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Verona Integron-encoded Metallo-beta-lactamase (VIM) is the most frequently-encountered carbapenemase in the healthcare-related pathogen Pseudomonas aeruginosa. In the Netherlands, a low-endemic country for antibiotic-resistant bacteria, no national surveillance data on the prevalence of carbapenemase-producing P. aeruginosa (CPPA) was available. Therefore, in 2016, a national surveillance pilot study was initiated to investigate the occurrence, molecular epidemiology, genetic characterization, and resistomes of CPPA among P. aeruginosa isolates submitted by medical microbiology laboratories (MMLs) throughout the country. From 1221 isolates included in the study, 124 (10%) produced carbapenemase (CIM-positive); of these, the majority (95, 77%) were positive for the blaVIM gene using PCR. Sequencing was performed on 112 CIM-positive and 56 CIM-negative isolates (n = 168), and genetic clustering revealed that 75/168 (45%) isolates were highly similar. This genetic cluster, designated Group 1, comprised isolates that belonged to high-risk sequence type ST111/serotype O12, had similar resistomes, and all but two carried the blaVIM-2 allele on an identical class 1 integron. Additionally, Group 1 isolates originated from around the country (i.e. seven provinces) and from multiple MMLs. In conclusion, the Netherlands had experienced a nationwide, inter-institutional, clonal outbreak of VIM-2-producing P. aeruginosa for at least three years, which this pilot study was crucial in identifying. A structured, national surveillance program is strongly advised to monitor the spread of Group 1 CPPA, to identify emerging clones/carbapenemase genes, and to detect transmission in and especially between hospitals in order to control current and future outbreaks.

Carbapenem-hydrolysing enzymes belonging to the OXA-48-like group are encoded byblaOXA-48-like alleles and are abundant amongEnterobacteralesin the Netherlands. Therefore, the objective here was to investigate the characteristics, gene content and diversity of theblaOXA-48-like carrying plasmids and chromosomes ofEscherichia coliandKlebsiella pneumoniaecollected in the Dutch national surveillance from 2014 to 2019 in comparison with genome sequences from 29 countries. A combination of short-read genome sequencing with long-read sequencing enabled the reconstruction of 47 and 132 completeblaOXA-48-like plasmids forE. coliandK. pneumoniae, respectively. Seven distinct plasmid groups designated as pOXA-48-1 to pOXA-48-5, pOXA-181 and pOXA-232 were identified in the Netherlands which were similar to internationally reported plasmids obtained from countries from North and South America, Europe, Asia and Oceania. The seven plasmid groups varied in size, G+C content, presence of antibiotic resistance genes, replicon family and gene content. The pOXA-48-1 to pOXA-48-5 plasmids were variable, and the pOXA-181 and pOXA-232 plasmids were conserved. The pOXA-48-1, pOXA-48-2, pOXA-48-3 and pOXA-48-5 groups contained a putative conjugation system, but this was absent in the pOXA-48-4, pOXA-181 and pOXA-232 plasmid groups. pOXA-48 plasmids contained the PemI antitoxin, while the pOXA-181 and pOXA-232 plasmids did not. Furthermore, the pOXA-181 plasmids carried avirB2-virB3-virB9-virB10-virB11type IV secretion system, while the pOXA-48 plasmids and pOXA-232 lacked this system. A group of non-related pOXA-48 plasmids from the Netherlands contained different resistance genes, non-IncL-type replicons or no replicons. Whole genome multilocus sequence typing revealed that theblaOXA-48-like plasmids were found in a wide variety of genetic backgrounds in contrast to chromosomally encodedblaOXA-48-like alleles. Chromosomally localizedblaOXA-48andblaOXA-244alleles were located on genetic elements of variable sizes and comprised regions of pOXA-48 plasmids. TheblaOXA-48-like genetic element was flanked by a direct repeat upstream of IS1R, and was found at multiple locations in the chromosomes ofE. coli. Lastly,K. pneumoniaeisolates carryingblaOXA-48orblaOXA-232were mostly resistant for meropenem, whereasE. coli blaOXA-48,blaOXA-181and chromosomalblaOXA-48orblaOXA-244isolates were mostly sensitive. In conclusion, the overallblaOXA-48-like plasmid population in the Netherlands is conserved and similar to that reported for other countries, confirming global dissemination ofblaOXA-48-like plasmids. Variations in size, presence of antibiotic resistance genes and gene content impacted pOXA-48, pOXA-181 and pOXA-232 plasmid architecture.

Carbapenem-hydrolyzing enzymes belonging to the OXA-48-like group are encoded by blaOXA-48-like alleles and are abundant among Enterobacterales in the Netherlands. Therefore, the objective was to investigate the characteristics, gene content, and diversity of the blaOXA-48-like carrying plasmids and chromosomes of Escherichia coli and Klebsiella pneumoniae collected in the Dutch national surveillance from 2014-2019 in comparison with genome sequences retrieved from 29 countries. By combining short-read and long-read sequencing, 47 and 132 complete blaOXA-48-like plasmids were reconstructed for E. coli and K. pneumoniae, respectively. Distinct plasmid groups designated as pOXA-48, pOXA-181, and pOXA-232 were identified in the Netherlands and varied in size, % G+C, presence of antibiotic resistance genes, replicons and gene content. The pOXA-48 plasmids were variable, while pOXA-181 and pOXA-232 plasmids were conserved. A group of non-related pOXA-48 plasmids contained different resistance genes, non-IncL type replicons or carried no replicons. K. pneumoniae isolates carrying blaOXA-48 or blaOXA-232 were mostly resistant, while E. coli blaOXA-48, blaOXA-181 and chromosomal blaOXA-48 or blaOXA-244 isolates were mostly sensitive for meropenem. Analysis of chromosomally localized blaOXA-48-like alleles revealed that these were flanked by a direct repeat (DR) upstream of IS1R, which were found at multiple locations in the chromosome of distinct genetic backgrounds. In conclusion, the overall blaOXA-48-like plasmid population in the Netherlands is conserved and similar to that reported for other countries, although a highly diverse blaOXA-48-like plasmid subgroup was present. Chromosomally encoded blaOXA-48-like alleles are from distinct genetic backgrounds and occurs at variable positions containing the DR, thereby indicating multiple independent transpositions.ImportanceOXA-48-type of carbapenem hydrolyzing enzymes encoded by blaOXA-48-like genes from transmissible plasmids or chromosomes of Escherichia coli and Klebsiella pneumoniae have spread world-wide and are of concern. Dissecting the blaOXA-48-like genome architecture at the molecular level by combining short-read and long-read sequencing will lead to understanding trends in the plasmid reservoir of E. coli and K. pneumoniae in the Netherlands and may enhance future international pathogen surveillance.

Aim: Assess the best approach to type methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcal protein A (spa) typing, multiple-locus variable number tandem repeat analysis (MLVA) or both. Materials & methods: Discriminatory power of spa typing and MLVA was determined using 20,771 MRSA isolates. Results: There were twice as many MLVA types (MTs) as spa types present in the collection. Among the top 70% of the isolates, 37 spa types and 139 MTs were found. MLVA diversity among the top-10 spa types was high (diversity index 0.96), while spa diversity among the top-10 MTs was much lower (diversity index 0.83). The probability that two MRSA isolates with the same spa type also had the same MT was low (Wallace's coefficient 0.27). By contrast, most MRSA isolates yielding the same MT also had the same spa type (Wallace's coefficient 0.90). Conclusion: MLVA is superior to spa typing and will suffice to characterize MRSA isolates for surveillance.

De verwerking van goodwill in de jaarrekening is gewijzigd in de Uitvoeringswet richtlijn jaarrekening uit 2015. Dit is de aanleiding om de goodwillverwerking in jaarrekeningen van Nederlandse ondernemingen in 2016 aan een onderzoek te onderwerpen. Uit het empirisch onderzoek blijkt dat goodwill een relatief omvangrijke post is in de jaarrekening, zowel gerelateerd aan posten van de balans als aan posten van de winst-en-verliesrekening. We hebben vastgesteld dat de afschrijvingstermijn van goodwill varieert van 5 tot 20 jaar en ook dat veelal meer dan één afschrijvingstermijn of een maximale afschrijvingstermijn wordt genoemd. Het zou wenselijk zijn als in de toelichting aanvullende informatie wordt opgenomen over hoe de onderneming tot deze schatting is gekomen. Alle ondernemingen die in 2016 vanwege de wetswijziging een stelselwijziging hebben moeten doorvoeren, hebben ervoor gekozen deze wijziging prospectief vanaf 1 januari 2016 te verwerken. Het voordeel van de praktische eenvoud van deze wijze van verwerking zal naar verwachting veelal leidend zijn geweest.

Analysis of methicillin-resistant Staphylococcus aureus (MRSA) isolates in the Netherlands in 2003 revealed that 8% of the hospital isolates carried the loci for Panton-Valentine leukocidin (PVL). Molecular subtyping showed that most Dutch PVL-MRSA genotypes corresponded to well-documented global epidemic types. The most common PVL-MRSA genotypes were sequence type ST8, ST22, ST30, ST59 and ST80. MRSA with ST8 increased in the Netherlands from 1% in 2002 to 17% in 2003. It is emphasised that PVL-MRSA might not only emerge in the community, but also in the hospital environment.

Opiaatverslaafden komen zonder methadonbehandeling niet in aanmerking voor heroineverstrekking. Opiaatgebruik enerzijds en het gemis van methadonbehandeling en heroineverstrekking anderzijds leiden bij deze gebruikers, die tevens veelvuldig crack gebruiken, vaak tot ernstige gezondheidsklachten, marginalisering en overlast. Bovendien missen zij vormen van aanvullende hulp die via de poliklinieken van de GGD aangeboden worden. Uit oogpunt van openbare gezondheidszorg is het echter van belang het langzaam afnemende bereik van de methadonbehandeling voor alle gebruikers op peil te houden en waar mogelijk te maximaliseren. Inzicht in de belemmeringen voor methadonbehandeling vanuit het perspectief van de gebruiker is nodig om dit doel te bereiken. De hier beschreven kwalitatieve studie richtte zich specifiek op onbehandelde Amsterdamse heroineverslaafden en maakte gebruik van open vragen om nieuwe informatie te verzamelen.

In The Netherlands, MRSA ST398 has emerged in hospitals and human carriers have been associated with exposure to pigs and cattle. High prevalences of MRSA ST398 in pigs and pig farmers have been determined and the transmission routes of MRSA on pig farms need to be elucidated. In the south of the Netherlands, in recent years, the black rat (Rattus rattus) has emerged as a prominent rodent on livestock farms. From March till May 2008, a survey on MRSA in rats living on livestock farms in the south of The Netherlands and the north of Belgium was conducted. In total, 40 black rats (R. rattus) and 3 brown rats (Rattus norvegicus) were collected on 12 farms including five pig farms, five poultry farms, one mixed pig and veal farm and one goat farm. MRSA ST398 was detected in black rats captured at two of the five pig farms as well as in a black rat living on the mixed pig and veal farm. From one black rat captured at another pig farm MRSA ST 97 was isolated. Considering the behaviour of rats on livestock farms, it is concluded that rats might play a role in the spread and persistence of MRSA on pig farms.

Recently methicillin resistant Staphylococcus aureus (MRSA) was isolated from pigs and pig farmers in The Netherlands. In order to assess the dissemination of MRSA in the Dutch pig population, we screened 540 pigs in 9 slaughterhouses, where a representative portion of Dutch pigs (63%) was slaughtered in 2005. We found 209 (39%) of the pigs to carry MRSA in their nares. Forty-four of 54 groups of 10 consecutive pigs (81%), each group from a different farm, and all slaughterhouses were affected. All MRSA isolates belonged to 1 clonal group, showing Multi-Locus Sequence Type 398 and closely related spa types (mainly t011, t108 and t1254). Three types of the Staphylococcal Chromosome Cassette (SCCmec) were found: III (3%), IVa (39%) and V (57%). All 44 tested isolates (1 isolate per group) were resistant to tetracycline, reflecting the high and predominant use of tetracyclines in pig husbandry. Twenty-three percent of the isolates were resistant to both erythromycin and clindamycin and 36% to kanamycin, gentamicin and tobramycin but only a single isolate was resistant to co-trimoxazole and none to ciprofloxacin and several other antibiotics. The percentage of MRSA positive pigs was significantly different among slaughterhouses and among groups within slaughterhouses, indicating a high prevalence of MRSA in pigs delivered from the farms as well as cross contamination in the slaughterhouses.

The state of many fisheries and fishery resources requires a major change in development and management policies and strategies, at national and regional levels. The international Code of Conduct for Responsible Fisheries, adopted in FAO in 1995, provides the operational framework for such change, in all fisheries, in the oceans, inland waters, EEZs, international waters, as well as in aquaculture. In their respective areas of competence and in close collaboration, FAO and the World Bank are committed to facilitate the implementation of the Code by fishing and coastal nations. This paper presents the strategy they have developed for the purpose. The paper elaborates on: (1) the main policy-related issues faced by fisheries worldwide (bio-ecological, technological, economic, socio-cultural, institutional and legal, as well as scientific); (2) the Code of Conduct, its background, structure and scope; (3) the basis of the implementation strategy by FAO and the Bank; and the main types of activities involved at global, regional and national levels. In conclusion it describes briefly the main elements of changes imbedded in the strategy and shows that the implementation by FAO and the Bank as well as by the countries has already actively started.

Objective. To determine whether the twitch force of the adductor pollicis remains stable when 0.1 Hz single twitch stimulation is started after stabilization of the thumb preload at a constant degree of thumb abduction; also to study any possible increase in twitch force before the onset of and after the recovery from neuromuscular block. Methods. Measurements were performed in thirty patients under general anaesthesia. Twitch forces were first allowed to stabilize after allowing the preload to drift to its resting tension at a constant degree of thumb abduction. Three groups of ten patients then each received either vecuronium (2, 4, 8, 16 and 32 µg/kg-1, successively at intervals of 2 min), d-tubocurarine (5, 10, 20, 40 and 80 µg/kg-1, successively at intervals of 2 min), or suxamethonium (0.025, 0.05, 0.1, 0.2 and 0.4 mg/kg-1, successively at intervals of 2 min). Measurements were continued until twitch forces had recovered from neuromuscular block and were stable. Results.Twitch forces stabilized at 114% (sd = 8.9) of the initial value after 10.9 (6.1) min of stimulation. Increase in twitch force before the onset of neuromuscular block was seen in two patients receiving vecuronium and in two patients receiving d-tubocurarine. Increase in twitch force after recovery from neuromuscular block was seen in all patients receiving suxamethonium. Conclusions. Twitch forces may increase when stimulation is started after stabilization of thumb preload at a constant degree of thumb abduction. In some patients twitch forces may increase before the onset of neuromuscular block with vecuronium or d-tubocurarine; twitch forces increase after recovery from suxamethonium.

Objective. In order to study the stabilization time, the increase in twitch force during stabilization and the maintenance of stability during mechanomyography of the adductor pollicis muscle, neuromuscular function was monitored in 20 patients anaesthetized without the use of a neuromuscular blocking agent. The effect of the type of stimulation (single twitch [ST; 0.1 Hz], or train-of-four [TOF; 4 stimuli at 2 Hz, repeated every 12 s]) on these variables was studied. When applying TOF stimulation, the variables were also investigated for the TOF percentage [quotient of fourth and first twitch of a TOF stimulus × 100%]. Methods.Two groups of ten patients were monitored with either ST or TOF stimulation. Measurements continued for at least 45 minutes. Multiple linear regression analysis was applied to examine the effect of stimulation on the stabilization time and the increase in twitch force. Results. According to our criteria for stability, we found that the stabilization time did not differ for ST (13.7 [10.2] min; mean [sd]) and TOF stimulation (18.1 [9.6] min) (p > 0.10). Stabilized twitch forces were larger during TOF than during ST stimulation (134% [19] and 113% [11]; p = 0.01). In both groups of stimulation, six patients showed an interruption of stability. The TOF percentage was stable throughout the measurement period in all patients. Conclusions. Stabilization of twitch force takes too long for many studies of neuromuscular function in the clinical research setting. Therefore, we do not recommend its routine use when performing mechanomyography of the adductor pollicis muscle.

An outbreak of community-acquired methicillin-resistant Staphylococcus aureus occurred among members and close contacts of a soccer team. Typing of the isolates showed the outbreak was caused by the well-known European ST80-IV strain. To our knowledge, this is the first report of an outbreak of this strain among members of a sports team.

The worldwide emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) can have severe public health implications. Familial transmissions of CA-MRSA in The Netherlands were investigated. Among the families studied, two clusters of CA-MRSA could be identified. This report demonstrates that family members can serve as reservoirs of CA-MRSA which may become a serious problem in containing the spread of MRSA.

Seventeen laboratories participated in a cooperative study to validate the regional susceptibility testing of Neisseria gonorrhoeae in The Netherlands. International reference strains were distributed. Each laboratory determined the MICs of ciprofloxacin, penicillin, and tetracycline, for each strain by Etest. To explore a more transparent assessment of quality and comparability, a statistical regression model was fitted to the data that accounted for the censoring of the MICs. The mean MICs found by all of the laboratories except three were closer than one 2-fold dilution step to the overall mean, and the mean MICs of each antimicrobial agent were close to the MICs for the international reference strains. This approach provided an efficient tool to analyze the performance of the Dutch decentralized gonococcal resistance monitoring system and confirmed good and comparable standards.

Artificial sources of late leaf spot were established by inoculation of one plant at the centre of several groundnut plots differing in age. First-generation dispersal and resulting primary gradients of disease were then compared. The gradients were corrected for source strength, spontaneous infection (primary gradient), and interplot interference (first-generation dispersal). The shapes of the gradients for spore dispersal and of the gradients of disease corresponded for each age of groundnut plot, but differed between the ages. The slopes of gradients were steeper in the older plots. Spore dispersal and the resulting disease gradients were not isodiametric, gradients being most protracted in a north-to-north westerly direction. The results suggest that the strength of the sources was reduced by abscission of infected leaves in the sources of the younger plots, whereas accessibility of the canopy to the transported spores was reduced by increasing canopy density in the older ones.

In 2007 in the Netherlands, 30% of all human isolates of methicillin-resistant Staphylococcus aureus (MRSA) sent to the National Institute for Public Health and the Environment could not be typed by pulsed-field gel electrophoresis (non-typable (NT)-MRSA). Molecular characterisation of the NT-MRSA isolates revealed 27 different spa types and two distinct SCCmec types, type IV and V. All NT-MRSA isolates were closely related based on spa and multi-locus sequence typing and belonged to the ST398 lineage. The rapid increase of NT-MRSA (ST398) isolates over the last years shows the importance of this relatively new clonal lineage.

In a household setting within a residential care facility for visually and intellectually disabled people, a resident (index case) was diagnosed with dermal abscesses caused by a methicillin-resistant Staphylococcus aureus (MRSA) which was non-typeable by standard pulsed-field gel electrophoresis. In the process of 'search and destroy', all residents and staff in contact with the index case (a total of 200 people) were screened for MRSA. Five people (three personnel and two residents) carried non-typeable MRSA and were treated with antibiotics to eradicate the infection. The 'search and destroy' efforts did not result in the identification of a source. Goats and rabbits which were kept on the premises tested negative for MRSA. The condition of the index case is improving. Further restrictive measures were implemented within the facility to prevent wider spread of the MRSA. This discovery and spread within a residential care facility of a non-typeable MRSA which is often associated with livestock, is remarkable.

Background Molecular typing of methicillin-resistant Staphylococcus aureus (MRSA) is required to study the routes and rates of transmission of this pathogen. Currently available typing techniques are either resource-intensive or have limited discriminatory ability. Multiple-locus variable number tandem repeat analysis (MLVA) may provide an alternative high throughput molecular typing tool with high epidemiological resolution. Methodology/Principal Findings A new MLVA scheme for S. aureus was validated using 1681 S. aureus isolates collected from Dutch patients and 100 isolates from pigs. MLVA using 8 tandem repeat loci was performed in 2 multiplex PCRs and the fluorescently labeled PCR products were accurately sized on an automated DNA sequencer. The assessed number of repeats was used to create MLVA profiles consisting of strings of 8 integers that were used for categorical clustering. MLVA yielded 511 types that clustered into 11 distinct MLVA complexes which appeared to coincide with MLST clonal complexes. MLVA was at least as discriminatory as PFGE and twice as discriminatory as spa-sequence typing. There was considerable congruence between MLVA, spa-sequence typing and PFGE, at the MLVA complex level with group separation values of 95.1% and 89.2%. MLVA could not discriminate between pig-related MRSA strains isolated from humans and pigs, corroborating the high degree of relationship. MLVA was also superior in the grouping of MRSA isolates previously assigned to temporal-spatial clusters with indistinguishable SpaTypes, demonstrating its enhanced epidemiological usefulness. Conclusions The MLVA described in this study is a high throughput, relatively low cost genotyping method for S. aureus that yields discrete and unambiguous data that can be used to assign biological meaningful genotypes and complexes and can be used for interlaboratory comparisons in network accessible databases. Results suggest that MLVA offsets the disadvantages of other high discriminatory typing approaches and represents a promising tool for hospital, national and international molecular epidemiology.

A 34-year-old woman originally from Ghana was given efavirenz as antiretroviral therapy. One week later she was found to be in a psychotic state with paranoid hallucinations and anxiety; she then stabbed a nurse. The literature indicates that female patients of African origin appear to be more susceptible to the side effects of efavirenz due to genetically reduced clearance and therefore higher serum levels.

We investigated whether the response to a single twitch (ST) stimulus or the first response (T1) to a train-of-four (TOF; 4 stimuli at 2 Hz) stimulus following a stimulus interval of 10 s (i.e., the time between two consecutive ST or TOF stimuli) is influenced by the preceding stimulus in the presence of a stable 50% neuromuscular block. In addition, we determined whether ST and TOF stimulation yield different results under these circumstances.Twitch forces were measured in both tibialis anterior muscles of six cats. In the presence of a stable 50% neuromuscular block the stimulation pattern (ST or TOF) or stimulus interval (3.3, 10 or 30 s) was varied every 30 min. A linear mixed model was used for statistical analysis.ST forces with a stimulus interval of 3.3 s were 10.3% (95% CI: 7.3-13.3%) smaller than those with a stimulus interval of 10 s. For T1 forces this effect was 15.2% (95% CI: 12-18.4%). There was no significant difference between twitch forces with stimulus intervals of 30 and 10 s. For a stimulus interval of 3.3 s the ST forces exceeded the T1 forces by 7.6% (95% CI: 4.4-10.8%); no significant differences were found between the ST and T1 forces for stimulus intervals of 10 and 30 s.The ST or T1 force during stimulation with a stimulus interval of 10 s or more during a stable 50% neuromuscular block in the tibialis anterior muscle of the cat is not affected by the preceding stimulus. In addition, ST and T1 forces do not differ when employing a stimulus interval of 10 s or more under these circumstances. Our results thus indicate that the known differences between ST and T1 forces after a bolus injection of a muscle relaxant can not be explained by differences in acetylcholine release when the stimulus interval exceeds 10 s.

To investigate the effects of maintaining a constant preload and of maintaining a constant degree of thumb abduction on the isometric twitch force during mechanomyography of the thumb, we monitored neuromuscular function in patients anaesthetized without the use of a neuromuscular blocking agent. In addition, we studied the relationship between the degree of thumb abduction, twitch force and preload.Fourteen patients were divided randomly into two groups, determining the sequence of the experiments in respect of correcting the preload and maintaining a constant degree of abduction after allowing the twitch forces to stabilize. Both experiments lasted 15 minutes. In both groups the relationship between the degree of thumb abduction, twitch force and preload was studied.We found a progressive increase in twitch force both with (6.6%; CI: 3.7-9.3%; p0.001) and without (1.9%; CI: 0.4-3.5%; p = 0.020) continuous correction of the thumb preload. A significant greater increase in twitch force was seen when the preload had been corrected than when it was not (4.7%; CI: 0.8-8.7%; p = 0.023). In addition, both twitch force and preload appeared to depend on the degree of thumb abduction both before and at the time of measurement.Changes in length of the contracting muscle fibres and creep phenomena in the connective tissue of the muscles, both leading to changes in the sarcomere length of the muscle fibres, may explain the observations in this study. In general, a stabilized preload at a constant degree of abduction seems to be required in order to obtain a stable twitch force.

The genetic relationship among fecal vancomycin-resistant Enterococcus faecium (VREF) and vancomycin-susceptible E. faecium (VSEF) isolates ( n = 178) from the same populations of pigs, human healthy volunteers, and hospitalized patients (from The Netherlands) and chickens (from The Netherlands and Greece) was studied by amplified-fragment length polymorphism (AFLP). The majority of VREF isolates from pigs, healthy volunteers, and hospitalized patients grouped together (genetic similarity, ≥65%). In a previous AFLP study by our group the VREF isolates from hospitalized patients grouped separately, most likely because these were clinical and not fecal isolates as in the present study. Furthermore, VSEF isolates from humans and pigs were found much more genetically diverse than VREF isolates, whereas VREF and VSEF isolates from chickens clustered together in a separate genogroup (genetic similarity, ≥65%), a pattern clearly distinct from the patterns for human and pig isolates. The present study suggests that pigs are a more important source of VREF for humans than chickens and that human- and pig-derived VSEF isolates seem much more heterogeneous than VREF isolates.

A 65-year-old patient, ex-smoker, with facioscapulohumeral muscular dystrophy (FSHD) had been on home non invasive ventilatory support for three years when he experienced gradual increase of dyspnoea. The chest radiograph showed large bullae occupying most of the right hemithorax, with compression of lung tissue, mediastinal shift, and compression of the left lower lobe. Bullectomy resulted in rapid clinical and radiographic improvement. This is the first report of beneficial effects of emergency bullectomy in FSHD. Bullectomy has proved most successful in patients with localized bullae and compression of surrounding lung tissue. Patients with respiratory infections and bronchiectasis benefit less.

In order to study the stabilization time, the increase in twitch force during stabilization and the maintenance of stability during mechanomyography of the adductor pollicis muscle, neuromuscular function was monitored in 20 patients anaesthetized without the use of a neuromuscular blocking agent. The effect of the type of stimulation (single twitch [ST; 0.1 Hz], or train-of-four [TOF; 4 stimuli at 2 Hz, repeated every 12 s]) on these variables was studied. When applying TOF stimulation, the variables were also investigated for the TOF percentage [quotient of fourth and first twitch of a TOF stimulus x 100%].Two groups of ten patients were monitored with either ST or TOF stimulation. Measurements continued for at least 45 minutes. Multiple linear regression analysis was applied to examine the effect of stimulation on the stabilization time and the increase in twitch force.According to our criteria for stability, we found that the stabilization time did not differ for ST (13.7 [10.2] min; mean [sd]) and TOF stimulation (18.1 [9.6] min) (p0.10). Stabilized twitch forces were larger during TOF than during ST stimulation (134% [19] and 113% [11]; p = 0.01). In both groups of stimulation, six patients showed an interruption of stability. The TOF percentage was stable throughout the measurement period in all patients.Stabilization of twitch force takes too long for many studies of neuromuscular function in the clinical research setting. Therefore, we do not recommend its routine use when performing mechanomyography of the adductor pollicis muscle.

Surveillance of antibiotic resistance in Neisseria gonorrhoeae showed a decrease in the percentage of β-lactamase-producing isolates but an increase in intermediately penicillin-resistant strains and strains resistant to a high level of tetracycline. MICs for the ciprofloxacin-resistant isolates that emerged increased, and these isolates had mutations in gyrA and parC similar to those observed in the Far East.

Background Sporadic cases of CA-MRSA in persons without risk-factors for MRSA carriage are increasing.

To test the hypothesis that vasodilation occurs because of the release of a vasoactive substance after a brief muscle contraction and to determine whether acetylcholine spillover from the motor nerve is involved in contraction-induced hyperemia, tetanic muscle contractions were produced by sciatic nerve stimulation in anesthetized dogs (n = 16), instrumented with flow probes on both external iliac arteries. A 1-s stimulation of the sciatic nerve at 1.5, 3, and 10 times motor threshold increased blood flow above baseline (P

In summary, it can be stated that Amsterdam has a wide variety of helping modalities. Approximately 70 percent of the city's 7,000 drug addicts are in contact with this helping system. In The Netherlands, no evidence could be found to support the fear that low-threshold methadone programs keep addicts away from drug-free treatment. Figure 1 shows that the number of addicts entering drug-free treatment doubled in the period 1981-85 (most popular has been the drug-free aftercare). This is even more striking since the estimated number of addicts did not increase in that same period. So, instead of keeping addicts away from treatment, low-threshold programs and outreach activities may have been effective tools in motivating addicts to enter drug-free treatment. Figure 2 shows the rise of the mean age of drug addicts, while figure 3 indicates that the percentage of addicts under 22 years decreases (14.4 percent in 1981 and 5.1 percent in 1986). Since the total number of addicts is quite stable, this may suggest that heroin is becoming less attractive to young people.

An image sensor for a consumer camera should be inexpensive and small. Although the frame transfer organisation requires separate image and storage sections, our results show that a very compact design is possible, high resolution and high sensitivity being obtained with a chip area of 90 mm2 for 3.6 µm design rules.

A new type of charge transfer sensor, the resistive gate sensor will be described. This resistive gate sensor is compared with existing charge transfer sensors. The comparison is favorable for the resistive gate sensor with respect to point anti-blooming, the sensitivity to blue light and the overall sensitivity. A lot of work has still to be done to show whether this sensor is a practical proposition for consumer applications.