Maastricht, Netherlands
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Corcoran M.S.,MUMC | van Well G.T.J.,MUMC | van Well G.T.J.,Maastricht University | van Loo I.H.M.,School for Public Health and Primary Care
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2014

Molecular methods such as real-time polymerase chain reaction (PCR) are rapidly replacing traditional tests to detect fecal viral pathogens in childhood diarrhea. This technique has now increased the analytical sensitivity so drastically that positive results are found in asymptomatic children, leading to complex interpretation of real-time PCR results and difficult distinction between asymptomatic shedding and etiological cause of disease. We performed a review of the literature including pediatric studies using real-time PCR and a minimal inclusion period of one year to exclude bias by seasonality. We searched for studies on rotavirus, norovirus, adenovirus, astrovirus, and sapovirus, known to be the most common viruses to cause gastroenteritis in the pediatric population. For these viruses, we summarized the detection rates in hospitalized and community-based children with clinical symptoms of gastroenteritis, as well as subjects with asymptomatic viral shedding. Moreover, insight is given into the different viral sero- and genotypes causing pediatric gastroenteritis. We also discuss the scoring systems for severity of disease and their clinical value. A few published proposals have been made to improve the clinical interpretation of real-time PCR results, which we recapitulate and discuss in this review. We propose using the semi-quantitative measure of real-time PCR, as a surrogate for viral load, in relation to the severity score to distinguish asymptomatic viral shedding from clinically relevant disease. Overall, this review provides a better understanding of the scope of childhood gastroenteritis, discusses a method to enhance the interpretation of real-time PCR results, and proposes conditions for future research to enhance clinical implementation. © 2014, Springer-Verlag Berlin Heidelberg.


Bauwens M.,MUMC | Bauwens M.,Maastricht University | Wierts R.,MUMC | Van Royen B.,MUMC | And 5 more authors.
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2014

Purpose: Brown adipose tissue (BAT) has transformed from an interfering tissue in oncological 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) to an independent imaging research field. This review takes the perspective from the imaging methodology on which human BAT research has come to rely on heavily. Methods: This review analyses relevant PubMed-indexed publications that discuss molecular imaging methods of BAT. In addition, reported links between BAT and human diseases such as obesity are discussed, and the possibilities for imaging in these fields are highlighted. Radiopharmaceuticals aiming at several different biological mechanisms of BAT are discussed and evaluated. Results: Prospective, dedicated studies allow visualization of BAT function in a high percentage of human subjects. BAT dysfunction has been implicated in obesity, linked with diabetes and associated with cachexia and atherosclerosis. Presently, 18F-FDG PET/CT is the most useful tool for evaluating therapies aiming at BAT activity. In addition to 18F-FDG, other radiopharmaceuticals such as 99mTc- sestamibi, 123I-metaiodobenzylguanidine (MIBG), 18F- fluorodopa and 18F-14(R,S)-[18F]fluoro-6-thia- heptadecanoic acid (FTHA) may have a potential for visualizing other aspects of BAT activity. MRI methods are under continuous development and provide the prospect of functional imaging without ionizing radiation. Conclusion: Molecular imaging of BAT can be used to quantitatively assess different aspects of BAT metabolic activity. © 2014 Springer-Verlag.


Nijhuis R.,Rijnstate | Samuelsen T.,University of Tromsø | Savelkoul P.,MUMC | van Zwet A.,Rijnstate
Diagnostic Microbiology and Infectious Disease | Year: 2013

To prevent the spread of carbapenemase-producing bacteria, a fast and accurate detection of patients carrying these bacteria is extremely important. The Check-Direct CPE assay (Check-Points, Wageningen, The Netherlands) is a new multiplex real-time PCR assay, which has been developed to detect and differentiate between the most prevalent carbapenemase genes encountered in Enterobacteriaceae (blaKPC, blaOXA-48, blaVIM, and blaNDM) directly from rectal swabs. Evaluation of this assay using 83 non-duplicate isolates demonstrated 100% sensitivity and specificity and the correct identification of the carbapenemase gene(s) present in all carbapenemase-producing isolates. Moreover, the limit of detection (LoD) of the real-time PCR assay in spiked rectal swabs was determined and showed comparable LoDs with the ChromID CARBA agar. With an excellent performance on clinical isolates and spiked rectal swabs, this assay appeared to be an accurate and rapid method to detect blaKPC, blaOXA-48, blaVIM, and blaNDM genes directly from a rectal screening swab. © 2013 Elsevier Inc.


Vaes A.W.,Program Development Center | Cheung A.,Catharina Hospital | Atakhorrami M.,Philips | Groenen M.T.J.,Program Development Center | And 4 more authors.
Annals of Medicine | Year: 2013

Aim. This review evaluated the effects of activity monitor-based counseling on physical activity (PA) and generic and disease-specific health-related outcomes in adults with diabetes mellitus type II (DMII), chronic obstructive pulmonary disease (COPD), or chronic heart failure (CHF). Methods. Four electronic databases were searched for randomized controlled trials using activity monitor-based counseling versus control intervention or usual care in adults with DMII, COPD, or CHF. Pooled effect sizes were calculated using a random effects model. Results. Twenty-four articles were included: 21 DMII studies and 3 COPD studies. No CHF studies were identified. Pooled analysis showed that activity monitor-based counseling resulted in a significantly greater improvement in PA compared to control intervention or usual care in DMII. Furthermore, these interventions had a beneficial effect on hemoglobin A1c (HbA1c), systolic blood pressure, and body mass index (BMI) (P < 0.05), whereas no differences were found on diastolic blood pressure, and health-related quality of life. Meta-analysis of COPD studies was not possible due to lack of available data. Conclusion. Activity monitor-based counseling had a beneficial effect on PA, HbA1c, systolic blood pressure, and BMI in patients with DMII. Data in patients with COPD and CHF are limited or non-existing, respectively. © 2013 Informa UK, Ltd.


Hyperinflation is an important element in chronic obstructive pulmonary disease (COPD), contributing significantly to dyspnoea and exercise intolerance. Bronchodilators have some, albeit slight, effect on hyperinflation. Lung volume reduction surgery has been advocated in a highly select group of patients with heterogeneous, predominantly upper lobe, emphysema but morbidity and mortality associated with this intervention have hampered its widespread use in respiratory medicine. Bronchoscopic lung volume reduction has recently been introduced. Several studies have shown promising results, again in a highly select group of patients, with clinically relevant effects on symptoms, lung function and quality of life. However, for most COPD patients, prevention and slowing down of disease progression are much more important. Smoking cessation is the single most important intervention to achieve these goals. Furthermore, effective new anti-inflammatory drugs are needed since inhaled steroids, although widely used in COPD, are largely ineffective.


Van Gorkom G.N.Y.,MUMC
Nederlands Tijdschrift voor Geneeskunde | Year: 2013

A 64-year-old man presented with a slowly progressive left-sided orbital swelling that had been present for years. MRI of the orbits showed hypertrophic ocular muscles. Histopathological examination of a biopsy confirmed the diagnosis of small B-cell non-Hodgkin lymphoma.


Pannier F.,MUMC | Rabe E.,University of Bonn | Rits J.,Riga Vein Center | Kadiss A.,Riga Vein Center | Maurins U.,Riga Vein Center
Phlebology | Year: 2011

Background: Endovenous laser ablation (EVLA) is an efficient method to treat insufficient great saphenous veins (GSV) with high occlusion rates. 1-5 Most studies used 810, 940 or 980 nm diode lasers and a bare fibre. 1,2,6 Moderate postoperative pain and bruising are frequent findings. 2,6 Laser systems with higher wavelengths like 1470 nm with a higher absorption in water show less pain and bruising after the procedure. 7-9 A newlydeveloped fibre (radial fibre, Biolitec) emits the laser energy radially around the tip directly into the venous wall contrary to the bare fibre. 9 The aim of this study was to demonstrate the outcome and side-effects after EVLA of GSV with a 1470 nm diode laser (Ceralas E, Biolitec) by using the radial fibre. Methods: Non-randomized, prospective study including 50 unselected limbs of 50 patients with a duplex sonographically verified incompetent GSV. EVLA was performed with a 1470 nm diode laser (Ceralas E, Biolitec) and a radial fibre. In the same session all insufficient tributaries were treated by phlebectomy. Tumescent local anaesthesia with 0.05% lidocaine was applied perivenously. Laser treatment was carried out in a continuous mode with a power of 15W. Compression stockings (30 mmHg) were applied for one month. Postinterventional checkups took place one, 10, 30 days and six months after the procedure. Results: Three patients were lost to follow-up. The average linear endovenous energy density (LEED) was 90.8 J/cm vein (SD 35.3). At the six month follow-up all treated veins remained occluded and no new reflux in the treated segments occurred. No recurrent varicose veins had occurred so far. No severe complications such as deep venous thrombosis could be detected. In four patients at 30 days and three patients at six months local paresthesia occurred in the region of EVLA. Forty-four percent of patients did not have any pain after the treatment and 50% did not take any analgesic tablets at any time after the procedure. Postoperative ecchymoses in the track of the treated GSV was rare. In 80% of the limbs, no ecchymoses was observed after the treatment. Conclusion: EVLA of GSV with a radially emitting laser fibre by using a 1470 nmdiode laser is a safe and efficient treatment option.


van Gorkom G.N.,MUMC
Nederlands tijdschrift voor geneeskunde | Year: 2013

A 64-year-old man presented with a slowly progressive left-sided orbital swelling that had been present for years. MRI of the orbits showed hypertrophic ocular muscles. Histopathological examination of a biopsy confirmed the diagnosis of small B-cell non-Hodgkin lymphoma.


An increasing number of people with mild cognitive impairment (MCI) visits a memory clinic to find out whether their symptoms indicate Alzheimer's disease (AD). Markers in cerebrospinal fluid are increasingly used for the diagnosis of Alzheimer's disease. In the short term, CSF biomarkers are more accurate in ruling out progression to AD-type dementia than demonstrating progression. The predictive value of the CSF biomarkers increases with longer-duration follow-up and declines with age. The added value of CSF biomarkers is not yet clear in MCI patients in whom extensive clinical, neuropsychological examination or imaging have already been performed.


An increasing number of people with mild cognitive impairment (MCI) visits a memory clinic to find out whether their symptoms indicate Alzheimer's disease (AD). Markers in cerebrospinal fluid are increasingly used for the diagnosis of Alzheimer's disease. In the short term, CSF biomarkers are more accurate in ruling out progression to AD-type dementia than demonstrating progression. The predictive value of the CSF biomarkers increases with longer-duration follow-up and declines with age. The added value of CSF biomarkers is not yet clear in MCI patients in whom extensive clinical, neuropsychological examination or imaging have already been performed.

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