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Biomedical subjects

J Kingma

Publications and source records attributed to J Kingma.

At least 19 recordsLinked to original sources

Applying the Quebec Task Force criteria as a frame of reference for studies of whiplash injuries.

Research prior to 1995 showed a diversity of either inclusion or exclusion criteria (or both) for diagnosing whiplash injury. As a consequence, the Quebec Task Force (QTF) developed expert-based criteria, which may be considered as a the 'new' gold standard. Here, we examined the inclusion criteria and exclusion criteria used in research populations from the major 82 research studies performed during the period 1980-1998, comparing their similarities and dissimilarities to the QTF standard. None of the articles satisfied the QTF definitions completely, either before or after their introduction in 1995. Nevertheless, the QTF still seems to have had some impact on either the published inclusion or exclusion criteria. We observed that both sets of criteria showed a qualitative shift following the QTF publication in 1995. For the inclusion criteria, we found both a statistically significant increase in use of the QTF definition (acceleration-deceleration mechanism, rear-end collision, motor vehicle collision or other mishaps) and in the criterion 'neck pain'. We also observed some smaller changes in both inclusion and exclusion criteria but none of these was significant statistically.

Cervical Vertebrae↗

Interrater reliability for the basic categories of the AO/ASIF's system as a frame of reference for classifying distal radial fractures.

This study is about agreement on the assignment into the three basic classes or categories (A, B, C) of the Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation's (AO/ASIF) classification system for distal radial fractures. A random sample of 124 distal radial fractures was classified by two experienced observers. Their agreement was calculated according to Cohen's kappa statistic. To investigate the possible bases for disagreement, all conflicting X-ray assessments were discussed in a consensus meeting. It appeared that the kappa value was .65 (good agreement) before the meeting; kappa rose to .86 (excellent agreement) after the consensus meeting. It appeared that the undisplaced fractures were a major source of disagreement. Further, the presence of articular involvement was an important issue. It was frequently noted that one observer classified the fracture as extraarticular (basic Class A), while the other observer chose classification as an intra-articular fracture (basic Class C) or vice versa. This phenomenon has been called the A/C reversal shift. It is concluded that radiological innovations might enhance agreement on articular involvement, and a separate category for undisplaced fractures should be defined in the Arbeitsgemeinschaft für Osteosynthesefragen (AO) system. However, agreement on relevant distinctive features and discussion of conflicting assessments may also be important in achieving excellent agreement.

Adolescent↗

Sprain of the neck in clinically treated patients in The Netherlands: an inventory of different categories of car accidents.

Different categories of car accidents of victims with sprain of the neck were investigated for both drivers and passengers. The predominant category of the car crash was a collision with another car for drivers as well as for passengers. The second cause was unknown. The distribution of the accidents was statistically significantly different for drivers and passengers.

Accidents, Traffic↗

Tyrosine residues serve as proton donor in the catalytic mechanism of epoxide hydrolase from Agrobacterium radiobacter.

Epoxide hydrolase from Agrobacterium radiobacter catalyzes the hydrolysis of epoxides to their diols via an alkyl-enzyme intermediate. The recently solved X-ray structure of the enzyme shows that two tyrosine residues (Tyr152 and Tyr215) are positioned close to the nucleophile Asp107 in such a way that they can serve as proton donor in the alkylation reaction step. The role of these tyrosines, which are conserved in other epoxide hydrolases, was studied by site-directed mutagenesis. Mutation of Tyr215 to Phe and Ala and mutation of Tyr152 to Phe resulted in mutant enzymes of which the k(cat) values were only 2-4-fold lower than for wild-type enzyme, whereas the K(m) values for the (R)-enantiomers of styrene oxide and p-nitrostyrene oxide were 3 orders of magnitude higher than the K(m) values of wild-type enzyme, showing that the alkylation half-reaction is severely affected by the mutations. Pre-steady-state analysis of the conversion of (R)-styrene oxide by the Y215F and Y215A mutants showed that the 1000-fold elevated K(m) values were mainly caused by a 15-40-fold increase in K(S) and a 20-fold reduction in the rate of alkylation. The rates of hydrolysis of the alkyl-enzyme intermediates were not significantly affected by the mutations. The double mutant Y152F+Y215F showed only a low residual activity for (R)-styrene oxide, with a k(cat)/K(m) value that was 6 orders of magnitude lower than with wild-type enzyme and 3 orders of magnitude lower than with the single tyrosine mutants. This indicates that the effects of the mutations were cumulative. The side chain of Gln134 is positioned in the active site of the X-ray structure of epoxide hydrolase. Mutation of Gln134 to Ala resulted in an active enzyme with slightly altered steady-state kinetic parameters compared to wild-type enzyme, indicating that Gln134 is not essential for catalysis and that the side chain of Gln134 mimics bound substrate. Based upon this observation, the inhibitory potential of various unsubstituted amides was tested, resulting in the identification of phenylacetamide as a competitive inhibitor with an inhibition constant of 30 microM.

Acetamides↗

Neck sprain after motor vehicle accidents in drivers and passengers.

Neck sprain is a general term denoting a soft tissue injury of the neck, which seldom causes major disability but is considered a modern epidemic. The purpose of the present study was to determine the prevalence of sprain of the neck injury due to motor vehicle accidents (MVAs) in both drivers and passengers. In addition, the degree of seat belt wearing in both driver and passenger was analysed. A second aim was to identify groups at risk by analysing the age and gender distribution of patients with neck sprain. The results of this population-based study revealed a sharp increase in neck sprain from 1989 through 1995, whereas a more or less stable pattern was found for seat belt use. The sharp increase was found to be attributable to outpatients. Finally, we found a driver predominance as well as a female predominance; groups at risk were the 20- to 24-year-olds for drivers and 15- to 19-year-olds for passengers.

Accidents, Traffic↗

Measurement of severity of sports injuries: an epidemiological study.

OBJECTIVE: To evaluate the severity of sports injuries in relation to the severity of injuries due to other causes and in relation to type of sport, using generally applied measures of injury severity. SUBJECTS: A total of 12403 patients, 4-50 years old, who were treated in the trauma department of the Groningen University Hospital for a sports injury, from January 1990 until January 1997. METHOD: All patients treated because of an injury entered the study. A distinction was made between injuries caused by playing sports, home and leisure accidents, traffic accidents and violence. The severity of the injuries was assessed by using the criteria of rate of admission, Injury Severity Scale (ISS). Finally the sports injuries were analysed with regard to type of sport. RESULTS: In total, 57760 injuries were registered. After injuries due to home and leisure accidents (44%; 25228) sports injuries (21%; 12 403) were the most frequent cause of injury. Of the patients with a sports injury, 7.9% (980) were admitted, which is more than with home and leisure accidents (6.7%; 1690) but less than with traffic accidents (21.5%; 2202) and violence (9.3%; 364). In a majority of cases, admission was related to a limited number of types of sport. The mean ISS of sports injuries was low, as with injuries following home and leisure accidents and violence. The percentage of sports injuries with an ISS higher than or equal to 16 and the percentage mortality were both low in comparison to injuries due to violence or traffic accidents. CONCLUSIONS: Sports injuries rank second highest in terms of cause of injury, after home and leisure accidents; and rank third in terms of severity, after traffic accidents and violence. Even though the ISS is low, sports injuries may have serious consequences.

Adolescent↗

Injuries due to school sports accidents in 4 to 13-yr.-old children.

505 kindergarten and primary school children from 4 to 13 years of age were treated for school sports injuries during the period 1990-1997. The incidence of injuries increased statistically significantly from .5 per 1,000 children 4- to 5-yr.-old to 4.8 injured children per 1,000 in 12- to 13-yr.-old. 59% of the injuries involved upper extremities; 35% of these were in the wrist region. 33.5% of the injuries were of the lower extremities, with 50% being of the feet and 36.4% of the ankle. Accidental falls were the main situation (53%) in which school sport accidents occurred. Nearly 65% of these accidental falls occurred at the ground level; the remaining accidents (35%) occurred when the child was working on an apparatus, e.g., parallel bars, balancing beam, side horse. The 4- to 5-yr.-old children were the most vulnerable to accidental fall (67%). A statistically significant increase in injuries in ball sports was observed from 4- to 5-yr.-olds (0%) to the 12- to 13-yr.-olds (28%).

Accidents↗

Severity of injuries due to accidental fall across the life span: a retrospective hospital-based study.

This retrospective study investigated injuries due to accidental fall across the life span for which 19,593 patients were admitted to the Emergency Unit of the Groningen University Hospital during the period 1990 through 1997. 64% of the accidental falls were found for those in the age range between 10 years and 59 years; however, the proportion of accidental falls with regard to other causes of injuries by age group were the highest in youngsters (infants up to 9 years old) and in elderly persons (over 60 years old), 43% or more of these patients having falls with injuries. The clinically treated patients had on the average a statistically greater Injury Severity Score (7.2) than the outpatients (2.4). The highest percentages of medically treated inpatients were the patients of 60 years and over. Their mean ISS score was about the same for elderly inpatients, but the percentage of clinical treatment increased with age as well as the mortality. 30% of the injuries were found in the lower extremities and 30% in the upper extremities. Bone fracture was statistically significantly the major (36%) injury followed by contusion (20%). 34% of the accidental falls occurred at home, and statistically significantly more females, 50 years of age and older, were injured than males.

Accidental Falls↗

Clinicians' recognition of 10 different types of distal radial fractures.

This study concerned baseline performance in recognition of 10 different types of distal radial fractures. Verbal tasks of admitting knowing about fractures and Visual tasks were designed for each fracture type. The Verbal task of admitting knowing consisted of a description with the relevant distinctive features of the fracture. The surgical resident was asked whether he admitted knowing the particular fracture described. The Visual task consisted of X-rays for which the subject had to label the fracture or identify its distinctive features. The test was presented to 30 surgical trainees working in five teaching hospitals. On the Verbal task of admitting knowing, scores were statistically significantly higher (68% "yes") than on the Visual task (33% correct). Responses met our criterion of 80% correct for the following fracture types: Colles's, distal forearm, and Smith's fracture. For seven other fracture types (combination radius and scaphoid, radial styloid process, dorsal Barton's, volar Barton's, pilon, chauffeur's, and lunate load fracture), the 80% criterion was not met. Analysis of the incorrect answers on the Visual task indicated that the surgical residents tended to label unknown fracture types as Colles's or Smith's fractures. Furthermore, the residents tended to overestimate their own diagnostic competence (overconfidence bias) for several fracture types. It was concluded that to improve diagnosis, the relevant distinctive features of distal radial fractures should be taught.

Adult↗

Alcohol consumption in victims of violence: a trend study for the period 1970-1998.

This 29-yr. retrospective study is about alcohol consumption by victims of violence intentionally injured (N = 13,048) and general patients unintentionally injured (N = 296,544) who were treated for their injuries at the Trauma Center of the University Hospital Groningen (The Netherlands) during the period 1970-1998. The incidence rate for general patients with alcohol consumption was statistically significantly greater than the incidence rate of victims of violence with alcohol consumption. A long-term significant linear trend was observed for both types of patients during the 29-yr. period. However, the increase in incidence rate among the general patients with alcohol consumption was four times greater than the increase in incidence rate for the victims of violence with alcohol consumption. Males predominated in both types of patients (with and without alcohol consumption). The statistically significant highest incidence rates (and male predominance) were found in the age group 20-24 years for both categories of patients.

Adult↗

Conversion of 3-chlorocatechol by various catechol 2,3-dioxygenases and sequence analysis of the chlorocatechol dioxygenase region of Pseudomonas putida GJ31.

Pseudomonas putida GJ31 contains an unusual catechol 2,3-dioxygenase that converts 3-chlorocatechol and 3-methylcatechol, which enables the organism to use both chloroaromatics and methylaromatics for growth. A 3.1-kb region of genomic DNA of strain GJ31 containing the gene for this chlorocatechol 2,3-dioxygenase (cbzE) was cloned and sequenced. The cbzE gene appeared to be plasmid localized and was found in a region that also harbors genes encoding a transposase, a ferredoxin that was homologous to XylT, an open reading frame with similarity to a protein of a meta-cleavage pathway with unknown function, and a 2-hydroxymuconic semialdehyde dehydrogenase. CbzE was most similar to catechol 2,3-dioxygenases of the 2.C subfamily of type 1 extradiol dioxygenases (L. D. Eltis and J. T. Bolin, J. Bacteriol. 178:5930-5937, 1996). The substrate range and turnover capacity with 3-chlorocatechol were determined for CbzE and four related catechol 2,3-dioxygenases. The results showed that CbzE was the only enzyme that could productively convert 3-chlorocatechol. Besides, CbzE was less susceptible to inactivation by methylated catechols. Hybrid enzymes that were made of CzbE and the catechol 2, 3-dioxygenase of P. putida UCC2 (TdnC) showed that the resistance of CbzE to suicide inactivation and its substrate specificity were mainly determined by the C-terminal region of the protein.

Amino Acid Sequence↗

Purification of a glutathione S-transferase and a glutathione conjugate-specific dehydrogenase involved in isoprene metabolism in Rhodococcus sp. strain AD45.

A glutathione S-transferase (GST) with activity toward 1, 2-epoxy-2-methyl-3-butene (isoprene monoxide) and cis-1, 2-dichloroepoxyethane was purified from the isoprene-utilizing bacterium Rhodococcus sp. strain AD45. The homodimeric enzyme (two subunits of 27 kDa each) catalyzed the glutathione (GSH)-dependent ring opening of various epoxides. At 5 mM GSH, the enzyme followed Michaelis-Menten kinetics for isoprene monoxide and cis-1, 2-dichloroepoxyethane, with Vmax values of 66 and 2.4 micromol min-1 mg of protein-1 and Km values of 0.3 and 0.1 mM for isoprene monoxide and cis-1,2-dichloroepoxyethane, respectively. Activities increased linearly with the GSH concentration up to 25 mM. 1H nuclear magnetic resonance spectroscopy showed that the product of GSH conjugation to isoprene monoxide was 1-hydroxy-2-glutathionyl-2-methyl-3-butene (HGMB). Thus, nucleophilic attack of GSH occurred on the tertiary carbon atom of the epoxide ring. HGMB was further converted by an NAD+-dependent dehydrogenase, and this enzyme was also purified from isoprene-grown cells. The homodimeric enzyme (two subunits of 25 kDa each) showed a high activity for HGMB, whereas simple primary and secondary alcohols were not oxidized. The enzyme catalyzed the sequential oxidation of the alcohol function to the corresponding aldehyde and carboxylic acid and followed Michaelis-Menten kinetics with respect to NAD+ and HGMB. The results suggest that the initial steps in isoprene metabolism are a monooxygenase-catalyzed conversion to isoprene monoxide, a GST-catalyzed conjugation to HGMB, and a dehydrogenase-catalyzed two-step oxidation to 2-glutathionyl-2-methyl-3-butenoic acid.

Amino Acid Sequence↗

Factors to consider when designing phase III clinical trials involving economic evaluations.

Given the recognized need to examine cost-effectiveness data in addition to clinical data when making decisions relating to choice of clinical interventions, there is a growing interest and experience in undertaking economic evaluations alongside clinical trials. It has been argued, when an economic evaluation is necessary for assessing the cost-effectiveness of a medical intervention, the integration of both the medical and clinical issues need to be included at the start of designing a clinical trial. A proposal has been made for how clinical researchers and health economists may cooperate successfully at the successive phases in designing a clinical trial. Therefore, discussion points for clinical researchers and health economists are given, and the possible methodological consequences of adding an economic evaluation to a trial are addressed.

Clinical Trials, Phase III as Topic↗

Neck sprain in patients injured in car accidents: a retrospective study covering the period 1970-1994.

During the 25-year period 1970-1994 694 patients were diagnosed with neck sprain resulting from a car accident at the Emergency Room of the University Hospital Groningen. The purpose of the present study was to analyse the prevalence, groups at risk and trends in these patients, taking into account changes in the number of cars per inhabitant and the average number of kilometres driven. We defined the population as car accident victims diagnosed with neck sprain. Binominal tests were used to obtain measures of statistical significance. Over the 25-year period a steady increase in the number of these patients was observed, from 10 in 1970 to 122 in 1994. The highest prevalence was found for the age group 25- to 29-year olds (28.3 per 100,000), followed by 40- to 44-year-olds (27.9 per 100,000). Across the life span, the male: female ratio was 1: 0.98. Eight percent of the victims were treated as inpatients. The increase in the number of car accident victims with neck sprain appears not to be an isolated phenomenon, because a parallel rise in the number of cars per inhabitant and in the average number of kilometres driven was found. No direct relation was observed between seat belt legislation and the increase in neck sprain injuries. The effect of the media on awareness of the consequences of car accidents is discussed.

Accidents, Traffic↗

Neck sprain not arising from car accidents: a retrospective study covering 25 years.

During the 25-year period 1970-1994, 680 patients were diagnosed with neck sprain due to causes other than car accidents at the Emergency Room of the University Hospital Groningen. The purpose of the present study was to analyse the prevalence, groups at risk and trends in patients with neck sprain. We defined the population as patients diagnosed with neck sprain that was not due to a car accident (NCA). The binominal test was used to obtain measures of statistical significance, deltax was used to obtain both the total increase in the number of neck sprain victims over the whole period (1970-1994) and the relative contribution of successive 5-year periods. Over the 25-year period a steady increase in the number of patients was observed from 55 in 1970-1974 to 241 in 1990-1994. The highest prevalence was found among 15- to 19-year-olds (3.92 per 10,000), followed by 10- to 14-year-olds (3.40 per 10,000). The major causes of neck sprain NCA were accidental falls (25%), sports injuries (24%) and bicycling injuries. Across the life span, the male: female ratio was 0.63. Ten percent of patients were treated as inpatients. The increase in neck sprain NCA can be only partly attributed to increased media attention. The reduction of working hours resulting in more leisure time activities, which in turn increases the exposure time in at risk situations, and the awareness of both patients and physicians is discussed.

Accidental Falls↗

Fracture of the distal forearm: epidemiological developments in the period 1971-1995.

This study describes longterm epidemiological trends of 8361 distal forearm fractures out of 256,431 trauma patients (3 per cent) treated in a Dutch university hospital. The mean incidence rate across the whole lifespan was 42 per 10,000 inhabitants. The general picture was that the incidence rate decreased from 47 in 1971 to 38 per 10,000 in 1995. The highest age-specific incidence rate was found in the age group above 79 years (90 per 10,000), followed by the age group of 0-9 years (80 per 10,000). The pattern of aetiology did not change: the distribution was accidental fall (62 per cent), sports and leisure (19 per cent) and traffic (14 per cent). The rate of hospital admission increased from 6 per cent in 1971 to 14 per cent of patients in 1995. It appeared that the longterm increase of hospital admission can largely be attributed to patients younger than 50 years of age. It has been discussed that the rise in operative treatment may be explained by a growing population and a change in surgical policy leading to more indications to operate on distal forearm fractures.

Accidental Falls↗

A glutathione S-transferase with activity towards cis-1, 2-dichloroepoxyethane is involved in isoprene utilization by Rhodococcus sp. strain AD45.

Rhodococcus sp. strain AD45 was isolated from an enrichment culture on isoprene (2-methyl-1,3-butadiene). Isoprene-grown cells of strain AD45 oxidized isoprene to 3,4-epoxy-3-methyl-1-butene, cis-1, 2-dichloroethene to cis-1,2-dichloroepoxyethane, and trans-1, 2-dichloroethene to trans-1,2-dichloroepoxyethane. Isoprene-grown cells also degraded cis-1,2-dichloroepoxyethane and trans-1, 2-dichloroepoxyethane. All organic chlorine was liberated as chloride during degradation of cis-1,2-dichloroepoxyethane. A glutathione (GSH)-dependent activity towards 3, 4-epoxy-3-methyl-1-butene, epoxypropane, cis-1,2-dichloroepoxyethane, and trans-1,2-dichloroepoxyethane was detected in cell extracts of cultures grown on isoprene and 3,4-epoxy-3-methyl-1-butene. The epoxide-degrading activity of strain AD45 was irreversibly lost upon incubation of cells with 1,2-epoxyhexane. A conjugate of GSH and 1, 2-epoxyhexane was detected in cell extracts of cells exposed to 1, 2-epoxyhexane, indicating that GSH is the physiological cofactor of the epoxide-transforming activity. The results indicate that a GSH S-transferase is involved in the metabolism of isoprene and that the enzyme can detoxify reactive epoxides produced by monooxygenation of chlorinated ethenes.

Biodegradation, Environmental↗

Sports members' participation in assessment of incidence rate of injuries in five sports from records of hospital-based clinical treatment.

This study is about the incidence rate of sports injuries in five different types of sports, gymnastics, soccer, volleyball, hockey, and basketball, for which 5,154 patients were admitted to the Emergency Unit of the Groningen University Hospital during the period 1990 through 1994. Incidence rate had been computed by membership participation. Basketball had the highest incidence rate (231 injured persons per 10,000 participants), followed by hockey (158 injured persons per 10,000 participants). The highest mean Injury Severity Score, 2.39, was found for gymnastics which had the lowest incidence rate (7 injured persons per 10,000 participants). Gymnastics had the highest percentage (12%) clinically treated patients, whereas basketball had the smallest percentage (2%) of clinically treated patients. The most frequent type of injury was distorsion, except for hockey, in which contusion had the highest percentage of occurrence. For all five types of sports, the majority (about 90%) of the injuries were observed at either the lower or at the upper extremities.

Adolescent↗