Use of loop diuretics in patients with chronic heart failure: an observational overview.

Introduction: This study aimed to evaluate the use and dose of loop diuretics (LDs) across the entire ejection fraction (EF) spectrum in a large, 'real-world' cohort of chronic heart failure (HF) patients.

Methods: A total of 10 366 patients with chronic HF from 34 Dutch outpatient HF clinics were analysed regarding diuretic use and diuretic dose. Data regarding daily diuretic dose were stratified by furosemide dose equivalent (FDE)>80 mg or ≤80 mg.

Improvement, Implementation, and Evaluation of the CMyLife Digital Care Platform: Participatory Action Research Approach.

Background: The evaluation of a continuously evolving eHealth tool in terms of improvement and implementation in daily practice is unclear. The CMyLife digital care platform provides patient-centered care by empowering patients with chronic myeloid leukemia, with a focus on making medication compliance insightful, discussable, and optimal, and achieving optimal control of the biomarker BCR-ABL1.

Objective: The aim of this study was to investigate to what extent the participatory action research approach is suitable for the improvement and scientific evaluation of eHealth innovations in daily clinical practice (measured by user experiences) combined with the promotion of patient empowerment.

Heart failure treatment in patients with and without obesity with an ejection fraction below 50.

Background: The aim of this study was to assess heart failure (HF) treatment in patients with and without obesity in a large contemporary real-world Western European cohort.

Methods: Patients with a left ventricular ejection fraction (LVEF) <50% and available information on body mass index (BMI) were selected from the CHECK-HF registry. The CHECK-HF registry included chronic HF patients in the period between 2013 and 2016 in 34 Dutch outpatient clinics.

Atrial fibrillation in chronic heart failure patients with reduced ejection fraction: The CHECK-HF registry.

Background: Atrial fibrillation (AF) is common in chronic heart failure (HF) patients and influences the choice and effects of drug and device therapy. In this large real-world HF registry, we studied whether the presence of AF affects the prescription of guideline-recommended HF therapy.

Methods: We analyzed 8253 patients with chronic HF with reduced ejection fraction (HFrEF) from 34 Dutch outpatient clinics included in the period between 2013 and 2016 treated according to the 2012 ESC guidelines.

Contemporary Drug Treatment of Chronic Heart Failure With Reduced Ejection Fraction: The CHECK-HF Registry.

Objectives: This study investigated adherence to drug therapy guidelines in heart failure (HF) with reduced left-ventricular ejection fraction (LVEF) of <40% (heart failure with reduced ejection fraction [HFrEF]), in which evidence-based treatment has been established.

Background: Despite previous surveys of HF, important uncertainties remain regarding guideline adherence in a representative real-world population.

Methods: A cross-sectional registry in 34 Dutch HF outpatient clinics that included 10,910 patients with the diagnosis of HF was examined.

Induction of active immunological hypo/non-responsiveness to C5 in adult C5-deficient DBA/2 mice.

Injection of C5-sufficient BALB/c serum rendered DBA/2 mice (C5-deficient) immunologically hypo- or non-responsive to C5. This was indicated by C5-elimination studies in the C5-deficient mice showing similar half-lives for C5 upon single and repeated BALB/c serum injection. Concrete evidence for C5 non-responsiveness came from experiments showing that C5-injected DBA/2 mice were unable to mount an anti-C5 antibody response after active immunization with C5-sufficient serum in Freund's complete adjuvant.

Parathyroid localization by 201Tl-99mTc subtraction scintigraphy: results in secondary hyperparathyroidism.

Subtraction scintigraphy with 201Tl and 99mTc for parathyroid localization was performed preoperatively in 13 patients with chronic renal failure and secondary hyperparathyroidism. Twenty of the 37 examined pathological glands were predicted correctly (sensitivity 54%). In 3 patients with recurrent hyperparathyroidism after surgery all pathological glands found at second operation had been detected correctly by subtraction scintigraphy.

Successful surgical treatment of parathyroid carcinoma in two haemodialysis patients.

Parathyroid carcinoma is rare, occurring in less than 2-3% of the patients with clinical features of primary hyperparathyroidism. In haemodialysis patients parathyroid carcinoma has only once been described, although secondary hyperparathyroidism in these patients is common. We discuss two female haemodialysis patients with parathyroid carcinoma.

The significance of indirect costs-application to clinical laboratory test economics using computer facilities.

The significance of indirect costs in the cost price calculation of clinical chemistry laboratory tests by way of the production centres method has been investigated. A cost structure model based on the 'production centres' method, the Academisch Ziekenhuis Groningen (AZG) 1-2-3 model, is used for the calculation of cost and cost prices as an add-in tool to the spreadsheet program Lotus 1-2-3. The system specifications of the AZG 1-2-3 cost structure model have been extended with facilities to impute all relevant indirect costs to cost centres by aid of allocation rules, which can be chosen freely.

House dust extracts contain potent immunological adjuvants.

A crude aqueous extract of house dust and two house dust subfractions were tested for adjuvant activity in a sensitivity assay performed in mice. Evidence is presented that house dust contains at least two potent immunological adjuvants. One of these, present in both subfractions, was probably endotoxin and acted in a complement-independent way.

Endotoxin-induced auto-immunity in mice. I. Time and dose dependence of production and serum levels of antibodies against bromelain-treated mouse erythrocytes and circulating immune complexes.

Injection of mice with endotoxin results in the formation of auto-antibodies and the appearance of soluble immune complexes in the blood. In this study the relationship between the production and serum levels of autohaemolysins and circulating immune complex titres was investigated. Immune complexes were detected by a solid-phase C1q-binding assay and found to contain antibodies of the IgM, but not of the IgG class.

House dust allergen activates the classical complement pathway in mouse serum.

A house dust fraction was tested for complement activation in mouse serum using a microtitre complement fixation assay. It was observed that the preparation was a potent activator of the classical, but not of the alternative pathway suggesting an analogy with the complement activation in human serum. The activation showed similarity with that by classical complement activators such as aggregated IgG, DNA, lipopolysaccharide (LPS), but some discrepancy with mite allergen was observed.

A new, sensitive assay to determine immunological adjuvant activity based on the immunogenicity of neuraminidase-treated sheep erythrocytes.

A novel, sensitive system to determine immunological adjuvant activity is presented. It is based on the direct haemagglutinin response of mice to neuraminidase-treated sheep red blood cells (asialo-SRBC) seven days after i.p.

Study of the optimal reaction conditions for assay of the mouse alternative complement pathway.

The optimal reaction conditions for hemolytic assay of alternative complement pathway activity in mouse serum were investigated. A microtiter system was used, in which a number of 7.5 X 10(6) rabbit erythrocytes per test well appeared to be optimal.

Surface-associated sialic acid is an immunological adjuvant.

The influence of neuraminidase on the immunogenicity of heterologous erythrocytes as determined by serum haemagglutination titres was investigated in mice. For this study sheep and rabbit erythrocytes were selected because of their high and low N-acetylneuraminic (sialic) acid content, respectively. Preincubation with neuraminidase resulted in a ten-fold reduction of the immunogenicity of sheep erythrocytes (ShE).

A study of the sensitivity of erythrocytes to lysis by heterologous sera via the alternative complement pathway.

In order to get insight in the distribution of alternative complement pathway activities as detected by lysis of xenogeneic erythrocytes in the presence of magnesium and ethyleneglycol-bis-(2-aminoethyl)-tetra-acetic acid (EGTA) over the species, the 156 heterologous combinations of erythrocytes and sera out of thirteen animal species were tested. An order could be noticed in the species with respect to serum complement activity tending to negative correlation with the sensitivity of the corresponding erythrocytes to lysis by heterologous sera. So far, the most sensitive erythrocyte for each individual serum must be considered to be the target cell of choice for developing assays for alternative complement pathway activity in the serum involved.

Effects of immunological adjuvants on the mouse complement system. I. The inability of the polyanion heparin to act as an adjuvant is paralleled by inefficient alternative complement pathway inhibition.

Interference with hemolytic complement activity by polyanionic substances was studied in relation to the ability of these compounds to act as an adjuvant for a dead listeria vaccine. Heparin appeared a poor inhibitor of the mouse alternative pathway not only in contrast to its effects on the mouse classical and the human classical and alternative pathways, but also when compared to two polyanions with known adjuvant activity: dextran sulfate and suramin. For the three polyanions mentioned a correlation between adjuvant activity and mouse alternative pathway inhibition was observed.

Antigen-specific helper activity in serum of mice primed with sheep red cells II. Partial purification of the factors involved.

The nature of antigen-specific, T-cell dependent helper activity (SSHA), present in serum of mice 9 h after intraperitoneal immunization with 2 x 10(8) sheep erythrocytes, was studied in more detail. SSHA could be enriched from serum by adsorption to formalinized sheep erythrocytes, elution of the cells with a chaotropic substance, and subsequent dialysis. This resulted in an enrichment of about 900 x with a yield of 64%.

Involvement of membrane-associated sialic acid in the resistance of sheep erythrocytes to lysis by mouse complement.

The sensitivity of the murine complement system to regulation by membrane-associated sialic acid was investigated. Therefore the C-mediated lysis of sialic acid-rich sheep erythrocytes, sialic acid-poor rabbit erythrocytes and enzymatically desialylated sheep erythrocytes was studied. Mouse complement differed from human and guinea pig complement in that besides the alternative, also the classical pathway appeared sensitive to regulation by surface sialic acid.

Interactions of killed Listeria monocytogenes with the mouse complement system.

Incubation of mouse serum with Listeria monocytogenes involved activation of the alternative complement pathway, resulting in depletion of both classical and alternative pathway activity. The activation process gave rise to reactive (calcium- and magnesium-independent) lysis of, specifically, rabbit erythrocytes, which become resistant to this form of hemolysis by sensitization with antibodies. The possible implications of these findings for L.

Determination of alternative pathway of complement activity in mouse serum using rabbit erythrocytes.

Rabbit, mouse and sheep erythrocytes expressing different concentrations of membrane sialic acid were used to study possible modes of activation of the alternative complement (C) pathway in mouse, human and guinea pig serum. Mouse erythrocytes activated only human serum, whereas rabbit erythrocytes activated the sera of all three species. Based on the observation that rabbit erythrocytes activate the murine alternative C pathway a method for estimation of alternative C pathway activity (AP50 value) in mouse serum was devised analogous to that used for human AP50 determination.

Estimation of classical pathway of mouse complement activity by use of sensitized rabbit erythrocytes.

A simple photometric assay was devised for determining classical complement pathway activity in mouse serum using sensitized rabbit erythrocytes as target cells. These cells appeared more sensitive to lysis by mouse complement than sensitized mouse and sheep erythrocytes, most probably by their ability to escape the C3b inactivator system. Advantages of the assay over other techniques are the high sensitivity and the avoidance of the use of radioisotopes.