Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Mar 2001
Review[Activated protein C, coagulation, inflammation, and treatment of severe sepsis].
During the past 20 years several treatments designed to reduce inflammatory responses to sepsis have been unsuccessful. Sepsis results from a generalised inflammatory and procoagulant response to an infection. Activated protein C, a component of the anticoagulant system, is an anti-thrombotic serine protease with anti-inflammatory properties. ⋯ Secondly, activated protein C can directly inhibit factors Va and VIIIa, resulting in decreased thrombin formation. Finally, activated protein C can reduce plasminogen activator inhibitor I, thereby stimulating fibrinolysis. In addition to these effects on thrombin formation, activated protein C directly reduces pro-inflammatory responses by as yet unknown mechanisms.
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Homozygous mutations of the ob gene, encoding leptin, are associated with severe obesity, hyperphagia and insulin resistance in humans. Leptin conveys a signal from adipose tissue to hypothalamic nuclei that integrate whole body fuel metabolism, informing those nuclei about the magnitude of fuel reserves. In the absence of leptin, the brain perceives energy availability as insufficient and therefore activates powerful mechanisms to restore fuel depots. If leptin synthesis or signal transduction is perturbed in the presence of food, a severely obese phenotype ensues.
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Ned Tijdschr Geneeskd · Mar 2001
Review[Screening for lung cancer in the Netherlands: the role of spiral CT scan].
The very poor prognosis of lung cancer has barely changed in the last two decades despite all efforts. However, prognosis is better when the disease is detected earlier, so that curative surgery or radiotherapy can be applied. Lung cancer screening in the past by chest X-ray did not lead to a decrease in lung cancer mortality, because the chest X-ray has low sensitivity for early invasive stages. ⋯ These questions can only be resolved in a randomised controlled trial with lung cancer mortality as unbiased end-point. Such a study should be initiated in the Netherlands, a country with large experience in screening trials and a good health care system. Only after lung cancer screening has proven to be cost-effective can appropriate implementation be recommended to prevent uncontrolled and opportunistic diffusion of this new screening technique into clinical practice in the near future.