which eruption does not occur at all, in which it is delayed or incomplete, or in which the normal direction of eruption is influenced. If identified early enough, many undesirable dental conditions can be avoided or their seriousness can be limited. A possible impacting of permanent cuspids, for example, can be avoided by extracting the deciduous cuspids at the right moment; in cases of a large overjet or the threat of a cover-bite, lip interference can be prevented.

Proxy measurements in multiple sclerosis: agreement on different patient-reported outcome scales.

BACKGROUND: Patient-reported outcome (PRO) scales are often used in multiple sclerosis (MS) research. Full understanding of items can be influenced by disease worsening, mood disturbances and cognitive problems of the MS patient. Earlier research with the Multiple Sclerosis Impact Scale (MSIS-29) showed that proxy respondents (i.e. partners of patients) can provide useful information. OBJECTIVE: To determine agreement between patients and proxy respondents on different MS PRO scales. METHODS: 139 Patients and partners completed the MSIS-29 (Physical and Psychological scale), Multiple Sclerosis Walking Scale (MSWS-12), Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ) and Guy's Neurological Disability Scale (GNDS). We calculated the mean difference and intra-class correlation coefficients (ICC) on scale level and weighted kappas (κ(w)) on item level. RESULTS: On all scales, except MSNQ, the partner score was higher. ICCs were good for MSWS, GNDS and MSIS Physical, and moderate for MSNQ and MSIS Psychological. κ(w) was excellent for MSWS items, fair to good for GNDS, MSIS Physical and MSIS Psychological items, and poor for MSNQ items. CONCLUSION: Partners of patients with MS can be a useful source of information for several PRO scales, especially when the focus is on physical functioning. For psychological functioning this seems to be less reliable.

Closed reduction intermetacarpal Kirschner wire fixation in the treatment of unstable fractures of the base of the first metacarpal.

The purpose of this study was to describe the results of extra-articular and intra-articular fractures, at the base of the first metacarpal, treated with closed reduction and percutaneous fixation with intermetacarpal Kirschner wires. Outcome was evaluated by experienced pain, functional outcome and radiographic indications for arthritis. In total, 25 patients with unstable fractures at the base of the first metacarpal underwent closed reduction and percutaneous fixation of the fracture. Prospectively collected data of 25 consecutive patients were evaluated retrospectively, assessing stability of fixation, operation time and the occurrence of fracture dislocation during and after treatment. All patients were assessed at 1, 3, 6 and 24 months. Follow-up included questionnaires: functional tests including grip and pinch measurement and radiographic analysis for post-traumatic arthritis, using the modified Eaton-Littler classification. In total, 15 patients with extra-articular fractures and 10 patients with intra-articular fractures were treated with this technique. In the group of extra-articular fractures of 15 patients, only one patient had loss of grip strength greater than 20% in comparison with the contra-lateral side (corrected for hand dominance). No clinically important difference was found for pinch strength. One patient experienced functional limitations and was unable to return to a previous hobby. In the patients group with intra-articular fractures, seven patients had a Bennett fracture and three a Rolando fracture. One patient with a Bennett fracture had a loss of pinch strength greater than 20% corrected for hand dominance. One of the three patients with a Rolando fracture had grip loss greater than 20%. None of the patients with intra-articular fractures experienced any functional limitations. The described fixation procedure results in a stable fixation of the fracture fragments, and no secondary dislocation of the fracture occurred. Fractures consolidated within 32 (26-50) days and no new fractures were observed. These results suggest that this technique can be safely used in the treatment of extra-articular fractures as well as intra-articular fractures at the base of the first metacarpal.

Disease progression in multiple sclerosis: combining physicians' and patients' perspectives?

BACKGROUND: To assess disease progression in multiple sclerosis (MS) several outcome measures are available. The interrelation of changes on different scales has not been studied extensively and the concept of combining scales has only recently been introduced in MS. OBJECTIVE: To explore combining different clinical outcome measures in the evaluation of disease progression in MS. METHODS: In 553 patients we studied the presence of relevant changes according to standard definitions on the Expanded Disability Status Scale (EDSS), Nine-Hole Peg Test (9HPT), Timed 25-Foot Walk (T25FW) and the Multiple Sclerosis Impact Scale (MSIS-29). We examined 'exclusive worsening' (worsening on one measure while not worsening on any other measure) and 'opposing changes' (worsening on one measure while improving on another measure). Finally, we investigated the impact of combining assessments. RESULTS: Based on the EDSS alone, 140 patients progressed. However, almost twice as many (275) showed worsening on any of the clinical outcome measures. Exclusive worsening was observed in 37 patients on the EDSS, 13 on the 9HPT, 39 on the T25FW and 44 on the MSIS physical. Of all worsened patients 76 (28%) showed opposing changes, a phenomenon predominantly observed when combining physician-based and patient-derived outcome measures. CONCLUSION: When assessing disease progression in MS, sensitivity to change can be increased by combining different outcome measures. The added value is especially present when combining measures from different perspectives. However, further research is needed to evaluate the optimal way to combine outcome measures before implementing this strategy in clinical studies.

Proxy ratings from multiple sources: disagreement on the impact of multiple sclerosis on daily life.

BACKGROUND AND PURPOSE: The use of self-report measurements may be problematic in patients with limitations that interfere with reliable self-assessment like cognitive impairment, as may be the case in multiple sclerosis (MS). In these situations proxy respondents, such as close relatives or healthcare providers, may provide valuable information. To examine the accuracy and value of healthcare providers and close relatives to assess disease impact of MS. METHODS: MS patients, close relatives and healthcare providers completed the Multiple Sclerosis Impact Scale (MSIS-29) before and after a rehabilitation program. Agreement between outcomes was assessed by calculating mean absolute and directional differences and intraclass correlation coefficients. RESULTS: Comparison of ratings between patients and proxy respondents revealed low levels of agreement. Close relatives appeared to significantly overestimate the disease impact of MS whereas healthcare providers tended to underestimate the disease impact of MS. CONCLUSION: Caution is advised when incorporating close relatives and healthcare providers as proxy respondents in a rehabilitation setting. However, when close relatives are consulted, one should expect a certain level of overestimation of disease impact. When consulting healthcare providers, one should expect a certain level of underestimation of disease impact.

Clinical impact of 20% worsening on Timed 25-foot Walk and 9-hole Peg Test in multiple sclerosis.

INTRODUCTION: Quantitative tests of motor function, like the Timed 25-foot Walk (T25FW) and 9-hole Peg Test (9HPT), are increasingly being applied as outcome measures in multiple sclerosis (MS) clinical trials. The quantitative nature of the data has a favorable impact on responsiveness, but the clinical impact of the changes is uncertain. The goal of this study was to assess whether a change on T25FW and 9HPT does indeed have a clinical meaning. This was accomplished by comparing 20% changes on these quantitative measurements to concomitant changes on the Guy's Neurological Disability Scale (GNDS), a scale which measures patient-perceived daily life disability. METHODS: From a longitudinal database, we selected patients with at least two measurements of T25FW, 9HPT and GNDS with a minimal time interval of 350 days. In those patients who experienced at least a 20% change on T25FW or 9HPT, GNDS score changes were examined more closely. RESULTS: Of 527 patients, 143 experienced a >20% worsening on their T25FW and 71 on their 9HPT, respectively. Patients with a 20% increase in T25FW or 9HPT had more GNDS worsening than patients without such an increase. GNDS worsening associated with an increase in T25FW was mainly due to an increase in perceived disability related to lower extremity function and fatigue; GNDS worsening associated with an increase in 9HPT was more diffuse with respect to domains involved. CONCLUSION: Worsening on T25FW or 9HPT has a clinical impact on disability, as perceived by MS patients during daily life functioning.

[Mental and physical health problems of, and the use of healthcare by, Afghan, Iranian and Somali asylum seekers and refugees]. / Psychische en lichamelijke gezondheidsproblemen van en gebruik van zorg door Afghaanse, Iraanse en Somalische asielzoekers en vluchtelingen.

OBJECTIVE: To estimate the prevalence rates of mental and physical health problems and the use of healthcare services among adult asylum seekers and recognised refugees from Afghanistan, Iran and Somalia in the Netherlands. DESIGN: Cross-sectional study. METHOD: Asylum seekers were approached in 14 reception centres and refugees were interviewed in 3 municipalities (Arnhem, Leiden and Zaanstad). Respondents were interviewed in their own language and asked questions pertaining to: general health, chronic complaints, symptoms of post-traumatic stress disorder (PTSD), symptoms of depression/ anxiety, the use of healthcare services (general practitioner, medical specialists, hospitalisation, mental-health services, medication) and background variables. RESULTS: A total of 232 asylum seekers and 178 refugees participated (response rates of89% and 59%, respectively). Of these, 142 (61%) and 99 (56%), respectively were males and the average age was 34.4 (SD: 11.o) and 40.3 (SD: 13.3) years, respectively. Compared to refugees, asylum seekers more often considered their health to be poor (42% and 59%, respectively), had more symptoms of depression/anxiety (39% and 68%, respectively), and had more symptoms of PTSD (11% and 28%, respectively). No differences were found between refugees and asylum seekers in the self-reported use of healthcare services. CONCLUSION: This study showed that asylum seekers have more health problems than refugees, but that there are no differences in the self-reported use of healthcare services. More research is needed to answer the question ifasylum seekers have sufficient access to the healthcare system.

Proxy measurements in multiple sclerosis: agreement between patients and their partners on the impact of multiple sclerosis in daily life.

BACKGROUND: The use of self-report measurements in clinical settings has increased. The underlying assumption for self-report measurements is that the patient understands the questions fully and is able to give a reliable assessment of his or her own health status. This might be problematic in patients with limitations that interfere with reliable self-assessment such as cognitive impairment or serious mood disturbances, as may be the case in multiple sclerosis. In these situations proxies may provide valuable information, provided we can be certain that proxies and patients give consistent ratings. OBJECTIVE: To examine whether patients with multiple sclerosis and their partners agree on the impact of multiple sclerosis on the daily life of the patient by using the Multiple Sclerosis Impact Scale (MSIS-29). METHODS: 59 patients with multiple sclerosis and their partners completed the MSIS-29. Agreement was examined, comprehensively at scale score levels and item functioning, using both traditional and less conventional psychometric methods (Rasch analysis). RESULTS: Agreement between patients and partners was good for the physical scale, and slightly less but still adequate for the psychological scale. Mean directional differences did not show considerable systematic bias between patients and proxies. Intraclass correlation coefficients (ICCs) satisfied the requirements for agreement, but were higher for the physical scale (0.81) than for the psychological scale (0.72). These findings were supported by Rasch analyses. CONCLUSION: In this sample, albeit small, partners provided accurate estimates of the impact of multiple sclerosis. This supports the value of self-rating scales and indicates that partners might be useful sources of information when assessing the impact of multiple sclerosis on the daily life of patients.

Circulating urotensin II levels in moderate to severe congestive heart failure: its relations with myocardial function and well established neurohormonal markers.

Urotensin II (UII) is a potent vasoactive cyclic peptide thought to play a role in myocardial hypertrophy and remodelling. We therefore determined UII plasma levels in congestive heart failure (CHF) patients and its relationship with the severity of the disease and well-established markers of left ventricular function. UII was significantly higher in CHF patients (n = 57) than in controls (n = 48) [geometric mean (pg/ml), 95% PI: 1.32 (0.67-2.59) versus 0.84 (0.31-1.61), p < 0.0001], was related to the functional class of the disease and correlated negatively with left ventricular ejection fraction (r = -0.316, P = 0.016). Furthermore, UII correlated significantly with Big-ET1 (r = 0.32, p = 0.03), BNP (r = 0.42, p = 0.005) but poorly with Nt-proANP (r = 0.28, p = 0.07). Our results suggest that UII could play a role in worsening the course of congestive heart failure and is associated with established markers of cardiovascular dysfunction.

How similar are commonly combined criteria for EDSS progression in multiple sclerosis?

INTRODUCTION: Measuring disease progression is an important aspect of multiple sclerosis (MS) clinical trials. Commonly applied disability endpoints include time to clinically meaningful Expanded Disability Status Scale (EDSS) change, or the number of patients in whom such a change has occurred. Typically, clinically meaningful EDSS change has been defined as a change of 1.0 point on Kurtzke's EDSS in patients with an entry EDSS score of 5.5 or lower, or 0.5 point in patients with a higher EDSS score. Our goal was to evaluate whether these changes can be considered as similar. Therefore, we compared EDSS changes to corresponding changes in the Guy's Neurological Disability Scale (GNDS), which is a measure of patient perceived disability, and the Multiple Sclerosis Functional Composite (MSFC), which is an examination-based quantitative scoring of neurological impairment. METHODS: From a large longitudinal database, we selected two groups of patients with a clinically meaningful change in EDSS score according to the usual criteria: patients with EDSS change > or = 1.0 for baseline EDSS < or = 5.5 and patients with EDSS change > or = 0.5 for baseline EDSS > or = 6.0. We compared changes in GNDS sum score and in MSFC score between both groups. RESULTS: In the group with baseline EDSS > or = 6.0, GNDS and MSFC changes were higher than in patients with baseline EDSS < or = 5.5. The difference in change was 1.00 (95% confidence interval (CI): -0.35 to 2.36) for the GNDS and 0.412 (95% CI: 0.300-0.525) for the MSFC. CONCLUSION: Our results indicate that a 0.5 point EDSS change in patients with baseline EDSS > or = 6.0 cannot be considered equal to a 1.0 point change in patients with baseline EDSS < or = 5.5.

Psychometric evaluation of the multiple sclerosis impact scale (MSIS-29) for proxy use.

BACKGROUND: There may be difficulties in the use of self report measurements in patients with cognitive impairment or serious mood disturbances which interfere with reliable self assessment, as may be the case in multiple sclerosis (MS). In such cases proxies may provide valuable information. However, before using any questionnaires in a proxy sample, the questionnaire should be evaluated for proxy use. OBJECTIVE: To evaluate the psychometric properties of the 29 item Multiple Sclerosis Impact Scale (MSIS-29) when used by proxies of MS patients. METHODS: A sample of 62 partners of MS patients completed the MSIS-29. The data were evaluated for the psychometric criteria of the MSIS-29, including data quality, scaling assumptions, acceptability, reliability, validity, and responsiveness. RESULTS: Psychometric evaluation was satisfactory; data quality was high, and scaling assumptions and acceptability were good. Reliability was high (alpha>0.80). Findings were consistent with results of a psychometric evaluation in a patient sample. CONCLUSIONS: The MSIS-29 can be used reliably in proxies of patients with MS. As a next step the relation between data obtained from patients and proxies needs to be studied, focusing on factors that may affect agreement and discrepancies.

[The 'van der Linden' retainer]. / De Van der Linden-retainer.

Normally, only the anterior teeth have to be retained after an orthodontic treatment. For that purpose, a lingually bonded wire is preferred in the mandible and a removable plate in the maxilla. The design of the Van der Linden-retainer is based on theoretical considerations and secures rigid fixation of the six anterior teeth with solid anchorage in that region. A retention plate should not be used to move anterior teeth. However, with instant corrections small improvements can be realized. The fabrication and clinical use of the Van der Linden-retainer is explained and illustrated.

[The specialty of orthodontics in European perspective]. / Het specialisme orthodontie in Europees perspectief.

After clarifying the role and significance of the European Federations of Orthodontic Specialists Associations (EFOSA), the results of a recent survey on the situation of the Speciality of Orthodontics in Europe are presented. Among the many items included are the recognition and availability of orthodontic specialists, their training, their working conditions, the height of the charged fees and the present insurance and refunding systems.

Behavior and cortisol levels of dogs in a public animal shelter, and an exploration of the ability of these measures to predict problem behavior after adoption.

Behavior and plasma cortisol levels were examined in puppies and juvenile/adult dogs admitted to a public animal shelter. A behavioral test was developed to assess the responses of the dogs to novel or threatening conditions. Factor analysis of the behavioral responses of 166 dogs on day 3 in the shelter yielded six factors (locomotor activity, flight, sociability, timidity, solicitation, and wariness) that accounted for 68% of the total variance. Among those dogs remaining in the shelter for 9 days, plasma cortisol levels declined from day 2 to 9. Cortisol levels were weakly related to factor scores. In order to explore the relation of measures in the shelter to later behavior, questionnaires assessing problem behaviors were mailed to new owners of dogs 2 weeks and 6 months following adoption. Among puppies, wariness scores were negatively correlated with behavior problems at 2 weeks and cortisol levels were negatively correlated with behavior problems at 6 months. These results suggest how measures of behavior and endocrine activity obtained in shelters might prove useful for screening dogs for adoption or targeting dogs for behavioral intervention.

CT study of craniovertebral rotation in whiplash injury.

The present study investigates the diagnostic value of rotatory computed tomography (CT) examinations in normal subjects and patients with whiplash associated disorders (WAD), with the aim of reproducing earlier findings of rotatory CT studies. Forty-seven WAD patients with persistent complaints after a rear-end collision (non-cranial contact acceleration/deceleration trauma) were enrolled in this study. To guarantee a maximally homogeneous study population, only WAD patients with a marked passive cervical retroflexion restriction were included. Transversal CT slices in left and right rotation were made for all cervical levels (the skull included). CT slices in neutral position were used to reconstruct partially depicted vertebrae. Absolute rotatory values were estimated according the method of Penning and Dvorak. For all levels the relative rotatory (RR) value was calculated by dividing absolute rotation values of a particular cervical level by the corresponding total cervical rotation. The measuring error was estimated by comparing the findings of two separately performed measuring procedures. Two age groups of WAD patients were formed. A younger group was matched for age with 26 normal healthy volunteers (the original data of an earlier study). The use of neutral CT slices for reconstruction of a partially depicted cervical vertebra resulted in a measurement error of 1.9 degrees at the level of C0/C1 (occiput/atlas) and 3.5 degrees at C1/C2. Suspected hypermobility as defined by Dvorak was rare in our WAD patients (6.4% C0/C1 and 10.6% C1/C2). RR values at C0/C1 were significantly larger in 79% of the WAD patients. Discriminant analysis of the RR values showed 80% correctly classified WAD patients. Only 11.5% of the normal subjects were classified as false-positive. Since no hypermobility was found at C1/C2, a traumatic lesion of the alar ligaments is less likely. It was concluded that the use of absolute rotation values in rotatory CT scan procedures has a low diagnostic value in WAD patients. Excessive RR values were only found at C0/C1. A traumatic lesion of the ligaments at C0/C1, which prevent vertical translation of the skull with regard to the atlas, is hypothesised. The results of the discriminant analysis of the RR values make this method applicable for the individual WAD patient in daily practice.