93 results on '"de Metz J"'
Search Results
2. Interferon-γ administration does not affect human thyroid hormone metabolism in the post-surgical euthyroid sick syndrome
- Author
-
de Metz, J., Romijn, J. A., Gouma, D. J., ten Berge, I. J. M., Busch, O. R. C., Endert, E., and Sauerwein, H. P.
- Published
- 2002
- Full Text
- View/download PDF
3. Bloed- en urinebepalingen
- Author
-
de Metz, J., primary, Romijn, J.A., additional, and Levi, M., additional
- Published
- 2009
- Full Text
- View/download PDF
4. Bloed- en urinebepalingen
- Author
-
de Metz, J., primary, Romijn, J. A., additional, and Levi, M., additional
- Published
- 2004
- Full Text
- View/download PDF
5. Interferon-gamma administration to patients after major surgery influences cellular immunity without pro-inflammatory response
- Author
-
de Metz, J., Sauerwein, H. P., Gouma, D. J., Out, T. A., Reijneke, R. M. R., Hack, C. E., Romijn, J. A., and ten Berge, I. J. M.
- Published
- 2002
6. Interferon-gamma administration after abdominal surgery rescues antigen-specific helper T cell immune reactivity
- Author
-
Rentenaar, R. J., De Metz, J., Bunders, M., Wertheim-Van Dillen, P. M. E., Gouma, D. J., Romijn, J. A., Sauerwein, H. P., TEN BERGE, I. J. M., and Van Lier, R. A. W.
- Published
- 2001
7. Interferon-γ in healthy subjects: selective modulation of inflammatory mediators
- Author
-
de Metz, J., Hack, C. E., Romijn, J. A., Levi, M., Out, T. A., ten Berge, I. J. M., and Sauerwein, H. P.
- Published
- 2001
8. Interferon-γ preferentially reduces memory/effector CD8 T lymphocytes in healthy subjects
- Author
-
de METZ, J., OUT, T. A., WEVER, P. C., REIJNEKE, R. M. R., SPRANGERS, F., SAUERWEIN, H. P., ROMIJN, J. A., and ten BERGE, I. J. M.
- Published
- 1999
9. Extracorporeal life support for cardiac and respiratory failure in adults in the intensive care unit in the Netherlands. Indications for ECLS and requirements for an ECLS centre
- Author
-
Lansink, A (Ad), Van Den Brule, J, van Dijk, D, De Metz, J, Otterspoor, L, Gommers, Diederik, and Intensive Care
- Published
- 2016
10. Venodilatatie en venoconstrictie
- Author
-
De Metz, J. E.
- Published
- 1980
- Full Text
- View/download PDF
11. Interferon-gamma in healthy subjects: selective modulation of inflammatory mediators
- Author
-
de Metz, J., Hack, C. E., Romijn, J. A., Levi, M. [=Marcel M.], Out, T. A., ten Berge, I. J., Sauerwein, H. P., and Other departments
- Abstract
BACKGROUND: It is suggested that interferon-gamma (IFN-gamma), like other cytokines, is a mediator in the host inflammatory response, which could be of importance in the pathophysiology of sepsis. The role of IFN-gamma in human host inflammatory responses, however, has not been studied. DESIGN: In a placebo-controlled trial we studied the acute effects of IFN-gamma administration on host inflammatory mediators in healthy men: i.e. the cytokine/chemokine cascade system, acute-phase proteins, activation markers of the innate cellular immunity and coagulation/fibrinolysis parameters. RESULTS: IFN-gamma increased plasma levels of interleukin-6 (IL-6), IL-8 and IFN-gamma-inducible protein-10 (IP-10) (P
- Published
- 2001
12. Pleiotropic responses to interferon-gamma in humans
- Author
-
de Metz, J., Sauerwein, H.P., ten Berge, R.J.M., Romijn, J.A., and Faculteit der Geneeskunde
- Published
- 2000
13. Interferon-gamma has immunomodulatory effects with minor endocrine and metabolic effects in humans
- Author
-
de Metz, J., Sprangers, F., Endert, E., Ackermans, M. T., ten Berge, I. J., Sauerwein, H. P., Romijn, J. A., and Other departments
- Abstract
To evaluate whether interferon-gamma (IFN-gamma) is involved in the interaction between the immune and endocrine systems in vivo, we studied six healthy subjects twice in a placebo-controlled trial: once after administration of recombinant human IFN-gamma and, on another occasion, after administration of saline. The rate of appearance of glucose was determined by infusion of [6,6-2H2]glucose and resting energy expenditure by indirect calorimetry. Human leukocyte antigen-DR gene expression on monocytes and serum neopterin increased after administration of IFN-gamma (P
- Published
- 1999
14. No Beneficial Effect of Interferon- Treatment in 2 Human Immunodeficiency Virus-Infected Patients with Mycobacterium avium Complex Infection
- Author
-
Lauw, F. N., primary, van der Meer, J. T. M., additional, de Metz, J., additional, Danner, S. A., additional, and van der Poll, T., additional
- Published
- 2001
- Full Text
- View/download PDF
15. Biologic Responses to IFN-α Administration in Humans
- Author
-
Corssmit, E. P. M., primary, de Metz, J., additional, Sauerwein, H. P., additional, and Romijn, J. A., additional
- Published
- 2000
- Full Text
- View/download PDF
16. Interferon-γ has immunomodulatory effects with minor endocrine and metabolic effects in humans
- Author
-
de Metz, J., primary, Sprangers, F., additional, Endert, E., additional, Ackermans, M. T., additional, ten Berge, I. J. M., additional, Sauerwein, H. P., additional, and Romijn, J. A., additional
- Published
- 1999
- Full Text
- View/download PDF
17. Immunomodulatory effects of interferon-gamma on T-cell subsets in healthy volunteers
- Author
-
de Metz, J., primary, Wever, P.C., additional, Reijneke, R.M.J., additional, Sprangers, F., additional, Diepen, F.N.J.V., additional, Out, T.A., additional, Sauerwein, H.P., additional, Romijn, J.A., additional, and ten Berge, R.J.M., additional
- Published
- 1997
- Full Text
- View/download PDF
18. Review: Biologic Responses to IFN-x Administration in Humans
- Author
-
Corssmit, E.P.M., de Metz, J., Sauerwein, H.P., and Romijn, J. A.
- Published
- 2000
19. Differential Effects of Dihydroergotamine on the Circulatory Actions of Arterial and Venous Dilators in the Rat.
- Author
-
de Metz, J. E. and van Zwieten, P. A.
- Published
- 1981
- Full Text
- View/download PDF
20. Optical Design of a Laser System for Nuclear Fusion Research
- Author
-
de Metz, J.
- Abstract
High power laser improvements, high quality aspheric lenses, and sharp focusing on a solid deuterium target enable us to get numerous nuclear fusion reactions inside the deuterium plasma. Since Maiman successfully built the first light amplifier in 1960 [ Nature187, 493 ( 1960)] and Terhune performed air breakdown experiments in 1962 [ “ Optical Third Harmonic Generation,” Comptes rendus de la 3ème Conférence Internationale d’Electronique Quantique, Paris, 11–15 février 1963, GrivetP.BloembergenN., Eds. ( Dunod, Paris, 1964), pp. 1559– 1576], the laser has been thought of as a valuable energy source for fusion devices. Now a kind of race has started toward high temperature plasmas created by powerful lasers. However, the peak power of solid state laser is limited by glass damage, pump efficiences, and unwanted effects such as superradiance. So it is necessary to improve all the optical properties of the laser and the focusing of the lens on the target. In this paper, requirements for fusion implying a very high flux will be stated. Successive optical designs will be described together with measurement methods, and the contribution of optical improvements to the occurrence of nuclear fusion reaction in deuterium targets will be evaluated.
- Published
- 1971
21. Etude optique du faisceau émis par un laser de grande intensité
- Author
-
de Metz, J., Terneaud, A., and Veyrie, P.
- Abstract
The optical beam emitted by a high power laser has been studied. The beam cross section at various locations is considered, from optical and photometrical points of view. Output wavefront shaping is deduced as well as some ideas about focusing devices.
- Published
- 1966
22. Fusion reactions in a plasma created by the second harmonic of a Nd glass laser
- Author
-
Carion, A., primary, Lancelot, J., additional, de Metz, J., additional, and Saleres, A., additional
- Published
- 1973
- Full Text
- View/download PDF
23. Lower Body Negative Pressure: A Method to Differentiate Vasodilators in the Intact Rat
- Author
-
De Metz, J. E., primary and Van Zwieten, P. A., primary
- Published
- 1979
- Full Text
- View/download PDF
24. Vacuum U. V. stimulated emission in 5 to 15 bars xenon with e-beam excitation
- Author
-
Lagarde, F., primary, Novaro, M., additional, and de Metz, J., additional
- Published
- 1974
- Full Text
- View/download PDF
25. Static and dynamic investigation of a laser beam
- Author
-
de Metz, J., primary and Terneaud, A., additional
- Published
- 1968
- Full Text
- View/download PDF
26. Manufacture of high-performance aspheric condenser lenses
- Author
-
Marioge, J.P., primary, de Metz, J., additional, Millet, F., additional, and Mahé, C., additional
- Published
- 1970
- Full Text
- View/download PDF
27. Concentration of a laser beam with aspheric lenses
- Author
-
Champetier, J., primary, de Metz, J., additional, Marioge, J., additional, Millet, F., additional, and Terneaud, A., additional
- Published
- 1968
- Full Text
- View/download PDF
28. Sensitométrie infrarouge ultra-rapide
- Author
-
de Metz, J., primary
- Published
- 1970
- Full Text
- View/download PDF
29. Global warming could affect outpatient attendance.
- Author
-
Linthorst GE and de Metz J
- Published
- 2008
- Full Text
- View/download PDF
30. PRODUCTION OF HIGH FLUXES OF PHOTONS: UTILIZATION AND FOCUSING OF HIGH POWER LASERS.
- Author
-
de Metz, J
- Published
- 1970
31. Cost-effectiveness of extracorporeal cardiopulmonary resuscitation vs. conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a pre-planned, trial-based economic evaluation.
- Author
-
Delnoij TSR, Suverein MM, Essers BAB, Hermanides RC, Otterspoor L, Elzo Kraemer CV, Vlaar APJ, van der Heijden JJ, Scholten E, den Uil C, Akin S, de Metz J, van der Horst ICC, Maessen JG, Lorusso R, and van de Poll MCG
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Extracorporeal Membrane Oxygenation economics, Extracorporeal Membrane Oxygenation methods, Netherlands, Quality-Adjusted Life Years, Survival Rate trends, Cardiopulmonary Resuscitation economics, Cardiopulmonary Resuscitation methods, Cost-Benefit Analysis, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest economics, Quality of Life
- Abstract
Aims: When out-of-hospital cardiac arrest (OHCA) becomes refractory, extracorporeal cardiopulmonary resuscitation (ECPR) is a potential option to restore circulation and improve the patient's outcome. However, ECPR requires specific materials and highly skilled personnel, and it is unclear whether increased survival and health-related quality of life (HRQOL) justify these costs., Methods and Results: This cost-effectiveness study was part of the INCEPTION study, a multi-centre, pragmatic randomized trial comparing hospital-based ECPR to conventional CPR (CCPR) in patients with refractory OHCA in 10 cardiosurgical centres in the Netherlands. We analysed healthcare costs in the first year and measured HRQOL using the EQ-5D-5L at 1, 3, 6, and 12 months. Incremental cost-effectiveness ratios (ICERs), cost-effectiveness planes, and acceptability curves were calculated. Sensitivity analyses were performed for per-protocol and as-treated subgroups as well as imputed productivity loss in deceased patients. In total, 132 patients were enrolled: 62 in the CCPR and 70 in the ECPR group. The difference in mean costs after 1 year was €5109 (95% confidence interval -7264 to 15 764). Mean quality-adjusted life year (QALY) after 1 year was 0.15 in the ECPR group and 0.11 in the CCPR group, resulting in an ICER of €121 643 per additional QALY gained. The acceptability curve shows that at a willingness-to-pay threshold of €80.000, the probability of ECPR being cost-effective compared with CCPR is 36%. Sensitivity analysis showed increasing ICER in the per-protocol and as-treated groups and lower probabilities of acceptance., Conclusion: Hospital-based ECPR in refractory OHCA has a low probability of being cost-effective in a trial-based economic evaluation., Competing Interests: Conflict of interest: R.L. reports support from ABIOMED for consulting lecture work and consultancy on the Medical Advisory Board of Xenios., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
- Published
- 2024
- Full Text
- View/download PDF
32. Health-related quality of life one year after refractory cardiac arrest treated with conventional or extracorporeal CPR; a secondary analysis of the INCEPTION-trial.
- Author
-
van de Koolwijk AF, Delnoij TSR, Suverein MM, Essers BAB, Hermanides RC, Otterspoor LC, Elzo Kraemer CV, Vlaar APJ, van der Heijden JJ, Scholten E, den Uil CA, Dos Reis Miranda D, Akin S, de Metz J, van der Horst ICC, Winkens B, Maessen JG, Lorusso R, and van de Poll MCG
- Abstract
Background: Prospective, trial-based data comparing health-related quality of life (HRQoL) in patients surviving out-of-hospital cardiac arrest (OHCA) through extracorporeal cardiopulmonary resuscitation (ECPR) or conventional CPR (CCPR) are scarce. We aimed to determine HRQoL during 1-year after refractory OHCA in patients treated with ECPR and CCPR., Methods: We present a secondary analysis of the multicenter INCEPTION-trial, which studied the effectiveness of ECPR versus CCPR in patients with refractory OHCA. HRQoL was prospectively assessed using the EQ-5D-5L questionnaire. Poor HRQoL was pragmatically defined as an EQ-5D-5L health utility index (HUI) > 1 SD below the age-adjusted norm. We used mixed linear models to assess the difference in HRQoL over time and univariable analyses to assess factors potentially associated with poor HRQoL., Results: A total of 134 patients were enrolled, and hospital survival was 20% (27 patients). EQ-5D-5L data were available for 25 patients (5 ECPR and 20 CCPR). One year after OHCA, the estimated mean HUI was 0.73 (0.05) in all patients, 0.84 (0.12) in ECPR survivors, and 0.71 (0.05) in CCPR survivors (p-value 0.31). Eight (32%) survivors had a poor HRQoL. HRQoL was good in 17 (68%) patients, with 100% in ECPR survivors versus 60% in CCPR survivors (p-value 0.14)., Conclusion: One year after refractory OHCA, 68% of the survivors had a good HRQoL. We found no statistically significant difference in HRQoL one year after OHCA in patients treated with ECPR compared to CCPR. However, numerical differences may be clinically relevant in favor of ECPR., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
33. Favorable resuscitation characteristics in patients undergoing extracorporeal cardiopulmonary resuscitation: A secondary analysis of the INCEPTION-trial.
- Author
-
Ubben JFH, Heuts S, Delnoij TSR, Suverein MM, Hermanides RC, Otterspoor LC, Kraemer CVE, Vlaar APJ, van der Heijden JJ, Scholten E, den Uil C, Dos Reis Miranda D, Akin S, de Metz J, van der Horst ICC, Winkens B, Maessen JG, Lorusso R, and van de Poll MCG
- Abstract
Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used as a supportive treatment for refractory out-of-hospital cardiac arrest (OHCA). Still, there is a paucity of data evaluating favorable and unfavorable prognostic characteristics in patients considered for ECPR., Methods: We performed a previously unplanned post-hoc analysis of the multicenter randomized controlled INCEPTION-trial. The study group consisted of patients receiving ECPR, irrespective of initial group randomization. The patients were divided into favorable survivors (cerebral performance category [CPC] 1-2) and unfavorable or non-survivors (CPC 3-5)., Results: In the initial INCEPTION-trial, 134 patients were randomized. ECPR treatment was started in 46 (66%) of 70 patients in the ECPR treatment arm and 3 (4%) of 74 patients in the conventional treatment arm. No statistically significant differences in baseline characteristics, medical history, or causes of arrest were observed between survivors ( n = 5) and non-survivors ( n = 44). More patients in the surviving group had a shockable rhythm at the time of cannulation (60% vs. 14%, p = 0.037), underwent more defibrillation attempts (13 vs. 6, p = 0.002), and received higher dosages of amiodarone (450 mg vs 375 mg, p = 0.047) despite similar durations of resuscitation maneuvers. Furthermore, non-survivors more frequently had post-ECPR implantation adverse events., Conclusion: The persistence of ventricular arrhythmia is a favorable prognostic factor in patients with refractory OHCA undergoing an ECPR-based treatment. Future studies are warranted to confirm this finding and to establish additional prognostic factors. Clinical trial Registration: clinicaltrials.gov registration number NCT03101787., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘Roberto Lorusso reports consulting fees from Medtronic, LivaNova, Getinge, and Abiomed and participates in an advisory board of Eurosets and Xenios, which are not related to this work. All other authors report no conflicts of interest.’., (© 2024 The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
34. A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study.
- Author
-
Ali S, Moors X, van Schuppen H, Mommers L, Weelink E, Meuwese CL, Kant M, van den Brule J, Kraemer CE, Vlaar APJ, Akin S, Lansink-Hartgring AO, Scholten E, Otterspoor L, de Metz J, Delnoij T, van Lieshout EMM, Houmes RJ, Hartog DD, Gommers D, and Dos Reis Miranda D
- Subjects
- Adolescent, Adult, Humans, Middle Aged, Young Adult, Hospitals, Retrospective Studies, Time Factors, Cardiopulmonary Resuscitation, Emergency Medical Services, Out-of-Hospital Cardiac Arrest therapy
- Abstract
Background: The likelihood of return of spontaneous circulation with conventional advanced life support is known to have an exponential decline and therefore neurological outcome after 20 min in patients with a cardiac arrest is poor. Initiation of venoarterial ExtraCorporeal Membrane Oxygenation (ECMO) during resuscitation might improve outcomes if used in time and in a selected patient category. However, previous studies have failed to significantly reduce the time from cardiac arrest to ECMO flow to less than 60 min. We hypothesize that the initiation of Extracorporeal Cardiopulmonary Resuscitation (ECPR) by a Helicopter Emergency Medical Services System (HEMS) will reduce the low flow time and improve outcomes in refractory Out of Hospital Cardiac Arrest (OHCA) patients., Methods: The ON-SCENE study will use a non-randomised stepped wedge design to implement ECPR in patients with witnessed OHCA between the ages of 18-50 years old, with an initial presentation of shockable rhythm or pulseless electrical activity with a high suspicion of pulmonary embolism, lasting more than 20, but less than 45 min. Patients will be treated by the ambulance crew and HEMS with prehospital ECPR capabilities and will be compared with treatment by ambulance crew and HEMS without prehospital ECPR capabilities. The primary outcome measure will be survival at hospital discharge. The secondary outcome measure will be good neurological outcome defined as a cerebral performance categories scale score of 1 or 2 at 6 and 12 months., Discussion: The ON-SCENE study focuses on initiating ECPR at the scene of OHCA using HEMS. The current in-hospital ECPR for OHCA obstacles encompassing low survival rates in refractory arrests, extended low-flow durations during transportation, and the critical time sensitivity of initiating ECPR, which could potentially be addressed through the implementation of the HEMS system. When successful, implementing on-scene ECPR could significantly enhance survival rates and minimize neurological impairment., Trial Registration: Clinicaltyrials.gov under NCT04620070, registration date 3 November 2020., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
35. Transfusion of red blood cells in venoarterial extracorporeal membrane oxygenation: A multicenter retrospective observational cohort study.
- Author
-
Raasveld SJ, Karami M, Schenk J, Dos Reis Miranda D, Mandigers L, Dauwe DF, De Troy E, Pappalardo F, Fominskiy E, van den Bergh WM, Oude Lansink-Hartgring A, van der Velde F, Maas JJ, van de Berg P, de Haan M, Donker DW, Meuwese CL, Taccone FS, Peluso L, Lorusso R, Delnoij TSR, Scholten E, Overmars M, Ivančan V, Bojčić R, de Metz J, van den Bogaard B, de Bakker M, Reddi B, Hermans G, Broman LM, Henriques JPS, and Vlaar APJ
- Subjects
- Adult, Humans, Retrospective Studies, Prospective Studies, Erythrocytes, Hemorrhage, Extracorporeal Membrane Oxygenation methods
- Abstract
Background: Evidence-based recommendations for transfusion in patients with venoarterial extracorporeal membrane oxygenation (VA ECMO) are scarce. The current literature is limited to single-center studies with small sample sizes, therefore complicating generalizability. This study aims to create an overview of red blood cell (RBC) transfusion in VA ECMO patients., Methods: This international mixed-method study combined a survey with a retrospective observational study in 16 centers. The survey inventoried local transfusion guidelines. Additionally, retrospective data of all adult patients with a VA ECMO run >24 h (January 2018 until July 2019) was collected of patient, ECMO, outcome, and daily transfusion parameters. All patients that received VA ECMO for primary cardiac support were included, including surgical (i.e., post-cardiotomy) and non-surgical (i.e., myocardial infarction) indications. The primary outcome was the number of RBC transfusions per day and in total. Univariable logistic regressions and a generalized linear mixed model (GLMM) were performed to assess factors associated with RBC transfusion., Results: Out of 419 patients, 374 (89%) received one or more RBC transfusions. During a median ECMO run of 5 days (1st-3rd quartile 3-8), patients received a median total of eight RBC units (1st-3rd quartile 3-17). A lower hemoglobin (Hb) prior to ECMO, longer ECMO-run duration, and hemorrhage were associated with RBC transfusion. After correcting for duration and hemorrhage using a GLMM, a different transfusion trend was found among the regimens. No unadjusted differences were found in overall survival between either transfusion status or the different regimens, which remained after adjustment for potential confounders., Conclusion: RBC transfusion in patients on VA ECMO is very common. The sum of RBC transfusions increases rapidly after ECMO initiation, and is dependent on the Hb threshold applied. This study supports the rationale for prospective studies focusing on indications and thresholds for RBC transfusion., (© 2023 The Authors. Transfusion published by Wiley Periodicals LLC on behalf of AABB.)
- Published
- 2023
- Full Text
- View/download PDF
36. The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study.
- Author
-
Raasveld SJ, van den Oord C, Schenk J, van den Bergh WM, Oude Lansink-Hartgring A, van der Velde F, Maas JJ, van de Berg P, Lorusso R, Delnoij TSR, Dos Reis Miranda D, Scholten E, Taccone FS, Dauwe DF, De Troy E, Hermans G, Pappalardo F, Fominskiy E, Ivancan V, Bojčić R, de Metz J, van den Bogaard B, Donker DW, Meuwese CL, De Bakker M, Reddi B, Henriques JPS, Broman LM, Dongelmans DA, and Vlaar APJ
- Subjects
- Humans, Platelet Transfusion adverse effects, Retrospective Studies, Hemorrhage etiology, Hemorrhage therapy, Extracorporeal Membrane Oxygenation adverse effects, Thrombocytopenia complications, Thrombocytopenia therapy
- Abstract
Background: Thrombocytopenia, hemorrhage and platelet transfusion are common in patients supported with venoarterial extracorporeal membrane oxygenation (VA ECMO). However, current literature is limited to small single-center experiences with high degrees of heterogeneity. Therefore, we aimed to ascertain in a multicenter study the course and occurrence rate of thrombocytopenia, and to assess the association between thrombocytopenia, hemorrhage and platelet transfusion during VA ECMO., Methods: This was a sub-study of a multicenter (N = 16) study on transfusion practices in patients on VA ECMO, in which a retrospective cohort (Jan-2018-Jul-2019) focusing on platelets was selected. The primary outcome was thrombocytopenia during VA ECMO, defined as mild (100-150·10
9 /L), moderate (50-100·109 /L) and severe (< 50·109 /L). Secondary outcomes included the occurrence rate of platelet transfusion, and the association between thrombocytopenia, hemorrhage and platelet transfusion, assessed through mixed-effect models., Results: Of the 419 patients included, median platelet count at admission was 179·109 /L. During VA ECMO, almost all (N = 398, 95%) patients developed a thrombocytopenia, of which a significant part severe (N = 179, 45%). One or more platelet transfusions were administered in 226 patients (54%), whereas 207 patients (49%) suffered a hemorrhagic event during VA ECMO. In non-bleeding patients, still one in three patients received a platelet transfusion. The strongest association to receive a platelet transfusion was found in the presence of severe thrombocytopenia (adjusted OR 31.8, 95% CI 17.9-56.5). After including an interaction term of hemorrhage and thrombocytopenia, this even increased up to an OR of 110 (95% CI 34-360)., Conclusions: Thrombocytopenia has a higher occurrence than is currently recognized. Severe thrombocytopenia is strongly associated with platelet transfusion. Future studies should focus on the etiology of severe thrombocytopenia during ECMO, as well as identifying indications and platelet thresholds for transfusion in the absence of bleeding., Trial Registration: This study was registered at the Netherlands Trial Registry at February 26th, 2020 with number NL8413 and can currently be found at https://trialsearch.who.int/Trial2.aspx?TrialID=NL8413., (© 2023. BioMed Central Ltd., part of Springer Nature.)- Published
- 2023
- Full Text
- View/download PDF
37. Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation: A Secondary Analysis of an International Observational Study on Current Practices.
- Author
-
van Haeren MMT, Raasveld SJ, Karami M, Miranda DDR, Mandigers L, Dauwe DF, De Troy E, Pappalardo F, Fominskiy E, van den Bergh WM, Oude Lansink-Hartgring A, van der Velde F, Maas JJ, van de Berg P, de Haan M, Donker DW, Meuwese CL, Taccone FS, Peluso L, Lorusso R, Delnoij TSR, Scholten E, Overmars M, Ivancan V, Bojčić R, de Metz J, van den Bogaard B, de Bakker M, Reddi B, Hermans G, Broman LM, Henriques JPS, Schenk J, Vlaar APJ, and Müller MCA
- Abstract
Objectives: To achieve optimal hemostatic balance in patients on extracorporeal membrane oxygenation (ECMO), a liberal transfusion practice is currently applied despite clear evidence. We aimed to give an overview of the current use of plasma, fibrinogen concentrate, tranexamic acid (TXA), and prothrombin complex concentrate (PCC) in patients on ECMO., Design: A prespecified subanalysis of a multicenter retrospective study. Venovenous (VV)-ECMO and venoarterial (VA)-ECMO are analyzed as separate populations, comparing patients with and without bleeding and with and without thrombotic complications., Setting: Sixteen international ICUs., Patients: Adult patients on VA-ECMO or VV-ECMO., Interventions: None., Measurements and Main Results: Of 420 VA-ECMO patients, 59% ( n = 247) received plasma, 20% ( n = 82) received fibrinogen concentrate, 17% ( n = 70) received TXA, and 7% of patients ( n = 28) received PCC. Fifty percent of patients ( n = 208) suffered bleeding complications and 27% ( n = 112) suffered thrombotic complications. More patients with bleeding complications than patients without bleeding complications received plasma (77% vs. 41%, p < 0.001), fibrinogen concentrate (28% vs 11%, p < 0.001), and TXA (23% vs 10%, p < 0.001). More patients with than without thrombotic complications received TXA (24% vs 14%, p = 0.02, odds ratio 1.75) in VA-ECMO, where no difference was seen in VV-ECMO. Of 205 VV-ECMO patients, 40% ( n = 81) received plasma, 6% ( n = 12) fibrinogen concentrate, 7% ( n = 14) TXA, and 5% ( n = 10) PCC. Thirty-nine percent ( n = 80) of VV-ECMO patients suffered bleeding complications and 23% ( n = 48) of patients suffered thrombotic complications. More patients with than without bleeding complications received plasma (58% vs 28%, p < 0.001), fibrinogen concentrate (13% vs 2%, p < 0.01), and TXA (11% vs 2%, p < 0.01)., Conclusions: The majority of patients on ECMO receive transfusions of plasma, procoagulant products, or antifibrinolytics. In a significant part of the plasma transfused patients, this was in the absence of bleeding or prolonged international normalized ratio. This poses the question if these plasma transfusions were administered for another indication or could have been avoided., Competing Interests: Dr. van der Velde received a speaker fee from Hamilton Medical. Author Marcella C.A. Müller received a speaker fee from Werfen. The remaining authors have disclosed that they do not have any conflicts of interest., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
- Published
- 2023
- Full Text
- View/download PDF
38. Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest.
- Author
-
Suverein MM, Delnoij TSR, Lorusso R, Brandon Bravo Bruinsma GJ, Otterspoor L, Elzo Kraemer CV, Vlaar APJ, van der Heijden JJ, Scholten E, den Uil C, Jansen T, van den Bogaard B, Kuijpers M, Lam KY, Montero Cabezas JM, Driessen AHG, Rittersma SZH, Heijnen BG, Dos Reis Miranda D, Bleeker G, de Metz J, Hermanides RS, Lopez Matta J, Eberl S, Donker DW, van Thiel RJ, Akin S, van Meer O, Henriques J, Bokhoven KC, Mandigers L, Bunge JJH, Bol ME, Winkens B, Essers B, Weerwind PW, Maessen JG, and van de Poll MCG
- Subjects
- Humans, Advanced Cardiac Life Support methods, Hospitalization, Ventricular Fibrillation therapy, Netherlands, Cardiopulmonary Resuscitation methods, Out-of-Hospital Cardiac Arrest mortality, Out-of-Hospital Cardiac Arrest therapy
- Abstract
Background: Extracorporeal cardiopulmonary resuscitation (CPR) restores perfusion and oxygenation in a patient who does not have spontaneous circulation. The evidence with regard to the effect of extracorporeal CPR on survival with a favorable neurologic outcome in refractory out-of-hospital cardiac arrest is inconclusive., Methods: In this multicenter, randomized, controlled trial conducted in the Netherlands, we assigned patients with an out-of-hospital cardiac arrest to receive extracorporeal CPR or conventional CPR (standard advanced cardiac life support). Eligible patients were between 18 and 70 years of age, had received bystander CPR, had an initial ventricular arrhythmia, and did not have a return of spontaneous circulation within 15 minutes after CPR had been initiated. The primary outcome was survival with a favorable neurologic outcome, defined as a Cerebral Performance Category score of 1 or 2 (range, 1 to 5, with higher scores indicating more severe disability) at 30 days. Analyses were performed on an intention-to-treat basis., Results: Of the 160 patients who underwent randomization, 70 were assigned to receive extracorporeal CPR and 64 to receive conventional CPR; 26 patients who did not meet the inclusion criteria at hospital admission were excluded. At 30 days, 14 patients (20%) in the extracorporeal-CPR group were alive with a favorable neurologic outcome, as compared with 10 patients (16%) in the conventional-CPR group (odds ratio, 1.4; 95% confidence interval, 0.5 to 3.5; P = 0.52). The number of serious adverse events per patient was similar in the two groups., Conclusions: In patients with refractory out-of-hospital cardiac arrest, extracorporeal CPR and conventional CPR had similar effects on survival with a favorable neurologic outcome. (Funded by the Netherlands Organization for Health Research and Development and Maquet Cardiopulmonary [Getinge]; INCEPTION ClinicalTrials.gov number, NCT03101787.)., (Copyright © 2023 Massachusetts Medical Society.)
- Published
- 2023
- Full Text
- View/download PDF
39. Reduced anticoagulation targets in extracorporeal life support (RATE): study protocol for a randomized controlled trial.
- Author
-
van Minnen O, Oude Lansink-Hartgring A, van den Boogaard B, van den Brule J, Bulpa P, Bunge JJH, Delnoij TSR, Elzo Kraemer CV, Kuijpers M, Lambermont B, Maas JJ, de Metz J, Michaux I, van de Pol I, van de Poll M, Raasveld SJ, Raes M, Dos Reis Miranda D, Scholten E, Simonet O, Taccone FS, Vallot F, Vlaar APJ, and van den Bergh WM
- Subjects
- Adult, Anticoagulants adverse effects, Heparin adverse effects, Heparin, Low-Molecular-Weight adverse effects, Humans, Randomized Controlled Trials as Topic, Extracorporeal Membrane Oxygenation adverse effects, Extracorporeal Membrane Oxygenation methods, Ischemic Stroke
- Abstract
Background: Although life-saving in selected patients, ECMO treatment still has high mortality which for a large part is due to treatment-related complications. A feared complication is ischemic stroke for which heparin is routinely administered for which the dosage is usually guided by activated partial thromboplastin time (aPTT). However, there is no relation between aPTT and the rare occurrence of ischemic stroke (1.2%), but there is a relation with the much more frequent occurrence of bleeding complications (55%) and blood transfusion. Both are strongly related to outcome., Methods: We will conduct a three-arm non-inferiority randomized controlled trial, in adult patients treated with ECMO. Participants will be randomized between heparin administration with a target of 2-2.5 times baseline aPTT, 1.5-2 times baseline aPTT, or low molecular weight heparin guided by weight and renal function. Apart from anticoagulation targets, treatment will be according to standard care. The primary outcome parameter is a combined endpoint consisting of major bleeding including hemorrhagic stroke, severe thromboembolic complications including ischemic stroke, and mortality at 6 months., Discussion: We hypothesize that with lower anticoagulation targets or anticoagulation with LMWH during ECMO therapy, patients will have fewer hemorrhagic complications without an increase in thromboembolic complication or a negative effect on their outcome. If our hypothesis is confirmed, this study could lead to a change in anticoagulation protocols and a better outcome for patients treated with ECMO., Trial Registration: ClinicalTrials.gov NCT04536272 . Registered on 2 September 2020. Netherlands Trial Register NL7969., (© 2022. The Author(s).)
- Published
- 2022
- Full Text
- View/download PDF
40. RBC Transfusion in Venovenous Extracorporeal Membrane Oxygenation: A Multicenter Cohort Study.
- Author
-
Raasveld SJ, Karami M, van den Bergh WM, Oude Lansink-Hartgring A, van der Velde F, Maas JJ, van de Berg P, de Haan M, Lorusso R, Delnoij TSR, Dos Reis Miranda D, Mandigers L, Scholten E, Overmars M, Silvio Taccone F, Brasseur A, Dauwe DF, De Troy E, Hermans G, Meersseman P, Pappalardo F, Fominskiy E, Ivancan V, Bojčić R, de Metz J, van den Bogaard B, Donker DW, Meuwese CL, de Bakker M, Reddi B, de Bruin S, Lagrand WK, Henriques JPS, Broman LM, and Vlaar APJ
- Subjects
- Adult, Australia, Belgium, Cohort Studies, Croatia, Erythrocyte Transfusion methods, Erythrocyte Transfusion statistics & numerical data, Extracorporeal Membrane Oxygenation methods, Female, Humans, Intensive Care Units organization & administration, Intensive Care Units statistics & numerical data, Italy, Male, Middle Aged, Netherlands, Retrospective Studies, Sweden, Treatment Outcome, Erythrocyte Transfusion standards, Extracorporeal Membrane Oxygenation statistics & numerical data
- Abstract
Objectives: In the general critical care patient population, restrictive transfusion regimen of RBCs has been shown to be safe and is yet implemented worldwide. However, in patients on venovenous extracorporeal membrane oxygenation, guidelines suggest liberal thresholds, and a clear overview of RBC transfusion practice is lacking. This study aims to create an overview of RBC transfusion in venovenous extracorporeal membrane oxygenation., Design: Mixed method approach combining multicenter retrospective study and survey., Setting: Sixteen ICUs worldwide., Patients: Patients receiving venovenous extracorporeal membrane oxygenation between January 2018 and July 2019., Interventions: None., Measurements and Main Results: The primary outcome was the proportion receiving RBC, the amount of RBC units given daily and in total. Furthermore, the course of hemoglobin over time during extracorporeal membrane oxygenation was assessed. Demographics, extracorporeal membrane oxygenation characteristics, and patient outcome were collected. Two-hundred eight patients received venovenous extracorporeal membrane oxygenation, 63% male, with an age of 55 years (45-62 yr), mainly for acute respiratory distress syndrome. Extracorporeal membrane oxygenation duration was 9 days (5-14 d). Prior to extracorporeal membrane oxygenation, hemoglobin was 10.8 g/dL (8.9-13.0 g/dL), decreasing to 8.7 g/dL (7.7-9.8 g/dL) during extracorporeal membrane oxygenation. Nadir hemoglobin was lower on days when a transfusion was administered (8.1 g/dL [7.4-9.3 g/dL]). A vast majority of 88% patients received greater than or equal to 1 RBC transfusion, consisting of 1.6 U (1.3-2.3 U) on transfusion days. This high transfusion occurrence rate was also found in nonbleeding patients (81%). Patients with a liberal transfusion threshold (hemoglobin > 9 g/dL) received more RBC in total per transfusion day and extracorporeal membrane oxygenation day. No differences in survival, hemorrhagic and thrombotic complication rates were found between different transfusion thresholds. Also, 28-day mortality was equal in transfused and nontransfused patients., Conclusions: Transfusion of RBC has a high occurrence rate in patients on venovenous extracorporeal membrane oxygenation, even in nonbleeding patients. There is a need for future studies to find optimal transfusion thresholds and triggers in patients on extracorporeal membrane oxygenation., Competing Interests: Dr. Lorusso’s institution received funding from Medtronic, Livanova, Eurosets, and Getinge. Dr. Dos Reis Miranda’s institution received funding from Xenios. Dr. Donker receives speaker fees from Getinge-Maquet and Xenios NovaLung Fresenius and research cooperation with Getinge-Maquet and Xenios NovaLung Fresenius. Dr. Broman received funding from Eurosets and Xenios. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
- Published
- 2022
- Full Text
- View/download PDF
41. Behavioural artificial intelligence technology for COVID-19 intensivist triage decisions: making the implicit explicit.
- Author
-
de Metz J, Thoral PJ, Chorus CG, Elbers PWG, and van den Bogaard B
- Subjects
- Artificial Intelligence, Humans, SARS-CoV-2, Technology, COVID-19, Triage
- Published
- 2021
- Full Text
- View/download PDF
42. [Thromboembolisms due to recreational use of nitrous oxide].
- Author
-
Oomens T, Fokkema TMM, van den Bogaard B, de Metz J, van Nieuwenhuizen RC, Riezebos RK, and Kuipers RS
- Subjects
- Female, Humans, Male, Nervous System Diseases therapy, Peripheral Nervous System Diseases chemically induced, Risk Assessment, Substance-Related Disorders etiology, Thromboembolism therapy, Vitamin B 12 Deficiency etiology, Young Adult, Illicit Drugs adverse effects, Nervous System Diseases chemically induced, Nitrous Oxide adverse effects, Thromboembolism chemically induced, Vitamin B 12 Deficiency complications
- Abstract
Nitrous oxide (N2O) is increasingly used as a recreational drug, and is presumed relatively safe and innocent. The risks for neurological complications are often known, however the risks of serious thromboembolic events are not. We describe three cases of acute thromboembolic events resulting in serious cardiovascular complications after N2O abuse: one case of myocardial infarction that resulted in a reduced ejection fraction, one case of peripheral arterial occlusion that led to limb amputation and one case of pulmonary embolism that resulted in hemodynamic instability requiring extracorporeal membrane oxygenation (ECMO) and surgical removal. All patients were young adults with a low cardiovascular risk profile. N2O inactivates vitamin B12, leading to vitamin B12 deficiency and subsequent to hyperhomocysteinemia, which is associated with the formation of fibrinolysis-resistant blood thrombi. In conclusion, we contest the safety and innocence of recreational N2O (ab)use. Our three cases illustrate that, next to previously described neurological complications, the use of nitrous oxide is associated with thromboembolic cardiovascular complications, presumably mediated by hyperhomocysteinemia.
- Published
- 2021
43. Telemedicine in a Dutch intensive care unit: A descriptive study of the first results.
- Author
-
van der Voort PH, de Metz J, Wester JP, van Stijn I, Feijen HM, Balzereit A, Rijkenberg S, Obster R, and Bosman RJ
- Subjects
- Adult, Aged, Aged, 80 and over, Critical Care standards, Family psychology, Female, Hospital Mortality, Humans, Intensive Care Units statistics & numerical data, Length of Stay statistics & numerical data, Male, Middle Aged, Netherlands, Patient Satisfaction, Retrospective Studies, Critical Care methods, Quality of Health Care standards, Telemedicine instrumentation, Telemedicine methods, Telemedicine standards
- Abstract
Introduction: Tele-intensive care (teleIC) can be used to increase the level of care in the intensive care unit (ICU) with the tele-intensivist being at a remote site. In this study we describe the implementation and outcomes, including patient and family satisfaction, of the first Dutch teleIC., Methods: In a retrospective analysis the patient characteristics are described with a focus on patient outcomes and patient and family satisfaction. The teleIC started on 6 December 2010 in an ICU with three beds. Data for all admitted patients were collected from 1 January 2011 through 31 December 2013 from available systems. Severity of disease (APACHE IV) and standardized mortality ratios (SMR) were available over the complete calendar years 2012 and 2013. A prospective self-made survey of patient and family satisfaction was performed over a 14-month period after the implementation of teleIC., Results: In 2012 and 2013, 556 patients were admitted. The number of operating room recovery patients in the ICU declined over time. One hundred and seven patients were transferred to a higher-level ICU (19%). The SMR for non-transferred patients was 0.73 (95% CI (confidence interval) 0.54-0.98) and 0.66 (95% CI (confidence interval) 0.40-1.02) for transferred patients. These numbers are in line with national data. Thirty-six percent of family and 38% of the patients responded to the survey and showed a positive response concerning communication within the tele IC setting., Conclusion: Implementation of teleIC in a Dutch situation was successful and showed favourable results in patient outcomes and the satisfaction of patients and family members., (© The Author(s) 2015.)
- Published
- 2016
- Full Text
- View/download PDF
44. ["The dear friend syndrome": if the patient is a colleague and the colleague is the doctor].
- Author
-
de Metz J, Wijnandts P, and Levi M
- Subjects
- Adult, Humans, Male, Patient Rights, Physician's Role, Patients psychology, Physician-Patient Relations ethics, Physicians psychology
- Published
- 2009
45. Glucose kinetics during fasting in young children with severe and non-severe malaria in Suriname.
- Author
-
Zijlmans W, van Kempen A, Ackermans M, de Metz J, Kager P, and Sauerwein H
- Subjects
- Alanine blood, Blood Glucose analysis, Child, Preschool, Fatty Acids, Nonesterified blood, Female, Gluconeogenesis, Humans, Infant, Kinetics, Male, Fasting metabolism, Glucose metabolism, Malaria metabolism
- Abstract
Fasting could be an important factor in the induction of hypoglycemia in children with malaria because fasting results in a decrease in endogenous glucose production. The influence of extended fasting on plasma glucose concentration, glucose production, and gluconeogenesis were measured using [6,6-(2)H(2)]glucose and (2)H(2)O in 12 Surinamese children with severe malaria and compared with 16 children with non-severe malaria during a 16-hour controlled fast. Glucose concentration and glucose production were comparable after 8 hours of fasting and decreased in both groups (P < 0.001) with an extension of the fast up to 16 hours. Glucose concentration decreased faster in the non-severe group than in the severe group (P = 0.029). The decrease in glucose production was not different between groups (P = 0.954). Thus, fasting predisposes for hypoglycemia in young children with Plasmodium falciparum malaria. Hypoglycemia caused by fasting develops later in young children with severe malaria than in children with non-severe malaria.
- Published
- 2008
46. Very young children with uncomplicated falciparum malaria have higher risk of hypoglycaemia: a study from Suriname.
- Author
-
Zijlmans WC, van Kempen AA, Ackermans MT, de Metz J, Kager PA, and Sauerwein HP
- Subjects
- Age Factors, Blood Glucose analysis, Child, Preschool, Fasting blood, Female, Humans, Infant, Male, Nutritional Status, Risk Factors, Suriname, Blood Glucose biosynthesis, Gluconeogenesis, Hypoglycemia blood, Malaria, Falciparum blood
- Abstract
Objective: To measure glucose kinetics and the influence of age, nutritional status and fasting duration in children with uncomplicated falciparum malaria (UFM) under the age of 5 years., Methods: Plasma glucose concentration, endogenous glucose production (EGP) and gluconeogenesis (GNG) were measured using [6,6-(2)H(2)]glucose and (2)H(2)O in 17 very young (<3 years) and 7 older (3-5 years) Surinamese children with UFM admitted to the Distrikt Hospital Stoelmanseiland and Diakonessen Hospital Paramaribo over 17 months., Results: Plasma glucose concentration was lower in the group of very young children than in the older children (P = 0.028). There were no differences in EGP and GNG between the groups. Overall GNG contributed 56% (median, range 17-87%) to EGP, with no differences between the groups (P = 0.240). Glucose clearance was lower in the older children (P = 0.026). Glucose concentration did not differ between children with weight for length/height less than -1.3 SD and children with weight for length/height greater than -1.3 SD (P = 0.266). Plasma glucose concentration was not predicted by fasting duration (P = 0.762)., Conclusions: Our data suggest a higher risk of hypoglycaemia in very young children with uncomplicated malaria as plasma glucose concentration was lower in this study group. Since this could not be attributed to an impaired EGP, and because glucose clearance was lower in the older children, we presume that older children were better capable of reducing glucose utilization during fasting. Studies on glucose kinetics are feasible in very young children with malaria and give more insight in the pathophysiology of hypoglycaemia.
- Published
- 2008
- Full Text
- View/download PDF
47. Interferon-gamma increases monocyte HLA-DR expression without effects on glucose and fat metabolism in postoperative patients.
- Author
-
de Metz J, Romijn JA, Endert E, Ackermans MT, Weverling GJ, Busch OR, de Wit LT, Gouma DJ, ten Berge IJ, and Sauerwein HP
- Subjects
- Aged, Blood Glucose drug effects, Energy Metabolism drug effects, Female, Glycerol metabolism, Hormones blood, Humans, Male, Middle Aged, Monocytes metabolism, Postoperative Period, Antineoplastic Agents administration & dosage, Blood Glucose metabolism, HLA-DR Antigens metabolism, Interferon-gamma administration & dosage, Lipid Metabolism, Monocytes drug effects
- Abstract
Tissue injury is associated with decreased cellular immunity and enhanced metabolism. Immunodepression is thought to be counteracted by interferon (IFN)-gamma, which increases human leukocyte antigen (HLA)-DR expression. Hypermetabolism could be enhanced by IFN-gamma because cytokines induce a hypermetabolic response to stress. In healthy humans, IFN-gamma enhanced HLA-DR expression without effects on glucose and fat metabolism. In the present study, we evaluated whether IFN-gamma lacks potential harmful side effects on metabolic and endocrine pathways while maintaining its beneficial effects on the immune system under conditions in which the inflammatory response system is activated. In 13 patients scheduled for major surgery, we studied HLA-DR expression on peripheral blood monocytes before surgery and postoperatively randomized the patients into an intervention and a placebo group. Subsequently, we evaluated the effects of a single dose of IFN-gamma vs. saline on short-term monocyte activation, glucose and lipid metabolism, and glucose and lipid regulatory hormones. HLA-DR expression on monocytes was restored from postoperative levels of 54% (42-60%; median and interquartiles) to 92% (91-96%) 24 h after IFN-gamma administration but stayed low in the placebo-treated patients. IFN-gamma did not affect glucose metabolism (plasma glucose, rate of appearance and disappearance of glucose) and lipid metabolism (plasma glycerol, plasma free fatty acids, and rates of appearance and disappearance of glycerol). IFN-gamma had no effect on plasma cortisol, adrenocorticotropic hormone, growth hormone, insulin, C-peptide, glucagon, epinephrine, and norepinephrine concentrations. We conclude that IFN-gamma exerts a favorable effect on cell-mediated immunity in patients after major surgery without effects on glucose and lipid metabolism.
- Published
- 2004
- Full Text
- View/download PDF
48. Interferon-gamma in healthy subjects: selective modulation of inflammatory mediators.
- Author
-
de Metz J, Hack CE, Romijn JA, Levi M, Out TA, ten Berge IJ, and Sauerwein HP
- Subjects
- Acute-Phase Proteins metabolism, Adult, Blood Coagulation drug effects, Chemokines blood, Cytokines blood, Fibrinolysis drug effects, Granulocytes drug effects, Granulocytes metabolism, Humans, Injections, Subcutaneous, Interferon-gamma administration & dosage, Male, Monocytes drug effects, Monocytes metabolism, Inflammation Mediators blood, Interferon-gamma pharmacology
- Abstract
Background: It is suggested that interferon-gamma (IFN-gamma), like other cytokines, is a mediator in the host inflammatory response, which could be of importance in the pathophysiology of sepsis. The role of IFN-gamma in human host inflammatory responses, however, has not been studied., Design: In a placebo-controlled trial we studied the acute effects of IFN-gamma administration on host inflammatory mediators in healthy men: i.e. the cytokine/chemokine cascade system, acute-phase proteins, activation markers of the innate cellular immunity and coagulation/fibrinolysis parameters., Results: IFN-gamma increased plasma levels of interleukin-6 (IL-6), IL-8 and IFN-gamma-inducible protein-10 (IP-10) (P < 0.05), but did not affect plasma levels of other cytokines (IL-4, IL-10, tumour necrosis factor-alpha, IL-12p40/p70). Plasma concentrations of C-reactive protein and secretory phospholipase A2 both increased (P < 0.05). Plasma levels of the leucocyte activation marker elastase-alpha1-antitrypsin complexes increased after IFN-gamma administration (P < 0.05), IFN-gamma increased the percentage of high-affinity Fcgamma-receptor (FcgammaRI) -positive neutrophils (P < 0.05), but did not affect the mean fluorescence intensity of FcgammaRI on neutrophils. Procoagulant and profibrinolytic effects of IFN-gamma were evidenced by increased plasma levels of prothrombin fragment F1 + F2, tissue-plasminogen activator and plasmin-alpha2-antiplasmin complexes (P < 0.05)., Conclusion: We conclude that IFN-gamma selectively affects host inflammatory mediators in humans.
- Published
- 2001
- Full Text
- View/download PDF
49. Dietary fat content alters insulin-mediated glucose metabolism in healthy men.
- Author
-
Bisschop PH, de Metz J, Ackermans MT, Endert E, Pijl H, Kuipers F, Meijer AJ, Sauerwein HP, and Romijn JA
- Subjects
- Adult, Calorimetry, Indirect, Dietary Carbohydrates administration & dosage, Dietary Carbohydrates pharmacology, Dietary Fats administration & dosage, Energy Metabolism, Fatty Acids blood, Gas Chromatography-Mass Spectrometry, Glucose Clamp Technique, Humans, Insulin metabolism, Kinetics, Male, Middle Aged, Blood Glucose metabolism, Dietary Fats pharmacology, Insulin blood, Insulin Resistance, Liver metabolism
- Abstract
Background: A high dietary fat intake is involved in the pathogenesis of insulin resistance., Objective: The aim was to compare the effect of different amounts of dietary fat on hepatic and peripheral insulin sensitivity., Design: Six healthy men were studied on 3 occasions after consuming for 11 d diets with identical energy and protein contents but different percentages of energy as fat and carbohydrate as follows: 0% and 85% [low-fat, high-carbohydrate (LFHC) diet], 41% and 44% [intermediate-fat, intermediate-carbohydrate (IFIC) diet], and 83% and 2% [high-fat, low-carbohydrate (HFLC) diet]. Insulin sensitivity was quantified by using a hyperinsulinemic euglycemic clamp (plasma insulin concentration: approximately 190 pmol/L)., Results: During hyperinsulinemia, endogenous glucose production was higher after the HFLC diet (2.5 +/- 0.3 micromol x kg(-1) x min(-1); P < 0.05) than after the IFIC and LFHC diets (1.7 +/- 0.3 and 1.2 +/- 0.4 micromol x kg(-1) x min(-1), respectively). The ratio of dietary fat to carbohydrate had no unequivocal effects on insulin-stimulated glucose uptake. In contrast, insulin-stimulated, nonoxidative glucose disposal tended to increase in relation to an increase in the ratio of fat to carbohydrate, from 14.8 +/- 5.1 to 20.6 +/- 1.9 to 26.2 +/- 2.9 micromol x kg(-1) x min(-1) (P < 0.074 between the 3 diets). Insulin-stimulated glucose oxidation was significantly lower after the HFLC diet than after the IFIC and LFHC diets: 1.7 +/- 0.8 compared with 13.4 +/- 2.1 and 19.0 +/- 2.1 micromol x kg(-1) x min(-1), respectively (P < 0.05). During the clamp study, plasma fatty acid concentrations were higher after the HFLC diet than after the IFIC and LFHC diets: 0.22 +/- 0.02 compared with 0.07 +/- 0.01 and 0.05 +/- 0.01 mmol/L, respectively (P < 0.05)., Conclusion: A high-fat, low-carbohydrate intake reduces the ability of insulin to suppress endogenous glucose production and alters the relation between oxidative and nonoxidative glucose disposal in a way that favors storage of glucose.
- Published
- 2001
- Full Text
- View/download PDF
50. No beneficial effect of interferon-gamma treatment in 2 human immunodeficiency virus-infected patients with Mycobacterium avium complex infection.
- Author
-
Lauw FN, van Der Meer JT, de Metz J, Danner SA, and van Der Poll T
- Subjects
- AIDS-Related Opportunistic Infections microbiology, Adult, Female, Humans, Male, Mycobacterium avium-intracellulare Infection microbiology, Treatment Outcome, AIDS-Related Opportunistic Infections drug therapy, Interferon-gamma therapeutic use, Mycobacterium avium Complex, Mycobacterium avium-intracellulare Infection drug therapy
- Abstract
Two human immunodeficiency virus-infected patients with refractory disseminated Mycobacterium avium complex infection were treated with recombinant interferon-gamma (IFN-gamma) given subcutaneously for 3 and 4 months, respectively. Although both patients demonstrated some clinical improvement initially, IFN-gamma therapy did not produce sustained benefit.
- Published
- 2001
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.