Clémance Claussin: Homologous recombination: a Swiss Army knife for protecting genome integrity Alle informatie die noodzakelijk is om te leven is …
Tim de Jong: Towards customized intraocular lenses Als bij het maken van kunstlenzen voor staaroperaties rekening wordt gehouden met kleine …
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Marian Wiegersma: Pelvic organ prolapse – Conservative treatments in primary care Een verzakking – of urogenitale prolaps – is een veelvoorkomende …
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Steven Hendriks: Sex and gender differences in diabetes care Uit internationaal onderzoek blijkt dat de gezondheid van vrouwen met type 2 diabetes …
Background: In previous studies in primary Sjögren’s syndrome (pSS), the prevalence of
pulmonary involvement varied greatly depending on differences in inclusion criteria and
definitions of pulmonary involvement. The ESSDAI has been developed for standardized
assessment of the main organ involvements. Our aim was to evaluate the prevalence and types
of pulmonary involvement in pSS patients and to classify the manifestations using the
pulmonary domain of the ESSDAI.
Methods: This retrospective cohort study included all consecutive pSS patients, fulfilling the
AECG and/or ACR classification criteria, who visited the department of Rheumatology and
Clinical Immunology of the UMCG in 2015. Data were obtained from electronic patient records
of the first visit in 2015. In some cases, the difference between pulmonary manifestations
caused by pSS or coincidental factors remained unclear, resulting in a range of assumed to
possible pulmonary involvement in pSS.
Results: Of the 262 included pSS patients, 93% were female and mean age was 56 ± 15 years.
Pulmonary complaints were present in 88 (34%) patients. Additional pulmonary diagnostics
was performed in 225 (86%) patients. Pulmonary involvement was present in 25-39 (10-15%)
pSS patients. Overall, most common was interstitial lung disease (ILD), which was present in
15 patients; especially non-specific interstitial pneumonia (NSIP). In total, 16 (6%) patients had
a positive ESSDAI for the pulmonary domain; low activity (n=4), moderate activity (n=11) and
high activity (n=1).
Conclusion: In this cross-sectional study in daily clinical practice, pulmonary involvement was
present in 10-15% of pSS patients, most common ILD. Of all pSS patients, 6% were scored as
active on the pulmonary domain of the ESSDAI.
IBsachckemgrioa-urnepde rfusion injury (IRI) of the liver is a common clinical problem after liver surgery
and transplantation and new therapies are required to prevent it. Calcium overload in
hepatocytes plays a central role in the pathogenesis of IRI, but the nature of the Ca+ channels
responsible for this is unknown. Accumulating evidence shows that the Transient Receptor
Potential Melastatin 2 (TRPM2) channel, which is activated in oxidative stress, could play a
major role in Ca2+ overload. This study aims to investigate whether pharmacological inhibition
of TRPM2 could reduce IRI of the liver in rats and mice.
TMweoth doidffse rent types of experiments were conducted. In the first experiment, rats were subjected
to 45 minutes of liver ischemia and 1 hour reperfusion. Each animal randomly received one of
the TRPM2 inhibitors – chlorpromazine (n = 3), N-(p-amylcinnamoyl)anthranilic acid (ACA)
(n = 3) or curcumin (n = 4). The control groups only received the vehicles (n = 3) prior to
ischemia. Bile flow recovery during reperfusion was used to assess final liver damage.
In the second experiment, mice were subjected to 45 minutes of liver ischemia and 24 hours of
reperfusion. Each mouse randomly received either TRPM2 inhibitor curcumin (n = 8) or its
vehicle (n = 7) prior to ischemia and at the start of reperfusion. TRPM2-KO mice were used
as positive control group (n = 4). ALT and AST levels and liver histology after reperfusion
were used to assess final liver damage.
IRne tshuel tesx periments using rats, no significant difference in bile flow recovery was found between
ACA and its vehicle, and between curcumin and its vehicle. Rats treated with chlorpromazine
showed significantly less bile flow recovery compared to the vehicle treated group.
In the experiments using mice, ischemia increased AST and ALT enzyme levels compared to
sham-operated controls. No significant differences in ALT and AST levels were found between
mice treated with curcumin and mice treated with its vehicle only. Interestingly, enzyme levels
in TRPM2-KO mice were not significantly lower compared to levels in WT mice. Comparing
percentages of necrosis, similar results were found between these groups.
TChoenscel udsaitoan d o not show a reduction in liver IRI through pharmacological TRPM2 inhibition.
Further research on the role of TRPM2 channels in liver IRI is needed.
Although the literature on mergers and acquisitions (M&As) is quite advanced, analyses of micro-mergers—mergers of internal functional units within the same organization—remain limited. Clarification is needed regarding micro-mergers and their effects on performance. Therefore, this case study investigated micro-mergers within professional service firms (PSFs), specifically focusing on healthcare providers. Thereby, this study addresses the following research question: How do different types of micro-mergers affect the performance of PSFs?
Thus, it examined the various types of micro-mergers and the relationship between the type of micro-merger and PSF performance. In addition, it focused on the factors moderating the relationship between the type of micro-merger and PSF performance.
This study analyzed data on three cases within University Medical Center Groningen (UMCG). Twenty-one semi-structured interviews provided the bulk of this data. The results demonstrated that Napier’s (1989) typology of mergers also applies to micro-mergers, since all three types of micro-mergers (extension, collaborative, and redesign) were identifiable.
None of these micro-merger types led to a decline in the PSF’s performance. The collaborative and redesign micro-mergers led to an increase in the PSF’s performance. Furthermore, the results indicated that merging syndrome moderates the relationship between the type of micro-merger and PSF performance. Moreover, two factors affect the severity of the merging syndrome: equivalency and feelings of unity (social identity).
Regarding future research, researchers should explore whether these results hold true for other micro-mergers. Furthermore, the conceptual framework proposed should be further explored in a quantitative matter by measuring PSF performance. Regarding managerial implications, management should be aware that governance has significant effect on the micro-merging process. Thereby, communication is key to reduce uncertainty and stress, so as to create high levels of trust.
Sanne Kemner: Life events and bipolar disorder Een bipolaire stoornis (ook wel bekend als manisch-depressieve stoornis) komt vaker voor in bepaalde …
Zhuoran Yin: Microglia phenotypes in aging-associated diseases Bij het ouder worden neemt de ontstekingsactiviteit in de witte stof van de hersenen …
Background: Gamma Knife Radiosurgery (GKRS) is frequently used for the treatment of brain arteriovenous malformations (BAVM). Patients with unruptured BAVM have a risk of 2.2% per year for intracranial hemorrhage with severe morbidity and mortality. Patients with ruptured BAVM have 4.5% risk for a second haemorrhage. Adverse radiation effects (ARE’s) are seen post treatment with variable incidence (1.8-22.9%). The latency period post GKRS is a crucial time frame for hemorrhage and ARE’s to occur. Timely follow-up and treatment are essential during this period.
Objective: The purpose of this report was to evaluate the risk of hemorrhage post GKRS for unruptured BAVM versus the natural history, in order to conclude that treatment in unruptured BAVMs with GKRS is a good approach in preventing hemorrhages. Secondly the goal was to evaluate the risk of a second hemorrhage post GKRS in ruptured BAVM versus the rebleeding risk. The incidence of ARE’s were evaluated to analyse the safety of GKRS treatment. Lastly, to evaluate the effect of treatment, obliteration rates for hemorrhage and non-hemorrhage BAVM were analysed.
Methods: The investigation was carried through a retrospective descriptive study of patients with BAVM who underwent GKRS between 2002 and 2015 at the Gamma Knife Center of the Elisabeth-Tweesteden hospital in Tilburg, the Netherlands. Patients were included based on the inclusion criteria ( age > 18 years, angiographically established BAVM and with a minimal follow-up of ≥ 3 years). Univariate and multivariate analyses were performed. The Chi square test was used to calculate the significance level (p<0.05) of hemorrhage risk post GKRS in our study versus the bleeding risk in the natural history of BAVM. Ruptured BAVMs were compared to the rebleed risk (4.5%). Incidence rates for ARE’s were calculated. Survival analysis (Kaplan-Meier) was performed for the obliteration rates.
Results: From a total of 443 treatments, we yielded 373 BAVM treatments fulfilling the selection criteria. Out of 373 treatments, 74 were double or triple treatments and 6 patients refused further treatment. Overall we included 293 patients for further analysis of which 275 had symptomatic BAVM and 18 non-symptomatic BAVM. In the symptomatic BAVM population, the non-hemorrhage group (n =140), 2.1% (n =3) experienced hemorrhage post GKRS. In the hemorrhage group 5.9% (n=8) experienced hemorrhage post GKRS. The incidence of ARE’s is between 0.27-2%. 84 patients in the hemorrhage group and 109 patients in the non-hemorrhage group achieved full obliteration in a follow up(FU) time of 5 years.
Conclusion: We cannot conclude that in our study population the risk of hemorrhage post GKRS is significantly less, higher or the same compared to the natural history. This is due to the short follow up time (until obliteration), unequal number of patients in each group and different AVM grading system compared to other studies . Also no control group could be formed due to the limited time frame for this study. What we do conclude is that patients with prior hemorrhage have a higher risk of hemorrhage post treatment; this is in line with other studies. There is no difference in obliteration rate between hemorrhage and non-hemorrhage BAVM patients. GKRS could be a good and safe treatment option for symptomatic BAVM with moderate side-effects (0.27-2%) and a 60-70% complete obliteration after single treatment. For more accurate post treatment risk assessment a longer FU-time, equal distribution of patients in the comparing groups and more profound categorization of the BAVM angioarchitecture is needed.
Introductie: Ongeveer vijf tot elf per 1,000 levende pasgeborenen komen ter wereld met een congenitale hartafwijking (CHD). Dankzij verbeterde zorg bereikt tegenwoordig ongeveer 85% van deze kinderen de volwassen leeftijd. Kinderen met CHD hebben echter een hoger risico op neurologische ontwikkelingsstoornissen als gevolg van een complexe interactie tussen pre-operatieve, intra-operatieve en postoperatieve gebeurtenissen. Mogelijk ontstaat hersenschade ten gevolge van chronische foetale en vroeg neonatale hypoxie of ischemie van het brein. Een niet-invasieve en continue manier om de saturatie in het hersenweefsel te meten is door middel van near-infrared spectroscopy (NIRS). Neurologische uitkomst kan voorspeld worden door de beoordeling van general movements (GMs). Dit zijn spontane bewegingen die door het hele lichaam gemaakt worden en zeer voorspellend zijn voor latere neurologische uitkomst. In dit onderzoek wordt een correlatie gezocht tussen de kwaliteit van GMs op een leeftijd van 7 dagen en de cerebrale oxygenatie tijdens de eerste zeven dagen postnataal bij kinderen met CHD.
Methode: Kinderen met een antenataal bekende ductusafhankelijke CHD werden geïncludeerd en bij hen werd vervolgens gedurende de eerste zeven dagen de cerebrale oxygenatie door middel van NIRS gemeten. Op een leeftijd van 7 dagen werden de general movements gefilmd en vervolgens geanalyseerd.
Resultaten: Achttien kinderen in het Universitair Medisch Centrum Groningen (UMCG) werden geïncludeerd, waarvan er tien afwijkende GMs lieten zien. Er was geen relatie tussen de GMs bij zeven dagen en de cerebrale zuurstofsturatie in de eerste zeven dagen, ook niet na correctie voor de leeftijd waarop gefilmd werd.
Discussie: In een vervolgstudie zouden meer kinderen geïncludeerd moeten worden om de resultaten sterker te maken, daarnaast zouden kinderen ook bij drie maanden nog gefilmd moeten worden voor GMs, omdat dit een duidelijkere voorspeller is voor latere neurologische uitkomst.
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Background: Non-alcoholic steatohepatitis (NASH) is an emerging indication for liver transplantation due to the obesity pandemic. NASH frequently coexists with multiple comorbidities such as type 2 diabetes mellitus (T2DM), cardiovascular disease and the metabolic syndrome(MetS). Recent studies have shown that long-term patient and graft survival of patients transplanted for NASH cirrhosis are comparable to other indications. However, limited data exists about the short-term (procedure- related) complications after transplantation. Therefore, our aim was to investigate whether these patients are at an increased risk of short-term complications following transplantation.
Methods: This is a single centre retrospective cohort study including all adult patients (≥18 years) who underwent liver transplantation between January 2009 and December 2015 (N=224). Exclusion criteria were liver transplantation for acute hepatic failure or non-cirrhotic liver disease. Patients were censored at time of re-transplantation (n=17). Post-operative complications within 90 days were classified according to the Clavien-Dindo classification of surgical complications. NASH was defined by either: 1) histologic evidence of NASH on biopsy or explant; 2) imaging showing hepatic steatosis; 3) a phenotypic diagnosis consisting of BMI ≥ 30 kg/m2 and presence of T2DM (by either HbA1c ≥ 47 mmol/L or glucose lowering medication use) or the presence of at least 3 out of 5 diagnostic criteria for MetS as defined by the NCEP Adult Treatment Panel (ATP III). A p<0.05 was considered significant.
Results: Out of 169 eligible patients, 34 patients (20.1%) were transplanted for NASH cirrhosis. Patients with NASH cirrhosis were significantly older (59.2 vs. 54.8 years, p=0.011), more often obese (BMI≥30 kg/m2) (61.8% vs. 8.1%, p<0.001), had more T2DM (73.5% vs. 20.0%, p<0.001) and were more likely to meet criteria for MetS (83.3% vs. 37.8%, p<0.001). In univariate analysis, this group suffered from more grade I complications (p=0.016) and more grade II urogenital infections (47.1% vs. 20.0%, p=0.001). Major complications as well as 90-day graft survival in both groups was similar.
Conclusion: In patients transplanted for NASH cirrhosis postoperative major morbidity and mortality rates were comparable with patients transplanted for other indications, despite increased (minor) grade I postoperative complications.