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Biomedical subjects

Jan Jansen

Publications and source records attributed to Jan Jansen.

11 recordsLinked to original sources
PubMed2006

The impact of home parenteral nutrition on daily life-a review.

BACKGROUND: Total parenteral nutrition (TPN) is a lifesaving therapy in patients with severe intestinal failure that can be administered at home. However, patients have to face complex technological nutritional support issues at home, which will influence their personal life. OBJECTIVES: This review aims to describe the implications of home parenteral nutrition (HPN) on the quality of life, as experienced by patients, as well as to describe the caregiver's reactions regarding these notions. SEARCH STRATEGY: A systematic review of the literature published between 1965 and 2005 was conducted. Cinahl, Medline, and Psychlit databases were searched. Systematic data extraction and narrative data synthesis were performed. SELECTION CRITERIA: Papers were included if they described original research published in a peer reviewed journal, with a focus on adult patients on HPN and/or their family caregivers. DATA COLLECTION (AND ANALYSIS): A standardised record was used for data extraction. MAIN RESULTS: A total of 26 studies were included. The quality of life reported by patients was moderate to good, but psychological problems, e.g. depression and anxiety, were common. Social life was disturbed due to the venous access device, the time schedule for HPN administration, the inability to have normal oral intake, gastrointestinal mobility problems, and physical complaints. Frequently mentioned somatic problems included fatigue, diarrhoea, pain, polyuria during infusion and sleep disruption. Despite social restrictions, depression and fatigue, caregivers reported their overall QoL as similar to the norms for healthy populations. CONCLUSION: Patients on HPN meet a broad range of problems. Apart from the well-known metabolic and infectious complications, many of these are psychological or social in nature.

Caregivers↗
PubMed2006

Topical ibopamine in the treatment of chronic ocular hypotony attributable to vitreoretinal surgery, uveitis, or penetrating trauma.

PURPOSE: To study whether topical ibopamine effectively increases the intraocular pressure in patients with ocular hypotony after vitreoretinal surgery, uveitis, or penetrating trauma. DESIGN: A prospective randomized, double-blind, placebo controlled, crossover study. METHODS: In ten patients with ocular hypotony, an ibopamine 2% solution or placebo eyedrop was administered at 8 am and frequent applanation tonometry was performed during 10 hours on 2 days, 2 weeks apart. RESULTS: The mean IOP integral after administration of ibopamine was 2.4 mm Hg higher (95% CI for median difference in AUC over 480 minutes [P = .010]) compared with placebo. CONCLUSIONS: The results of the study show that an ibopamine 2% eyedrop twice a day may increase the IOP for a period of over 8 hours in patients with hypotony.

Administration, Topical↗
PubMed2006

Delayed ABLC prophylaxis after allogeneic stem-cell transplantation.

Invasive fungal infections (IFI) are frequent causes of mortality after allogeneic stem-cell transplantation (SCT). A very important risk factor for IFI is the use of steroids. We used a risk-based chemoprevention in an open-labelled pilot study. All patients received oral fluconazole or itraconazole (200-400 mg day(-1)) during their neutropenic episode. Starting on day +30, patients receiving prednisone > or =30 mg day(-1) were switched to twice weekly Amphotericin-B-lipid-complex (ABLC) in a dose of 4 mg kg(-1). Patients receiving lower steroid doses continued on the fluconazole/itraconazole prophylaxis. Between 1999 and 2002, 100 patients were enrolled and followed for IFI for 1 year. Seven patients were started on therapeutic daily ABLC treatment before day +30 because of documented or suspected IFI; four had definite or probable aspergillosis, and two had candidaemia. Thirty patients did not need prophylactic ABLC; only one developed candidaemia. Sixty-three patients received ABLC prophylaxis for a median of 52 days (range: 1-289). Seven of these patients developed IFI; one definite and two probable cases of aspergillosis, one case of probable Trichosporon beigelii infection, and three cases of candidaemia. The twice weekly ABLC was well tolerated. This risk-based chemoprevention appears to be effective and might diminish the role of steroids as risk factor for IFI after allogeneic SCT. The relatively high incidence of early IFI suggests that additional prophylaxis for IFI may be indicated for poor-risk patients prior to day +30.

Administration, Oral↗
PubMed2005

Hypereosinophilic syndrome: long-term remission following allogeneic stem cell transplant in spite of transient eosinophilia post-transplant.

A 38-year-old male with progressive myeloproliferative variant of hypereosinophilic syndrome (HES) underwent allogeneic bone marrow transplantation from a matched unrelated donor. The preparative regimen consisted of TBI, cytarabine, and cyclophosphamide. The graft was T-cell-depleted. The patient had slow, but complete, hematologic recovery, and all cells were shown by VNTR analysis to be of donor origin. Five months after transplant, the patient developed prominent eosinophilia (peak 4.1 x 10(9)/L) with dermatographism and very high IL-5 levels. Eosinophils isolated to purity by cell sorting were all of donor origin. Mild increase in immunosuppression led to a normalization of eosinophil count after about 6 months. The patient is now 6 years after transplant, off all medications, and without evidence of disease. Allogeneic stem-cell transplantation is a potentially curative therapy for HES.

Adult↗
PubMed2005

Bioaccumulation of elements in bryophytes from Serra da Estrela, Portugal, and Veluwezoom, the Netherlands.

BACKGROUND, AIMS AND SCOPE: Pollution by heavy metals over large areas and long periods of time may cause chronic damage to living organisms and must be carefully controlled. One way to determine the extent of environmental contamination is by measuring the levels of contaminants in plants. The use of mosses as biomonitors is a convenient method to determine levels of (atmospheric) deposition, as terrestrial mosses obtain most of their supply of mineral elements from precipitation and dry deposition of airborne particles. Mosses have therefore received increasing attention as a suitable tool for monitoring regional patterns of elemental deposition from the atmosphere in large-scale studies in various countries, in areas close to industrial installations as well as in areas not expected to be contaminated. Although this technique is widely known, ecological studies of this type have rarely been done in Portugal. The aim of this paper is to evaluate and compare the spatial distribution of heavy metals in Hypnum cupressiforme, Pleurozium schreberi, Dicranum scoparium and Polytrichum piliferum collected from the Serra da Estrela natural park in Portugal and in the Veluwezoom natural park in the Netherlands. The selected species are the most widely used bryophytes for biomonitoring in the boreal region. The popularity of these species for this purpose is due to their wide ecological amplitude and distribution. METHODS: At 54 sampling sites in both nature parks, samples of Hypnum cupressiforme, Pleurozium schreberi, Dicranum scoparium and Polytrichum piliferum were collected. Plant digests were analysed for Al, Ba, Ca, Cr, Fe, K, Mg, Mn, Ni, Sr, V, Zn, Pb, Cu, Cd, N and P. Differentiations between sampling sites in terms of concentrations of elements in mosses were evaluated by ANOVA and the least significant difference was calculated. The normality of the analysed features was checked with the chi square test. After standardization, the matrix of 54 samples and 10 heavy metals was subjected to numerical classification to detect groups of samples with similar patterns of metal concentrations. The clustering algorithm was prepared with Ward's method, and the City Block Manhattan method was used for the similarity measure. Metals and samples were also subjected to ordination to reveal possible gradients of heavy metal levels, using PCA. Correlations were calculated between concentrations of metals and factors 1 and 2, allowing the dependence between the concentration of metals and factors (factor loading) to be estimated. RESULTS AND DISCUSSION: All species examined in both areas contained elevated levels of Mn and Pb. For each particular species, concentrations of N, P and Pb were significantly higher at Serra da Estrela, while concentrations of Cu were significantly higher at the Veluwezoom. Mosses from Portugal and the Netherlands differed significantly mainly in the concentrations of Al, Ba, Cr, Fe, Mn, Ni, Pb and V. This differentiation did not exceed that within the mosses from Portugal. CONCLUSIONS: Mosses from Portugal and the Netherlands differ significantly mainly in the concentrations of Al, Ba, Cr, Fe, Mn, Ni, Pb and V. This differentiation does not exceed the differentiation within the mosses from Portugal. RECOMMENDATION AND OUTLOOK: Further research is required into the origin and deposition of the polluting elements in other environmental compartments.

Bryophyta↗
PubMed2004

Clinical and genetic characteristics of hereditary pancreatitis in Europe.

BACKGROUND & AIMS: Hereditary pancreatitis is an autosomal dominant disease that is mostly caused by cationic trypsinogen (PRSS1) gene mutations. The aim was to determine phenotype-genotype correlations of families in Europe. METHODS: Analysis of data obtained by the European Registry of Hereditary Pancreatitis and Pancreatic Cancer was undertaken using multilevel proportional hazards modelling. RESULTS: There were 112 families in 14 countries (418 affected individuals): 58 (52%) families carried the R122H, 24 (21%) the N29I, and 5 (4%) the A16V mutation, 2 had rare mutations, and 21 (19%) had no PRSS1 mutation. The median (95% confidence interval [CI]) time to first symptoms for R122H was 10 (8, 12) years of age, 14 (11, 18) years for N29I, and 14.5 (10, 21) years for mutation negative patients (P = 0.032). The cumulative risk (95% CI) at 50 years of age for exocrine failure was 37.2% (28.5%, 45.8%), 47.6% (37.1%, 58.1%) for endocrine failure, and 17.5% (12.2%, 22.7%) for pancreatic resection for pain. Time to resection was significantly reduced for females (P < 0.001) and those with the N29I mutation (P = 0.014). The cumulative risk (95% CI) of pancreatic cancer was 44.0% (8.0%, 80.0%) at 70 years from symptom onset with a standardized incidence ratio of 67% (50%, 82%). CONCLUSIONS: Symptoms in hereditary pancreatitis start in younger patients and endpoints take longer to be reached compared with other forms of chronic pancreatitis but the cumulative levels of exocrine and endocrine failure are much higher. There is an increasingly high risk of pancreatic cancer after the age of 50 years unrelated to the genotype.

Adult↗
PubMed2002

Peripheral blood progenitor cell transplantation.

Peripheral blood progenitor cells (PBPCs) have become increasingly popular over the last 15 years as the source of hematopoietic stem cells for transplantation. In the early 1990s, PBPCs replaced bone marrow (BM) as the preferred source of autologous stem cells, and recently the same phenomenon is seen in the allogeneic setting. Under steady-state conditions, the concentration of PBPCs (as defined by CFU-GM and/or CD34+ cells) is very low, and techniques were developed to increase markedly this concentration. Such mobilization techniques include daily injections of filgrastim (G-CSF) or a combination of chemotherapy and growth factors. Leukapheresis procedures allow the collection of large numbers of circulating white blood cells (and PBPCs). One or two leukapheresis procedures are often sufficient to obtain the minimum number of CD34+ cells considered necessary for prompt and consistent engraftment (i.e., 2.5-5.0 x 10(6)/kg). As compared to BM, autologous transplants with PBPCs lead to faster hematologic recovery and have few, if any, disadvantages. In the allogeneic arena, PBPCs also result in faster engraftment, but at a somewhat higher cost of chronic graft-versus-host disease (GvHD). This may be a double-edged sword leading to both increased graft-versus-tumor effects and increased morbidity. The rapid advances in the study of hematopoietic, and even earlier, stem cells will continue to shape the future of PBPC transplantation.

Antigens, CD34↗
PubMed2002

Breast cancer cell contamination of blood stem cell products in patients with metastatic breast cancer: predictors and clinical relevance.

The incidence and clinical relevance of tumor cells contaminating the stem cell products of patients with advanced breast cancer treated with high-dose chemotherapy is uncertain because prior studies used small sample sizes and lacked standardization of the immunocytochemistry (ICC) detection method used. We evaluated blood stem cell and bone marrow samples obtained from 535 women with metastatic breast cancer who received high-dose chemotherapy and unmanipulated mobilized blood stem cell support. Of the patients tested, 20.6% and 26.3% had blood stem cell and bone marrow contamination, respectively. Blood stem cell contamination was significantly more frequent in patients with marrow involvement than in patients without marrow involvement (35% versus 18.4%, respectively; P = .009). In fact, according to multivariate analysis results, marrow involvement was the only significant predictor for blood stem cell product contamination. Patients without marrow involvement who had fewer apheresis procedures were also observed to have a significantly lower incidence rate of blood stem cell contamination than patients who had more procedures (P < or = .008), and patients who received combined chemotherapy and cytokine mobilization therapy had less contamination than patients who received cytokine alone (P = .0001). Combined mobilization therapy appears to be associated with a lower incidence of contamination as a result of fewer apheresis procedures rather than through an antitumor effect of chemotherapy (P < or = .001). Patients with ICC-negative blood stem cell products had significantly longer progression-free survival (PFS) and overall survival (OS) than did patients with ICC-positive blood stem cell products (median PFS, 401 versus 291 days, respectively, P = .007; median OS, 1060 versus 697 days, P = .009) . However, multivariate analysis did not reveal any significant independent predictors of survival outcomes. Thus, further study is needed to determine if contaminating tumor cells in the stem cell products of breast cancer patients ever directly impact survival outcomes or are only indicative of residual in vivo disease in high-dose chemotherapy recipients.

Adult↗
PubMedDate not supplied

Future burden and costs of smoking-related disease in the Netherlands: a dynamic modeling approach.

OBJECTIVES: In this article, we explore the future health gain of different policy measures to reduce smoking prevalence: health education campaigns specifically aimed at keeping (young) people from starting to smoke, campaigns aimed at persuading smokers to quit, and tax measures. METHODS: We drew up different policy scenarios based on evaluations of several health promotion campaigns. Implementing these into the dynamic multistate models, we simulated smoking prevalence, loss of life-years, and costs for several decades into the next century. RESULTS: In the short run, campaigns aimed at potential "quitters" appear to be most effective in terms of health gain. However, their effect fades away after several decades, while campaigns aimed at young "starters" or tax measures in the end yield a larger and more lasting decrease in smoking attributable disease burden. CONCLUSION: Dynamic modeling is very useful tool in calculating costs and effects of preventive public health measures.

Adult↗
PubMedDate not supplied

Transplantation of hematopoietic stem cells from the peripheral blood.

Hematopoietic stem cells can be collected from the peripheral blood. These hematopoietic stem cells (HSC), or better progenitor cells, are mostly expressed as the percentage of cells than react with CD34 antibodies or that form colonies in semi-solid medium (CFU-GM). Under steady-state conditions the number of HSC is much lower in peripheral blood than in bone marrow. Mobilization with chemotherapy and/or growth factors may lead to a concentration of HSC in the peripheral blood that equals or exceeds the concentration in bone marrow. Transplantation of HSC from the peripheral blood results in faster hematologic recovery than HSC from bone marrow. This decreases the risk of infection and the need for blood-product support. For autologous stem-cell transplantation (SCT), the use of peripheral blood cells has completely replaced the use of bone marrow. For allogeneic SCT, on the other hand, the situation is more complex. Since peripheral blood contains more T-lymphocytes than bone marrow, the use of HSC from the peripheral blood increases the risk of graft-versus-host disease after allogeneic SCT. For patients with goodrisk leukemia, bone marrow is still preferred, but for patients with high-risk disease, peripheral blood SCT has become the therapy of choice.

Animals↗