Vitamin and mineral status in chronic fatigue syndrome and fibromyalgia syndrome: A systematic review and meta-analysis

Original language English
Pages (from-to) e0176631
Journal PLoS ONE
Volume 12
Issue number 4
State Published – 28-Apr-2017
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Dosering antistollingsmedicijn aanpassen voor patiënt met chronische leverziekte

​Wilma Potze: Hemostasis and anticoagulant therapy in liver diseases Verschillende soorten antistollingsmiddelen blijken beduidend anders te werken …

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Isolation and characterization of a thermostable F420:NADPH oxidoreductase from Thermobifida fusca.

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Isolation and characterization of a thermostable F420:NADPH oxidoreductase from Thermobifida fusca.

J Biol Chem. 2017 Apr 14;:

Authors: Kumar H, Nguyen QT, Binda C, Mattevi A, Fraaije MW

Abstract
F420H2-dependent enzymes reduce a wide range of substrates that are otherwise recalcitrant to enzyme-catalyzed reduction, and their potential for applications in biocatalysis has attracted increasingly attention. Thermobifida fusca is a moderately thermophilic bacterium and holds high biocatalytic potential as a source for several highly thermostable enzymes. We report here on the isolation and characterization of a thermostable F420:NADPH oxidoreductase (Tfu-FNO) from T. fusca, being the first F420-dependent enzyme described from this bacterium. Tfu-FNO was heterologously expressed in Escherichia coli, yielding up to 200 mg recombinant enzyme per liter of culture. We found that Tfu-FNO is highly thermostable, reaching its highest activity at 65 °C and that Tfu-FNO is likely to act in vivo as an F420 reductase at the expense of NADPH, similar to its counterpart in Streptomyces griseus We obtained the crystal structure of FNO in complex with NADP+ at 1.8 Å resolution, providing the first bacterial FNO structure. The overall architecture and NADP+-binding site of Tfu-FNO were highly similar to those of the Archaeoglobus fulgidus FNO (Af-FNO). The active site is located in a hydrophobic pocket between an N-terminal dinucleotide-binding domain and a smaller C-terminal do-main. Residues interacting with the 2′-phosphate of NADP+ were probed by targeted mutagenesis, indicating that Thr28, Ser50, Arg51, and Arg55 are important for discriminating between NADP+ and NAD+. Interestingly, a T28A mutant increased the kinetic efficiency more than three-fold as compared with the wild-type enzyme when NADH is the substrate. The biochemical and structural data presented here provide crucial insights into the molecular recognition of the two cofactors, F420 and NAD(P)H by FNO.

PMID: 28411200 [PubMed – as supplied by publisher]

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The ten-year course of depression in primary care and long-term effects of psychoeducation, psychiatric consultation and cognitive behavioral therapy.

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The ten-year course of depression in primary care and long-term effects of psychoeducation, psychiatric consultation and cognitive behavioral therapy.

J Affect Disord. 2017 Mar 30;217:174-182

Authors: Conradi HJ, Bos EH, Kamphuis JH, de Jonge P

Abstract
BACKGROUND: While the majority of depressed patients are treated in primary care, long-term follow-up data on the naturalistic course of depression and treatment effectiveness in this setting are scarce. This study examined the ten-year course of depression in primary care patients who had participated in a randomized clinical trial aiming at enhancement of depression outcomes.
METHODS: Of the original sample (n=267), 166 patients participated in the ten-year follow-up; missingness was random. Four treatments were compared: (1) Care As Usual (CAU; n=51); (2) a Psychoeducational Prevention program (PEP; n=68); (3) Psychiatric Consultation followed by PEP (PC+PEP; n=21); and (4) brief Cognitive Behavioral Therapy followed by PEP (CBT+PEP; n=26). During the first three years interviews based on the Composite International Diagnostic Interview (CIDI) were three-monthly applied, the seven years thereafter were assessed with a once applied CIDI and a face-to-face life chart-based interview.
RESULTS: During the ten-year follow-up 76.5% of the patients developed a new depressive episode, 83.4% used antidepressants (median usage 3.1 years), median depression diagnosis-free time was 9.0 years, and median residual symptom-free time 3.8 years. Treatments did not significantly differ on these outcomes, only trends appeared for lower depression severity for CBT+PEP, and, along with PEP, a higher proportion of symptom-free time.
LIMITATIONS: Assessment with the once applied life chart interview (a valid and reliable instrument) is less precise than the three-monthly assessments during the first three years.
CONCLUSIONS: The long-term course of depression in primary care is unfavorable, whereas treatment effects over time seem absent or small.

PMID: 28411506 [PubMed – as supplied by publisher]

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Mining prokaryotes for antimicrobial compounds: from diversity to function.

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Mining prokaryotes for antimicrobial compounds: from diversity to function.

FEMS Microbiol Rev. 2017 Apr 11;:

Authors: Tracanna V, de Jong A, Medema MH, Kuipers OP

Abstract
The bacterial kingdom provides a major source of antimicrobials that can either be directly applied or used as scaffolds to further improve their functionality in the host. The rapidly increasing amount of bacterial genomic, metabolomic and transcriptomic data offers unique opportunities to apply a variety of approaches to mine for existing and novel antimicrobials. Here, we discuss several powerful mining approaches to identify novel molecules with antimicrobial activity across structurally diverse natural products, including ribosomally synthesized and posttranslationally modified peptides, nonribosomal peptides and polyketides. We not only discuss the direct mining of genomes based on identification of biosynthetic gene clusters, but also describe more advanced and integrative approaches in ecology-based mining, functionality-based mining and mode-of-action-based mining. These efforts are likely to accelerate the discovery and development of novel antimicrobial drugs.

PMID: 28402441 [PubMed – as supplied by publisher]

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Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism: a systematic review.

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Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism: a systematic review.

Nephrol Dial Transplant. 2017 Apr 10;:

Authors: van der Plas WY, Dulfer RR, Engelsman AF, Vogt L, de Borst MH, van Ginhoven TM, Kruijff S, Dutch Hyperparathryoid Study Group (DHSG)

Abstract
Background.: Patients with end-stage renal disease (ESRD) have a decreased quality of life (QoL), which is attributable in part to ESRD-related hyperparathyroidism (HPT). Both cinacalcet and parathyroidectomy (PTx) are treatments for advanced HPT, but their effects on QoL are unclear. We performed a systematic review to evaluate the impact of cinacalcet and PTx on QoL.
Methods.: A systematic literature search was performed using PubMed and EMBASE databases to identify relevant articles. The search was based on the following keywords: ‘parathyroidectomy’ or ‘cinacalcet’, ‘secondary hyperparathyroidism’ or ‘renal hyperparathyroidism’ combined with ‘quality of life’ or ‘SF-36’ or ‘symptomatology’. Only studies reporting on QoL at baseline and during follow-up were included. QoL scores were extracted from the selected manuscripts and weighted means were calculated. Due to a lack of available data on QoL improvement in patients using cinacalcet, a meta-analysis could not be performed.
Results.: In all, eight articles reached our inclusion criteria. Of this, five articles reported the effect of PTx on QoL. All PTx studies were observational and non-controlled. The physical component scores of the 36-item Medical Outcomes Study Short-Form Health Survey increased significantly with a weighted mean of 35.5% (P < 0.05). Mental component scores increased with 13.7% (P < 0.05). Parathyroidectomy assessment of symptom scores improved from 561 preoperatively to 302 postoperatively (-259 points; -46.2%). Visual analogue scale scores decreased significantly for skin itching (46.6%), joint pain (30.4%) and muscle weakness (28.7%) (P < 0.05). Three studies on the effect of cinacalcet on QoL were included, including one randomized controlled trial. None of these studies showed significant improvement of physical component and mental component scores.
Conclusions.: PTx improved QoL in patients treated for ESRD-related HPT, whereas cinacalcet did not. The difference in impact between PTx and cinacalcet on QoL has not been compared directly.

PMID: 28402557 [PubMed – as supplied by publisher]

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Characterization of the Paenibacillus beijingensis DSM 24997 GtfD and its glucan polymer products representing a new glycoside hydrolase 70 subfamily of 4,6-α-glucanotransferase enzymes.

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Characterization of the Paenibacillus beijingensis DSM 24997 GtfD and its glucan polymer products representing a new glycoside hydrolase 70 subfamily of 4,6-α-glucanotransferase enzymes.

PLoS One. 2017;12(4):e0172622

Authors: Gangoiti J, Lamothe L, van Leeuwen SS, Vafiadi C, Dijkhuizen L

Abstract
Previously we have reported that the Gram-negative bacterium Azotobacter chroococcum NCIMB 8003 uses the 4,6-α-glucanotransferase GtfD to convert maltodextrins and starch into a reuteran-like polymer consisting of (α1→4) glucan chains connected by alternating (α1→4)/(α1→6) linkages and (α1→4,6) branching points. This enzyme constituted the single evidence for this reaction and product specificity in the GH70 family, mostly containing glucansucrases encoded by lactic acid bacteria (http://www.CAZy.org). In this work, 4 additional GtfD-like proteins were identified in taxonomically diverse plant-associated bacteria forming a new GH70 subfamily with intermediate characteristics between the evolutionary related GH13 and GH70 families. The GtfD enzyme encoded by Paenibacillus beijingensis DSM 24997 was characterized providing the first example of a reuteran-like polymer synthesizing 4,6-α-glucanotransferase in a Gram-positive bacterium. Whereas the A. chroococcum GtfD activity on amylose resulted in the synthesis of a high molecular polymer, in addition to maltose and other small oligosaccharides, two reuteran-like polymer distributions are produced by P. beijingensis GtfD: a high-molecular mass polymer and a low-molecular mass polymer with an average Mw of 27 MDa and 19 kDa, respectively. Compared to the A. chroooccum GtfD product, both P. beijingensis GtfD polymers contain longer linear (α1→4) sequences in their structure reflecting a preference for transfer of even longer glucan chains by this enzyme. Overall, this study provides new insights into the evolutionary history of GH70 enzymes, and enlarges the diversity of natural enzymes that can be applied for modification of the starch present in food into less and/or more slowly digestible carbohydrate structures.

PMID: 28399167 [PubMed – in process]

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Screening for prostate cancer – medical policy by general practitioners in the northern part of the Netherlands

Introduction – The prostate-specific antigen (PSA) test has been widely introduced in the nineties. The use of the test as a screening method for prostate cancer is highly debated worldwide. Advocates argue that the PSA test allows for early detection of prostate cancer and the resulting decline in mortality, while opponents state that the PSA test has more negative consequences such as overdiagnosis and overtreatment. Guidelines concerning screening differ per country, and GPs (general practitioner) within the same continent have distinctive methods of using the PSA test. The aim of this study was to characterize the medical policy of GPs in the northern part of the Netherlands regarding PSA screening for prostate cancer.
Methods – A questionnaire was developed by the German counterpart of the study. After translating the questionnaire, a pilot study was conducted to test for feasibility and validity. The renewed version was spread during a training day for GP trainees (n=23) and it was sent to 179 GPs in the catchment area of the University Medical Center Groningen (UMCG). The questionnaire was designed to determine the associations between medical policy regarding the PSA test and characteristics and attitude of the GPs and consisted of three topics. The first topic was the use of PSA testing in practice. The second topic concerned determinants of PSA testing strategies. The third topic concerned the use of guidelines in PSA testing strategies.
Results – The study had an average response rate of 36% (100%, and 27.9%, respectively; n = 73). Regarding the characteristics, GPs who worked in a duo or group practice were more likely to perform a PSA test if a patient actively requested it (p = 0.046). Working experience of ten or more years was associated with a smaller probability to recommend the PSA test to relatives (p = 0.047). Concerning the attitude, GPs that are afraid of missing prostate cancer and GPs who find screening for cancer in general unimportant are more likely to perform a PSA test when a patient asks for it (p = 0.017, and p = 0.043, respectively). The majority of the GPs discusses the benefits and disadvantages of the PSA test with patients who actively request screening for PSA screening. GPs who are not afraid of missing prostate cancer and who find screening for cancer in general unimportant are less likely to recommend the PSA test to relatives (p = 0.001, and p = 0.001, respectively).
Conclusion – Working in a duo or group practice and being afraid of missing prostate cancer are correlated with a higher probability to perform PSA testing when a patient actively asks for screening for prostate cancer. GPs with ten or more years of working experience and not being afraid of missing prostate cancer are less likely to recommend the PSA test to their relatives. Finding screening for cancer in general unimportant is associated with both being more likely to performing a PSA and not recommending the PSA test to relatives.

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Popeye or Pinocchio? The relationship between muscle mass and grip strength in an elderly population by measuring muscle mass and testing grip strength

Background. The frailty syndrome is considered to be the most problematic expression of ageing. One of the underlying causes is a gradual decline in muscle mass and muscle strength. In the screening for patients at risk, standardization of the measurement instruments of loss of muscle is essential.
Objectives. This study aimed to measure muscle mass and muscle strength in elderly in order to correlate existing measurement instrument tools to each other. The second objective is to measure and correlate muscle density and muscle strength in elderly.
Design and setting. This prospective observational study included patients of 70 years and above visiting the outpatient clinic of the Gelre Hospital in Apeldoorn to undergo a Computed Tomography (CT) scan of the abdomen (January-April 2016). Muscle mass was calculated by Total Psoas Area (TPA). Muscle strength was measured by hand grip strength (GS). In pa-tients with identical amount of contrast fluid, muscle density was measured using the Houns-field Unit Average Calculation (HUAC).
Results. A total of 175 patients (median age 76 years) was included. After correction for con-founding factors (age, gender, and frail state) GS and TPA remained significantly correlated (R²=0.43, P=0.001). GS and HUAC were not significantly correlated (P=0.46 for men and P=0.39 for women). Influence of contrast fluid on HUAC was observed.
Conclusion. Although muscle strength (GS) and muscle mass (TPA) are correlated, they each symbolize different aspects of a patient’s physical condition. Muscle density (HUAC) is not correlated with muscle strength.

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The influence of posterior tilt of the femoral head on the failure rate of femoral neck fractures. Ananalysis of 164 undisplaced femoral neck fractures treated by Gannet osteosynthesis

Introduction: Failure rates of the so called undisplaced femoral neck fractures (FNF) vary from 4-23%. Literature states that undisplaced FNF always should be treated by internal fixation. The classification in undisplaced and displaced FNF is most commonly performed by the Garden classification. This classification is solely based upon the AP radiographs. Consequently the tilting of the femoral head in the anterior and posterior direction is not included in this classification. Over the years there have been many studies to identify pre- and post-operative predicators for failure. Yet posterior tilt, also known as retroversion or anterior angulation, of the femoral head as a predictor is only described by several authors. This study investigates two different methods to measure posterior tilt of the femoral head and its influence on the failure rate of undisplaced FNF.
Patients and methods: The posterior tilt of 164 undisplaced FNF treated by Gannet osteosynthesis were measured on the lateral X-ray of the hip using the Lateral Garden Angle (LGA) and the Posterior Tilt Measurement (PTM). Correlation between posterior tilt of the femoral head and the failure rate after Gannet osteosynthesis was assessed. Furthermore an intra- and inter observer reliability study was done with the two different methods to assess the validity of these measure methods.
Results: The overall failure rate was 5.5%. No correlation could be found between the posterior tilt of the femoral head and the failure rate if it was measured according to the LGA (P=0.366). If the posterior tilt was measured using the PTM a larger angle was associated with a higher failure rate (P=0.030). Retroversion of ≥20° measured using PTM is associated with a 4 times higher failure rate (OR = 4.286 (CI 95% 1.092 – 16.826) (P-value = 0.037)). The intra and inter observer reliability of the LGA was 0.765 and 0.601(P <0.001). For the PTM the intra and inter observer reliability was 0.790 and 0.773 (P <0.001). Conclusion: The Lateral Garden Angle should not be used to measure posterior tilt because its validity is inferior to the Posterior Tilt Measurement. If the posterior tilt of the femoral head is measured using the PTM it is associated with a higher failure rate. Posterior tilt of ≥20° can be used as a significant predictor for failure in undisplaced FNF treated by Gannet osteosynthesis. The introduction of the PTM may lead to a paradigm shift in the operative treatment of the undisplaced FNF because it identifies that ‘stable’ FNF with a posterior tilt greater than 20° in fact behave like unstable fractures. Therefore the indication for internal fixation in the elderly patients will shift to a hip replacement if the posterior tilt of the femoral head rises above 20°.

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Combination therapy of antithrombin and alpha-1 proteinase inhibitor in a murine model of direct acute lung injury.

SUMMARY
INTRODUCTION
Acute respiratory distress syndrome (ARDS) is characterized by hypoxemic respiratory failure following an either direct (e.g. pneumonia) or indirect (e.g. sepsis) pulmonary insult. Dealing with hypoxemia remains the major challenge at bedside and is currently approached with lung-protective mechanical ventilation since specific treatment targeting the pathogenesis of ARDS is lacking.
Pathological hallmarks of ARDS are uncontrolled inflammation and coagulation leading to alveolar and interstitial edema, as well as infiltration of inflammatory cells in the alveolar space. Various cytokines, proteases and their inhibitors play a pivotal role in modulation of inflammation. Recent evidence suggests that proteinase inhibitors antithrombin (AT) and α1-protease-inhibitor (A1PI), may exert anti-inflammatory, anti-coagulant and immunomodulatory properties and may even have synergistic beneficial effect in diminishing inflammation. We hypothesize that combination therapy of AT and A1PI (COMBO therapy) has beneficial effect on lung damage and inflammatory markers in a murine model of direct acute lung injury.
METHODS
Balb/c mice (n=44) received 5 mg/kg LPS (E. Coli, 0127:B8) intranasally (i.n.) simulating direct acute lung injury (T=0). One hour later (T=1) the intervention drugs AT, A1PI only and COMBO therapy were administered intraperitoneally (i.p.) and at T=6 all mice were sacrificed. State of inflammation was determined using Luminex to quantify levels of inflammatory markers TNFα, IL-1β, IL-6, KC and IL-10 in plasma and bronchoalveolar fluid (BALF), and assessing total protein levels and neutrophil influx in BALF.
RESULTS
Intranasal LPS administration induced lung injury, evidenced by markedly increased levels of TNF-α and IL-1β in BALF and increased vascular permeability in all intervention groups and the control group compared to the vehicle group (P<0.05, for all groups compared to vehicle). This study did not detect any differences with regards to markers of inflammation, neutrophil migration or alveolar-capillary permeability between the intervention groups compared to the control group. CONCLUSION This study investigated the combination therapy of AT and A1PI in a murine model of direct ARDS. No differences in markers of inflammation, neutrophil migration or alveolar-capillary permeability were detected between the intervention groups and the saline control group, not showing a beneficial effect of COMBO therapy. Future experiments are needed to test COMBO in different models, including pretreatment and an indirect lung injury model, to draw firm conclusions regarding the efficacy of COMBO.

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Outcomes of the failure of selective nonoperative management of penetrating abdominal trauma

Introduction: Over the past five decades there has been a shift from mandatory operative
exploration to selective non-operative management (SNOM) in penetrating abdominal
trauma(PAT). Besides all the proven benefits of SNOM, the main concern is the potential
harm in patients who fail SNOM and eventually experience a delay in treatment. The aim of
this study is to investigate if delayed surgery due to failed SNOM is associated with adverse
effects in PAT patients.
Methods: All patients presenting at the Trauma Centre of Groote Schuur Hospital, Cape
Town in a 13-month period (05/15-06/16) were included. Patient groups were divided in
patients who went immediately for surgery and patients who failed SNOM and then had
surgery. Outcomes included mortality, morbidity rate and length of stay.
Results: Of 485 patients, 219 (45%) were managed by SNOM of which 26 (12 %) failed the
observation period and 266 (55%) with immediate surgery. The median time to OR was in the
immediate surgery group 5 hours (Q1-Q3 2-8) and in the failed SNOM group 45 hours (Q1-
Q3 27-68). Mortality was only observed in the immediate surgery group. There was no
difference in the number of patients who had complications (failed SNOM 31% vs. 37%
p=0.71), or in length of stay (failed SNOM median 7(5-10) vs. 7(5-12) p=0.95)
Conclusion: Under a structured clinical protocol, the delay does not cause preventable
mortality, morbidity or length of stay. Nevertheless further research has to be carried out to
emphasize our results.

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The role of renal potassium excretion in serum potassium derangements in two different patient groups

Background
Potassium derangements are associated with increased mortality at the intensive care unit
(ICU). This study hypothesizes that increased renal loss of potassium plays a role in the
development of potassium derangements in patients with traumatic brain injury who received
thiopental to induce barbiturate coma (Study A) and in patients who were cooled to
therapeutic hypothermia (TH, 33°C) or therapeutic normothermia (TN, 36°C) following an
out-of-hospital cardiac arrest (OHCA) (Study B).
Methods
A single-centre retrospective study was performed. Serum potassium levels were used to
determine the incidence of potassium derangements. Potassium balances were calculated from
potassium intake and potassium excretion. In Study A three phases were compared; before,
during and after thiopental infusion. In Study B the hypothermia/normothermia phase
(HT/NT phase) consisted of two calendar days after admission. The post-HT/NT phase
consisted of two calendar days following cessation of the HT/NT phase.
Results
Five patients were included in Study A and 34 patients in Study B (n=16 for TH, n=18 for
TN). In Study A, the incidence of hypokalemia was higher during thiopental infusion
compared to before and after therapy, respectively, 100%, 60% and 25% (P=0.03). There
were no significant differences between potassium balances during thiopental therapy
compared to before and after therapy. In Study B, median cumulative potassium
administration during the HT/NT phase was 112 (IQR, 65 to 142) mmol in the TH group
compared to 36 (IQR, 25 to 54) mmol in the TN group (P<0.001), which resulted in median serum potassium levels of, respectively, 4.2 (IQR, 3.9 to 4.6) mmol/L and 4.0 (IQR, 3.8 to 4.3) mmol/L (P<0.001). Hyperkalemia was more common in the TH group than in the TN group, respectively, in 63% and 11% of patients (P=0.003). There was no difference in median potassium balances between the TH group and the TN group (P=0.145). Conclusion In our study increased renal loss of potassium did not play an evident role in the development of hypokalemia during thiopental infusion and during hypothermia. Since hypokalemia was common during thiopental infusion whereas hyperkalemia was common during and after cooling in the TH group, potassium should be monitored regularly in order to be able to adjust potassium administration. An additional study with increased sample size is necessary to determine the exact role of renal potassium loss in patients who received a barbiturate coma or were cooled to hypothermia/normothermia after hospital admission with an OHCA.

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The Quality of Clinical Information in Adverse Drug Reaction Reports by Patients and Healthcare Professionals: A Retrospective Comparative Analysis

Original language English
Journal Drug Safety
State Published – 12-Apr-2017
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Intestinal PPARδ protects against diet-induced obesity, insulin resistance and dyslipidemia

Intestinal PPARδ protects against diet-induced obesity, insulin resistance and dyslipidemia

Doktorova, M., Zwarts, I., Zutphen, T. V., Dijk, T. H. V., Bloks, V. W., Harkema, L., Bruin, A. D., Downes, M., Evans, R. M., Verkade, H. J. & Jonker, J. W. 12-Apr-2017 In : Scientific Reports. 7, 1, p. 846

Research output: Scientific – peer-reviewArticle

Original language English
Pages (from-to) 846
Journal Scientific Reports
Volume 7
Issue number 1
State Published – 12-Apr-2017
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Erosieve gebitsslijtage, wat weten jongvolwassenen hierover en hoe wensen zij tandheelkundige informatie te ontvangen :Een multicenter studie onder jongvolwassen tandartsbezoekers in Noord-Nederland, binnen het project ‘Tandheelkundig Onderzoek en Prakt

Probleem- en doelstelling
Erosieve gebitsslijtage is een veel voorkomend verschijnsel onder de gehele Nederlandse bevolking. Bij jongvolwassenen zijn vaak al tekenen van deze slijtage te zien. Het is niet duidelijk of jongvolwassenen kennis hebben van erosieve gebitslijtage.
Dit onderzoek heeft als doel inzicht te verkrijgen in de mate van kennis over erosieve gebitsslijtage door jongvolwassenen. Tevens is beoogd inzicht te verkrijgen in de gewenste manier van het overbrengen van tandheelkundige informatie op jongvolwassenen.
Materiaal en methoden
Dit onderzoek is opgezet binnen het project van “Tandheelkundig Onderzoek en Praktijk Noord Nederland” (TOP-NN project). Aan het onderzoek hebben 25 praktijken deelgenomen. In het onderzoek zijn vragenlijsten ingevuld door jongvolwassen (20 t/m 25 jaar) tandartsbezoekers. In totaal zijn er 331 vragenlijsten geïncludeerd. De vragenlijst bevat vragen over een drietal onderdelen, namelijk de achtergrond van de deelnemer, de kennis omtrent erosieve gebitsslijtage en hoe de deelnemer tandheelkundige informatie wenst te ontvangen.
Op basis van de juiste antwoorden op de vragen naar de kennis over erosieve gebitsslijtage is een kennisscore opgesteld. De maximaal te behalen kennisscore was 24 punten.
De intraclass correlatie (ICC) voor de deelnemers in de mondzorgpraktijken was nul, dit houdt in dat de kennisscore erosieve gebitsslijtage van de jongvolwassenen onafhankelijk is van de mondzorgpraktijken waartoe zij behoren. Statistische toetsing is uitgevoerd met behulp van de Mann-Whitney U test, de Kruskal Wallis test en een lineaire regressie analyse.
Resultaten
De mediane kennisscore is 16 punten en de 25%-75% kennisscores zijn 13-18 punten. Vragen die vaak juist zijn beantwoord (88-97% juist) gingen over de erosieve aspecten van cola, energiedranken, vruchtensappen en sportdrank. Tevens zijn de niet-erosieve aspecten van water en mineraalwater (resp. 97% en 91% juist) ook bij veel jongvolwassenen bekend. De vragen die door minder dan de helft (9-44%) van de jongvolwassenen goed zijn beantwoord gaan over de gevolgen van erosieve gebitsslijtage, het effect van een droge mond, effect van water drinken direct na een zuurmoment, het niet-erosieve effect van yoghurt en het aantal eet- en drinkmomenten op een dag. Het aantal eet- en drinkmomenten op een dag is slechts door 9% van de deelnemers juist beantwoord.
De lineaire regressie analyse toont een significante mate van samenhang tussen de behaalde kennisscore en twee predictoren, namelijk een hoog opleidingsniveau en een deelnemer die eerder informatie over tandslijtage heeft ontvangen van zijn tandarts of mondhygiënist scoren hoger.
De meeste jongvolwassenen (67%) zoeken zelf niet naar tandheelkundige informatie. Als de jongvolwassenen wel willen zoeken naar tandheelkundige informatie dan geven zij de voorkeur aan dit te doen via een internetzoekmachine (80%) of door het te vragen aan de tandarts (56%).
De jongvolwassenen ontvangen het liefste tandheelkundige informatie door middel van een gesprek (81%), een folder (39%) of een e-mail (28%). Hierbij konden meerdere antwoorden worden aangekruist. De combinatie van een gesprek met een folder of e-mail is vaak gekozen.
Tevens geven de jongvolwassenen aan de informatie het beste te kunnen onthouden wanneer het hen wordt verteld (71%) of wanneer ze het kunnen lezen (51%). Ook hierbij konden meerdere antwoorden worden aangekruist. De combinatie van verteld worden en kunnen lezen veel gekozen.
Slechts 8% van de jongvolwassenen geeft aan tandheelkundige informatie te willen ontvangen door het aanraden van een app. Bij het zelf zoeken naar tandheelkundige informatie geeft 2% aan dit via de app van het Ivoren Kruis te doen en 3% geeft aan een andere app te gebruiken hiervoor.
Conclusie
De jongvolwassenen weten nog lang niet alles over erosieve gebitsslijtage. Het maximale aantal eet- en drinkmomenten is bij bijna niemand bekend. Hoog opgeleiden en jongvolwassenen die al eerder tandheelkundige informatie over erosieve gebitsslijtage hebben ontvangen hebben een significant hogere kennisscore.
De jongvolwassenen wensen te worden geïnformeerd door een gesprek met de mondzorgprofessional in combinatie met een folder of een e-mail. Het aanraden van een app is niet zinvol.
Voor het verhogen van de tandheelkundige kennis onder jongvolwassenen zal individuele mondelinge voorlichting ondersteund met schriftelijke informatie nodig zijn. Het ontwikkelen van effectieve individuele schriftelijke ondersteuning met extra aandacht voor de lager opgeleiden kan een volgende stap zijn tegen erosieve gebitsslijtage.

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Het succes van endodontische behandelingen in een gedifferentieerde endodontologiepraktijk

Objectives
The aim of this study is to determine the success of endodontic treatment in a specialised en-dodontic practice and to identify factors predicting that success.
Method
In this study, the success rate of endodontically treated teeth was determined by looking at the healing and the survival of treated teeth. To achieve this, patient files were used in a retro-spective observation study. Using this method, a comparison was made between the preopera-tive status and the status at the time of recall, at least nine months after treatment. The surviv-al rate was decided by determining whether extraction took place or not. Healing was deter-mined by examining the clinical- and radiographic results. Assessment of these results were conducted using two criteria: strict- and loose-criteria.
Four factors were used for a significant predicting value on the outcome of healing: preoperative periapical radiolucency, complicating operative factors, the technical quality of the endodontic treatment, and the type of endodontic treatment. Statistical analysis was per-formed by using a logistic regression for outcomes of the several assessment criteria.
Results
Different study populations were performed by using the available information regarding rates of healing and survival. This research shows that 156 out of 157 teeth (99,4%) survived. By using the strict assessment criteria, 41 of the 131 teeth were classified as healed. Using the non-strict assessment criteria 109 of 131 teeth (83,2%) were classified as being healed.
The use of the strict criteria has shown a significant correlation between the presence or absence of a preoperative periapical radiolucency (OR: 95.55, p<0,001) and the presence or absence of complicating operative factors (OR: 5.91, p=0.029). The use of the loose-criteria has shown a significant correlation between the presence or absence of a preoperative periapical radiolucency and the type of endodontic treatment (OR: 2.686, p=0.041). Conclusions Comments can be made within the limits of this study concerning the success of endodontic treatment in a specialised endodontic practice. This study shows that a preoperative periapical radiolucency in particular has a significant predicting value on the rate of healing. Further-more, complicating operative factors and the type of endodontic treatment that was used, show a significant predicting value, depending on the assessment criteria used. Following the results of this study, additional research with multiple clinicians, work-ing at different endodontic practices is advised. Accessing the influence of specific elements of predictive values is advised. This would include the effect of the size of the preoperative periapical radiolucency and specific complicating operative factors.

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Stille COPD-epidemie op het platteland van Uganda

​Frederik van Gemert: Prevalence and impact of chronic obstructive pulmonary disease in a rural district of Uganda. De ziekte COPD (chronisch …

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Behandelwensen patiënt met hartfalen in kaart gebracht

​Imke Kraai: Patient-reported outcomes in patients with heart failure Onderzoeker Imke Kraai onderzocht hoe patiënten met hartfalen tegen hun eigen …

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IMPLANT SUPPORTED SINGLE TOOTH REPLACEMENT IN THE AESTHETIC ZONE :A 10 year follow-up study of a prospective, randomized clinical trial comparing the treatment outcome of three augmentation modalities

OBJECTIVE: The aim of this randomized controlled trial was to assess the 10-year effects of three different augmentation techniques for implant supported restorations in the maxillary aesthetic region regarding clinical and radiographic parameters, and patient-centred outcomes.
MATERIAL AND METHODS: Ninety-three patients requesting single tooth replacement and presenting with a horizontal bone deficiency were included. After augmentation, 93 ITIEstheticPlus implants were placed. Clinical variables, standardised radiographs and
photographs and patient questionnaires were analysed to assess the impact of the various augmentation techniques 1 month (T1), 12 months (T12) and 120 months (T120) after final crown placement.
RESULTS: 10-years implant survival was 95.7% and did not differ between the groups neither were significant differences observed in the other treatment outcomes assessed. Peri-implant bone loss was low, viz. 0.48±1.19 mm (mesial) and 0.30±1.24 mm (distal) at T120. Loss of midbuccal marginal gingival level at T120 was 0.32±0.83 mm. Mean overall satisfaction at T120 was 8.6 with 98.6% of the patients satisfied.
CONCLUSION: Clinical, radiographic, aesthetic and patient centred outcomes were very
favourable after 10 years and did not differ between the groups with different bone
augmentation techniques.

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