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Biomedical subjects

A Prins

Publications and source records attributed to A Prins.

At least 19 recordsLinked to original sources

Specification of adaxial and abaxial stomata, epidermal structure and photosynthesis to CO2 enrichment in maize leaves.

Acclimation to CO2 enrichment was studied in maize plants grown to maturity in either 350 or 700 microl l-1 CO2. Plants grown with CO2 enrichment were significantly taller than those grown at 350 microl l-1 CO2 but they had the same number of leaves. High CO2 concentration led to a marked decrease in whole leaf chlorophyll and protein. The ratio of stomata on the adaxial and abaxial leaf surfaces was similar in all growth conditions, but the stomatal index was considerably increased in plants grown at 700 microl l-1 CO2. Doubling the atmospheric CO2 content altered epidermal cell size leading to fewer, much larger cells on both leaf surfaces. The photosynthesis and transpiration rates were always higher on the abaxial surface than the adaxial surface. CO2 uptake rates increased as atmospheric CO2 was increased up to the growth concentrations on both leaf surfaces. Above these values, CO2 uptake on the abaxial surface was either stable or increased as CO2 concentration increased. In marked contrast, CO2 uptake rates on the adaxial surface were progressively inhibited at concentrations above the growth CO2 value, whether light was supplied directly to this or the abaxial surface. These results show that maize leaves adjust their stomatal densities through changes in epidermal cell numbers rather than stomatal numbers. Moreover, the CO2-response curve of photosynthesis on the adaxial surface is specifically determined by growth CO2 abundance and tracks transpiration. Conversely, photosynthesis on the abaxial surface is largely independent of CO2 concentration and rather independent of stomatal function.

Acclimatization↗

Effect of a comprehensive intervention program targeting general practice staff on quality of life in patients at high cardiovascular risk: a randomized controlled trial.

BACKGROUND: We implemented a comprehensive intervention program targeting general practice staff, that proved successful in optimizing practice organization and clinical decision-making. In this paper, health-related quality of life (HRQL) is investigated as a clinical outcome. OBJECTIVE: To evaluate the effect of the implementation of an intervention program on the HRQL in patients at high cardiovascular risk. RESEARCH DESIGN: Randomized controlled trial. Intervention practices (n = 62) received a comprehensive intervention program (by means of outreach visitors) lasting 21 months. HRQL of patients at high cardiovascular risk was assessed by the MOS 36-Item Short-Form Health Survey (SF-36), at baseline and after intervention. Three patient categories were distinguished: diabetes mellitus, cardiovascular disease and hypertension. RESULTS: HRQL deteriorated in all respondents, but more pronounced in the control group. In diabetes patients the differences between intervention and control group were significant for the Vitality and Mental Health scales, with mean difference in change of 3.93 (95% CI: 1.08-6.78) and 3.71 (95% CI: 0.73-6.68), respectively. Patients with cardiovascular disease had significantly different changes on three scales: physical functioning (3.57, 95% CI: 0.71-6.43), vitality (3.01, 95% CI: 0.72-5.30) and social functioning (3.96, 95% CI: 0.50-7.42). In patients with hypertension, there were no differences between the intervention and control group. CONCLUSION: Our comprehensive intervention program resulted in changes in HRQL on several domains, particularly in patients with diabetes and cardiovascular disease.

Aged↗

Intensive support to improve clinical decision making in cardiovascular care: a randomised controlled trial in general practice.

OBJECTIVE: To evaluate the effects of feedback reports combined with outreach visits from trained non-physicians on the clinical decision making of general practitioners (GPs) in cardiovascular care. DESIGN: Pragmatic cluster controlled trial with randomisation of practices to support (intervention group) or no special attention (control group); analysis after 2 years. SETTING: 124 general practices in The Netherlands. PARTICIPANTS: 185 GPs. MAIN OUTCOME MEASURES: Compliance rates for 12 evidence-based indicators for the management of patients with hypertension, hypercholesterolaemia, angina pectoris, or heart failure. The evaluation relied on the prospective recording of patient encounters by the participating GPs. RESULTS: The GPs reported 30 101 clinical decisions at baseline and 22 454 decisions after the intervention. A significant improvement was seen for five of the 12 indicators: assessment of risk factors in patients with hypercholesterolaemia (odds ratio 2.04; 95% CI 1.44 to 2.88) or angina pectoris (3.07; 1.08 to 8.79), provision of information and advice to patients with hypercholesterolaemia (1.58, 1.17 to 2.13) or hypertension (1.55, 1.35 to 1.77), and checking for clinical signs of deterioration in patients with heart failure (4.11, 2.17 to 7.77). Single handed practices, non-training practices, and practices with older GPs gained particular benefit from the intervention. CONCLUSIONS: Intensive support from trained non-physicians can alter certain aspects of the clinical decision making of GPs in cardiovascular care. The effect is small and the strategy needs further development.

Adult↗

Increased expression of the breast cancer resistance protein (BCRP) in relapsed or refractory acute myeloid leukemia (AML).

Expression of the multidrug resistance proteins P-glycoprotein, encoded by the MDR1 gene, multidrug resistance-associated protein (MRP1) and the lung resistance-related protein or major vault protein (LRP/MVP) is associated with clinical resistance to chemotherapy in acute myeloid leukemia (AML). Recently, the breast cancer-resistant protein (BCRP), the equivalent of mitoxantrone-resistant protein (MXR) or placental ABC transporter (ABCP), was described in AML. We investigated MDR1, MRP1, LRP/MVP and BCRP mRNA expression simultaneously in 20 paired clinical AML samples from diagnosis and relapse or refractory disease, using quantitative Taqman analysis. In addition, standard assays for P-glycoprotein expression and function were performed. BCRP was the only resistance protein that was expressed at a significantly higher RNA level (median 1.7-fold, P = 0.04) at relapsed/refractory state as compared to diagnosis. In contrast, LRP/MVP mRNA expression decreased as disease evolved (P = 0.02), whereas MDR1 and MRP1 mRNA levels were not different at relapse as compared to diagnosis. Also, at the protein level no difference of MDR1 between diagnosis and relapse was found. A significant co-expression of BCRP and MDR1 was found at diagnosis (r = 0.47, P = 0.04). The present results suggest that BCRP, but not MDR1, MRP1 or LRP/MVP is associated with clinical resistant disease in AML.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

Multifaceted support to improve clinical decision making in diabetes care: a randomized controlled trial in general practice.

AIMS: To evaluate the effectiveness of a multifaceted intervention to improve the clinical decision making of general practitioners (GPs) for patients with diabetes. To identify practice characteristics which predict success. METHODS: Cluster randomized controlled trial with 124 practices and 185 GPs in The Netherlands. The intervention group received feedback reports and support from a facilitator; the control group received no special attention. Outcome measures were the compliance rates with evidence-based recommendations pertaining to discussion of body weight control, discussion of problems with medication, blood pressure measurement, foot examination, eye examination, initiating anti-diabetic medication or increasing the dosage in cases of uncontrolled blood glucose, and scheduling a follow-up appointment. RESULTS: The GPs reported on their clinical decision making in 1410 consultations with Type 2 diabetic patients at baseline and 1449 consultations after the intervention period. The intervention resulted in statistically significant improvement for two of the seven outcome measures: foot examination (odds ratio 1.68; 95% confidence interval 1.19-2.39) and eye examination (1.52; 1.07-2.16). Discussion of problems with medication showed a near significant trend towards increased benefit for the intervention group (1.52; 0.99-2.32). Practice characteristics were not found to be related to the success of the intervention. CONCLUSIONS: Feedback reports with support from facilitators appear to increase rates of foot examination and eye examination in general practice. Alternative interventions should be explored to improve the pursuit of metabolic control by GPs.

Adult↗

Erectile and ejaculatory dysfunction in a community-based sample of men 50 to 78 years old: prevalence, concern, and relation to sexual activity.

OBJECTIVES: To determine the prevalence rates of erectile and ejaculatory dysfunction, associated bother, and their relation to sexual activity in a population-based sample of elderly men.Methods. Data were collected from 1688 men by way of self-administered questionnaires (including the International Continence Society male sex questionnaire) and measurements at a health center and urology outpatient department. RESULTS: The prevalence of significant erectile dysfunction (ie, erections of severely reduced rigidity or no erections) increased from 3% in men 50 to 54 years old to 26% in men 70 to 78 years old. In the same age strata, the prevalence of significant ejaculatory dysfunction (ie, ejaculations with significantly reduced volume or no ejaculations) increased from 3% to 35%. Pain or discomfort during ejaculation was rare (1%) and independent of age. In general, men were more concerned about erectile dysfunction than about ejaculatory dysfunction. However, most men had no or only little concern about their dysfunction. The percentage of men who reported being sexually active declined with increasing age and was lower in men with erectile and ejaculatory dysfunction and in men without a partner. In sexually active men, 17% to 28% had no normal erections, indicating that with advancing age normal erections are not an absolute prerequisite for a sexually active life. CONCLUSIONS: Erectile and ejaculatory dysfunction are common in elderly men. The results of this study indicate that these conditions are much less of a problem for older men than previously suggested.

Age Distribution↗

Voided volumes: normal values and relation to lower urinary tract symptoms in elderly men, a community-based study.

OBJECTIVES: To determine the normal values of voided volumes and explore the relation between bladder capacity and lower urinary tract symptoms (LUTS) in elderly men. METHODS: Data were collected from 1688 men 50 to 78 years old recruited from the population of Krimpen aan den IJssel, The Netherlands. Measurements included self-administered questionnaires (including the International Prostate Symptom Score), a 3-day frequency volume chart, transrectal ultrasonography of the prostate, uroflowmetry, and postvoid residual volume determination. RESULTS: The 24-hour voided volumes were independent of age (median 1506 mL; 25th to 75th percentiles 1160 to 1950). The average volume per void and functional bladder capacity (FBC, defined as the largest single voided volume) declined with advancing age. Moreover, FBC was lower in men with a reduced maximum flow rate (less than 15 mL/s) and independent of the postvoid residual volume. Multivariate analyses showed no significant effect of prostate enlargement on the FBC. FBC was strongly related to LUTS: a low FBC coincided with higher International Prostate Symptom Scores. Multivariate logistic regression analyses revealed that the presence of moderate to severe symptoms (International Prostate Symptom Score greater than 7) was independent of prostate volume, but dependent on age, a reduced flow rate, postvoid residual volume, and FBC. CONCLUSIONS: Prospective studies are needed to establish the causal relation between FBC and LUTS. Frequency volume charts are a valid, easy-to-use, noninvasive method to determine FBC as an aspect of urinary tract (dys)function in the evaluation of men with LUTS and to determine treatment options for LUTS.

Age Factors↗

Hip problems in older adults: classification by cluster analysis.

No validated classification system of hip disorders in primary care is available. This study explores whether it is possible to obtain such a classification with the method of cluster analyses. A total of 224 consecutive patients aged 50 years or older, consulting the general practitioner for pain in the hip region, and referred for X-ray investigation of the hip, underwent a standardized examination. Ward's cluster analysis with variables from history and physical examination of the hip region resulted in a classification with nine different clusters. These clusters were reproduced in 10 random subsamples and with an alternative cluster analysis. Significant relationships of various external variables (radiological and sonographic signs and variables of low-back and knee examination) with the distinctive clusters were found. Twenty of the approached experts recognized the symptoms in seven clusters as identifiable syndromes. However, further validation of the achieved classification system, especially with respect to the clinical importance, is needed before introducing it into clinical practice.

Cluster Analysis↗

Low serum S100beta protein levels following coronary artery surgery with or without cardiopulmonary bypass.

BACKGROUND: S100beta protein has been used as a serum marker of brain injury during cardiac surgery. Previous studies may have been confounded by the re-transfusion of shed mediastinal blood, which has a high concentration of S100beta. AIM: To examine serum S100beta levels in coronary artery surgery patients in whom re-transfusion of shed mediastinal blood was avoided, and to compare levels with and without cardiopulmonary bypass (CPB). METHODS: Serum S100beta levels were measured preoperatively, pre-heparin, post-protamine and 24 h postoperatively in 31 patients undergoing elective coronary artery surgery with (n = 14) or without (n = 17) CPB. The postoperative values were compared to their preoperative controls using two-tailed paired t-tests. RESULTS: There was a minor increase in serum S100beta post-protamine in the CPB group only (0.41 ng/mL; P < 0.01). All other levels in both groups were within normal limits. CONCLUSIONS: Coronary artery surgery without CPB is not associated with an increase in serum S100beta. The observed increase in the CPB group was four- to ninefold lower than levels previously reported. A possible explanation for the lower level was the avoidance of retransfusing shed mediastinal blood. If elevated S100beta levels are thought to represent a cerebral insult caused by CPB, the magnitude of the insult might be less than previously assumed.

Journal Article↗

Correlates for erectile and ejaculatory dysfunction in older Dutch men: a community-based study.

OBJECTIVES: We estimated correlates for erectile dysfunction (ED) (defined as a report of erections of severely reduced rigidity or no erections) and ejaculatory dysfunction (EjD) (defined as a report of ejaculations with significantly reduced volume or no ejaculations) in a large community sample of older men. DESIGN: A community-based study. SETTING: Krimpen aan den IJssel, a municipality near Rotterdam, The Netherlands. PARTICIPANTS: A total of 1,688 (50% of the eligible) men age 50 to 78. MEASUREMENTS: Presence of ED and EjD (International Continence Society sex questionnaire), urinary tract symptoms (international prostate symptom score), prostate enlargement (transrectal ultrasonography), urinary flow obstruction (uroflowmetry), obesity (body mass index), chronic obstructive pulmonary disease (COPD), diabetes mellitus, and cardiovascular problems. Determined marital status, educational level, and smoking and drinking habits. Population attributable risk (PAR) was estimated for correlates that yielded from multiple logistic regression models on ED and EjD. RESULTS: Multiple logistic regression analyses yielded the following correlates for significant ED: age, smoking, obesity, urinary tract symptoms, and treatment for cardiovascular problems and COPD. Age, erectile function, urinary symptoms, and previous prostate operations proved to be correlates for significant EjD. Urinary symptoms and obesity have the highest PAR for ED, whereas decreased erectile function has the highest PAR for EjD. CONCLUSIONS: Age, obesity, and urinary tract symptoms are the most-important correlates of significant ED in the population. Cardiac problems, COPD, and smoking are other independent correlates. Significant EjD is largely related to age, decreased erectile function, and previous prostate surgery.

Aged↗

Blood pressure control in treated hypertensive patients: clinical performance of general practitioners.

BACKGROUND: The blood pressure of many treated hypertensive patients remains above recommended target levels. This discrepancy may be related to general practitioners' (GPs') actions. AIM: To assess clinical performance of GPs in blood pressure control in treated hypertensive patients and to explore the influence of patient and GP characteristics on clinical performance. DESIGN OF STUDY: Cross-sectional study conducted on 195 GPs with invitations to participate made via bulletins and by letter. SETTING: One hundred and thirty-two practices in the southern half of The Netherlands from November 1996 to April 1997. METHOD: Performance criteria were selected from Dutch national hypertension guidelines for general practice. GPs completed self-report forms immediately after follow-up visits of hypertensive patients treated with antihypertensive medication. RESULTS: The GPs recorded 3526 follow-up visits. In 63% of these consultations the diastolic blood pressure (DBP) was 90 mmHg or above. The median performance rates of the GPs were less than 51% for most of the recommended actions, even at a DBP of > or = 100 mmHg. Performance of non-pharmacological actions increased gradually with increasing DBP; prescribing an increase in antihypertensive medication and making a follow-up appointment scheduled within six weeks rose steeply at a DBP of > or = 100 mmHg. Patient and GP characteristics contributed little to clinical performance. Action performance rates varied considerably between GPs. CONCLUSION: GPs seem to target their actions at a DBP of below 100 mmHg, whereas guidelines recommend targeting at a DBP of below 90 mmHg.

Adolescent↗

Strong effects of definition and nonresponse bias on prevalence rates of clinical benign prostatic hyperplasia: the Krimpen study of male urogenital tract problems and general health status.

OBJECTIVE: To estimate the prevalence of benign prostatic hyperplasia (BPH) in the community, and study the influence of BPH definition, age and response bias on prevalence rates. Subjects and methods A community-based longitudinal study of 3924 men aged 50-75 years was conducted in a Dutch municipality (Krimpen) near Rotterdam. Data from those responding were collected using self-administered questionnaires, and during visits to the health centre and outpatient clinic of the urology department. The questionnaires included symptom scores on general well being (Inventory of Subjective Health, ISH) and lower urinary tract symptoms (International Prostate Symptom Score, IPSS). A short version of the questionnaire (including the IPSS and ISH) was sent to a random sample of those not responding. All subjects participating fully underwent a physical examination, uroflowmetry, transrectal ultrasonometry of the prostate and had their prostate specific antigen level measured. Age-specific prevalence rates of BPH were estimated using different definitions, based on one or more of symptom severity, prostate volume and maximum flow rate. The influence of response bias was estimated using the questionnaires. RESULTS: The response rate was 50% (full participants). Of those not responding, 55% completed a short version of the questionnaire (partial participants). Compared with full participants, partial participants had a lower IPSS and slightly lower ISH. The prevalence rates of clinical BPH in the study population was 9-20% (95% confidence interval, 8-11% to 22-27%) depending on the definition used. After adjusting for nonresponse bias, the age-group specific prevalences for 5-year age strata were 1.1-1.8 times lower for all BPH definitions used. CONCLUSIONS: The prevalence rates of clinical BPH depend largely on the definition used and increase strongly with age. The effect of age is stronger when more variables are included in the definition. Adjustment for response bias results in substantially lower prevalence rates.

Age Distribution↗

Abdominal symptoms: do they predict gallstones? A systematic review.

BACKGROUND: Our objective was to evaluate the diagnostic accuracy of abdominal symptoms in gallstones in studies using ultrasonography or oral cholecystography as the reference standard and to assess the extent to which variability in diagnostic accuracy is explained by patient selection and other characteristics of study design. METHODS: A Medline search (1966-1998) was conducted in combination with reference checking for further relevant publications. Two independent assessors selected controlled studies that included patients > or =18 years of age. Articles were excluded if sensitivity and specificity could not be extracted or the included patients were at extraordinary risk for gallstones. Seven abdominal symptoms were evaluated. Modification of the diagnostic accuracy by clinical setting, extent of the disease, blinding, age, and sex was analysed by using logistic regression. RESULTS: A total of 24 publications were included. The symptoms 'biliary colic', 'radiating pain', and 'analgesics used' were consistently related to gallstones. The setting of the study had a significant effect on the diagnostic accuracy of these symptoms. The unadjusted, pooled diagnostic odds ratios, however, were low (2.6 (95% confidence interval, 2.4-2.9), 2.8 (2.2-3.7), and 2 (1.6-2.5), respectively). The diagnostic odds ratio of biliary colic increased with the extent of gallstone disease (13.3 (4.2-42). CONCLUSIONS: Although biliary colic was specific for gallstones, 80% of the referred patients with gallstones presented with other abdominal symptoms. There is no current evidence that justifies the use of single abdominal symptoms, other than biliary colic, in the diagnosis of symptomatic gallstones. Further research should focus on the prognosis of patients with non-specific abdominal symptoms and gallstones.

Abdominal Pain↗

How do general practitioners manage hip problems in adults?

OBJECTIVE: To investigate the medical management, and its consistency and determinants, of hip problems in adult patients. SETTING: General practice, The Netherlands. DESIGN: Observational study based on four "paper patients" and on computerised patients records (CPRs) of 400 patients (20 per general practitioner), aged 50 years and over, with new hip problems. SUBJECTS: 20 general practitioners. MAIN OUTCOME MEASURES: Examination, diagnosis and treatment of hip patients. RESULTS: Medical history and physical examination consisted mainly of questions concerning pain localisation and onset, and examining passive hip motion. The paper patients, except for the one with alarming symptoms, and the CPRs showed high variation in management between general practitioners, particularly for medication prescription and X-ray requests. Main factors influencing medical management were patients' age, number of visits and attitude of the individual general practitioner. A specific diagnosis was registered for only 32% of the 400 patients. The diagnosis osteoarthritis varied greatly between general practitioners even after adjustment for patients' age, gender and number of visits. Patients with osteoarthritis were infrequently referred to physical therapy and received nonsteroidal anti-inflammatory drugs (NSAIDs) more often than paracetamol. CONCLUSION: Diagnosis and treatment of hip problems varies widely between general practitioners. Treatment of patients with osteoarthritis is inconsistent with published recommendations.

Aged↗

Sonography for hip joint effusion in adults with hip pain.

OBJECTIVE: To study the prevalence of ultrasonic hip joint effusion and its relation with clinical, radiological and laboratory (ESR) findings in adults with hip pain. METHODS: Patients (n = 224) aged 50 years or older with hip pain, referred by the general practitioner for radiological investigation, underwent a standardised examination. The distance between the ventral capsule and the femoral neck, an increase in which represents joint effusion, was measured sonographically. Joint effusion was defined in three different ways: "effusion" according to Koski's definition, "major effusion", and "asymmetrical effusion" based on only individual side differences. RESULTS: "Effusion" was present in 80 (38%), "major effusion" in 20 (9%), and "asymmetrical effusion" in 47 (22%) patients. Pain in the groin or medial thigh, pain aggravated by lying on the side, decreased extension/internal rotation/abduction/flexion, painful external rotation, and pain on palpation in the groin showed a significant relation (adjusted for age and radiological osteoarthritis of the hip) with ultrasonic hip joint effusion. "Major effusion" showed a significant relation with an increased ESR. When patients with bilateral pain and increased ESR were excluded, a side difference in the range of motion of extension of the hip was shown to be a good predictor for "asymmetrical effusion" (positive predictive value: 71%, negative predictive value: 80%). CONCLUSION: This study showed a relatively high prevalence of ultrasonic joint effusion in adults with hip pain in general practice. Furthermore the results indicate a relation between joint effusion and clinical signs.

Aged↗

Meralgia paresthetica is related to degenerative pubic symphysis.

OBJECTIVE: To investigate the relationship between meralgia paresthetica, a mononeuropathy of the lateral femoral cutaneous nerve that often starts in middle age, and radiological degeneration of the pubic symphysis. METHODS: A case-control study of patients aged 40 years and older with meralgia paresthetica who underwent surgical release of the lateral femoral cutaneous nerve; cases were included only when a pelvic radiograph was available. The control group was from a population study including persons aged 55 years and older and was matched to cases (4 controls per case) for sex and age as far as possible. We checked patient records from general practice to ensure control subjects had no symptoms of meralgia paresthetica during the previous 10 years. Radiological degeneration of the pubic symphysis was defined as present when 2 of 3 independent observers noted degeneration on the radiograph. RESULTS: Mantel-Haenszel procedure (stratified for age group and radiological osteoarthritis of the hip) showed a positive relationship (p = 0.004, OR = 4.38) between radiological degenerative pubic symphysis and meralgia paresthetica. In a separate analysis limited to men we also found this positive relationship. CONCLUSION: This study confirmed a positive relationship between radiological degeneration of the pubic symphysis and meralgia paresthetica.

Female↗

Normal voiding patterns and determinants of increased diurnal and nocturnal voiding frequency in elderly men.

PURPOSE: We determined the normal value of diurnal and nocturnal voiding frequency, and its determinants in a population based sample of elderly men. MATERIALS AND METHODS: We collected data on 1,688 men 50 to 78 years old recruited from the population of Krimpen, The Netherlands. Measurements consisted of self-administered questionnaires, including the International Prostate Symptom Score (I-PSS), a 3-day frequency-volume chart, transrectal prostatic ultrasound, uroflowmetry and post-void residual urine volume measurement. RESULTS: Diurnal voiding frequency is independent of age and more frequent in men with benign prostatic hyperplasia (BPH). Nocturia 2 or more times is present in 30% of men 50 to 54 and in 60% of those 70 to 78 years old, while nocturia 3 or more times is present in 4% and 20%, respectively. In addition, nocturia is strongly associated with BPH and nocturnal polyuria but apparently not with cardiovascular symptoms, hypertension or diabetes mellitus. We noted poor agreement of the responses on the frequency-volume charts and the I-PSS question on nocturia. Using the I-PSS leads to a higher prevalence of nocturia. CONCLUSIONS: Diurnal frequency is independent of age (median 5 voids, interquartile range 4 to 6) but higher in men with BPH. Nocturia increases with advancing age and is more frequent in men with nocturnal polyuria. BPH is an independent risk factor for nocturia and increased diurnal voiding frequency. In those with nocturia there is a great difference in subjective symptoms and objective data, indicating that the weight of the I-PSS question on nocturia for making treatment decisions should be reconsidered.

Aged↗