Academic Ceremonies July 2015

“Rectal cancer: Steps towards tailored treatment”

Treatment options for rectal cancer include surgery, radiation therapy and chemotherapy. In recent years, there has been an increased interest in organ-saving treatment of rectal cancer. This dissertation is aimed at tailoring the treatment of patients with rectal cancer. Three aspects were studied, namely the use of PET scans to make radiation therapy more accurate, the development of models to predict reactions to radiation therapy and the intensifying of radiation therapy to increase the chances of the tumour reacting to treatment. PET imaging proved to be useful in making radiation therapy more accurate. Furthermore, it was found that reactions to radiation therapy can be predicted by using PET scans and blood samples, among other things.

Key words:

rectal cancer, treatment, PET scan

“Living Apart Together Across Borders; How Ghanaian couples form, transform, or dissolve in the context of international migration”

The prevailing notion that all migrants in the Netherlands want to unite their families by bringing the rest of their relatives here demonstrates a lack of understanding for the familial context in which these migrants live. This study on Ghanaian couples and families shows that long-term family relationships can be maintained across borders, sometimes with respect to the prevailing sociocultural practices in the country of origin. A restrictive migration policy, however, can undermine the constitution and maintenance of long-term transnational family relationships. A strict policy can also hinder the mobility of migrants (e.g. the high cost of residence permits, hard-to-obtain tourist visas, etc.), which makes it difficult if not impossible for migrants to visit family members in Ghana or for other family members to visit the Netherlands.

Key words:

migration, Ghana, family relationships

“Modulation of protein – protein interactions in inflammatory diseases”

“(Epi)genetic profiling of cutaneous melanoma: Diagnostic, prognostic, and biological relevance”

Melanoma is the deadliest form of skin cancer. Due to the fast-growing number of patients suffering from this disease, melanoma is an ever-increasing health problem. Although current clinical evaluation of melanoma is mainly based on histopathology, there is still room for improvement in making the diagnosis and predicting the course of disease. This dissertation has assessed molecular changes in the DNA of melanoma, resulting in an improved understanding of melanoma biology. Furthermore, new biomarkers have been identified helping doctors make the correct diagnosis and predict the course of disease. These new markers can contribute to the determination of the optimal treatment of melanoma patients. 

Key words:

melanoma, diagnosis

“Causes and consequences of lipid overload in skeletal muscle, liver and heart”

With obesity, fat begins to accumulate in tissues other than adipose tissue (ectopic fat accumulation). This can have adverse health effects (lipotoxicity) and is believed to play an important role in the development of chronic diseases such as diabetes. This dissertation examined why fat accumulates in ectopic tissues such as muscles, the liver and the heart, and the role free fatty acids play in this process. It also examined the effect of fat accumulation on organ function. The study found that, while free fatty acids play a key role in the accumulation of fat, fat accumulation does not always lead to organ dysfunction. 

Key words:

obesity, ectopic fat accumulation, free fatty acids

“Evaluation of treatment for heavy menstrual bleeding”

Many women experience heavy menstrual bleeding. Two widely used treatments to drastically reduce blood loss are hormonal intrauterine devices and endometrial ablation to remove the endometrial lining of the uterus. This dissertation shows that women who underwent endometrial ablation were satisfied with the results five to ten years after treatment. However, it is unclear which of these treatment options is best. The research results will be available in a few years’ time. This dissertation found that different outcomes are being researched based on existing impact assessments, which makes it difficult to compare studies and inform patients properly. To do so first requires these outcomes to be determined and standardised in advance.

“Supply-demand balance in the atrium”

“The course of mild cognitive impairment and the role of comorbidity”

This dissertation studied the natural course of and the impact of comorbidities on cognitive decline in people suffering from mild cognitive impairment. The findings show an early decline in memory as well as a sharp or early decline in global cognition and executive control functions prior to the diagnosis of dementia being made. Furthermore, it was found that poor concentration/speed task results and a decline in the ability to perform such tasks are not indicative of the development of dementia. However, speed task results are linked to the severity of comorbidities. Comorbidities are likely to cause cognitive decline rather than result from an underlying neurodegenerative process. 

Key words:

dementia, cognitive impairment, course of disease, comorbidities

“Keeping warm in the cold; human brown adipose tissue upon cold acclimation”

This dissertation studied the effects of cold acclimation on slim and overweight/obese test subjects. Cold acclimation induced an increase in the production of brown adipose tissue. After stimulation, brown adipose tissue induced the conversion of glucose and fats into extra heat. Cold acclimation also increased energy expenditure without shivering. A significant relation was found between brown adipose tissue activity and energy expenditure without shivering. Furthermore, slim test subjects were found to grow accustomed to cold. Regular exposure to cold can, therefore, serve as a means of increasing energy expenditure, which may have favourable effects on weight maintenance. 

Key words:

overweight, brown adipose tissue, cold acclimation, energy expenditure

“Cardiovascular magnetic resonance; A key to imaging cardiac function”

“Investing in employability interventions ?’;Methodological challenges and economic evaluation results”

At some point, we will all experience work limitations due to health issues. In some cases, these limitations can lead to a reduction in work efficiency or absenteeism. In the Netherlands, the cost of absenteeism weighs most heavily on employers, who are expected to pay 70% of the absent employee’s salary for a maximum of two years. Various employability interventions have been developed to help minimise costs and facilitate reintegration. Interventions that focus on cooperation are the most cost-effective and therefore the most recommended. These include interventions that focus on the prevention and early detection of work-related health problems by encouraging an active role by company doctors and interventions that focus on employee-employer cooperation with the help of a mediator.

Key words:

employability, labour, healthcare, economic evaluation, cost-effectiveness

“A New Approach to Running Style Analysis using a Pressure-sensitive Insole Device: A small step towards injury prevention”

Running-related injuries affect about 50% of runners every year. Our running style could be a contributing factor to the occurrence of these overuse injuries. We used a pressure insole device to observe the effect of running speed on running style, to compare the running style of previously injured and uninjured recreational runners, and to observe the effect of minimalistic vs conventional running shoes. Continuous measurement allowed us to assess variability of running style from one stride to the other, which warrants further investigation in the area of running injury prevention. Prospective follow-up of runners also identified using multiple pairs of running shoes simultaneously and practicing other sports besides running as protective against sustaining an overuse injury.

Key words:

running-related injuries, insole device

“Asthma in Children: Towards Improved Monitoring Strategies”

“Improving conservative management of intermittent claudication”

Peripheral arterial vascular disease (PAVD) is a frequently occurring problem. In the Netherlands, 1 in 5 people aged 55 years and older suffer from this disorder. Charcot’s syndrome, commonly known as intermittent claudication (IC), is the first symptom of PAVD. Treatment of IC consists of supervised walking therapy (SWT), an invasive vascular intervention only being indicated if SWT does not have the desired results (from the patient’s perspective). However, not all patients are offered SWT in the Netherlands. Although there are many reasons for this, SWT not being covered by basic healthcare insurance is a key factor. Due to SWT not being fully covered, patients suffering from IC are exposed to an unnecessary risk of complications and death associated with much more expensive invasive treatment. Another important factor is a comparison between these treatments being difficult to be made due to a lack of good outcome measures. This thesis provides a first step towards a new outcome measure for the treatment of IC.

“The hypoxic tumor microenvironment: from imaging to targeting”

A lack of oxygen caused by poorly formed blood vessels is a common phenomenon in tumours. These oxygen-poor (hypoxic) areas are less sensitive to existing anti-cancer therapies such as radiation therapy and chemotherapy. This dissertation has shown hypoxic areas in tumours by using PET imaging technology. The characteristics of three clinical hypoxia PET tracers were compared with each other in a preclinical tumour model. Next, the combination of a new drug specifically aimed at these hypoxic areas and radiation therapy was tested in a preclinical setting. The results being promising, a phase I study will be set up shortly to test this combined treatment on patients.

“The nature of mutual recognition in European Law; Re-examining the notion from an individual rights perspective with a view to its further development in the criminal justice area”

This dissertation includes a comparative study of the nature of mutual recognition in European law within the framework of the European arrest warrant, among others. One of the conclusions is that mutual recognition does not mean a judge should blindly implement a ruling made by another Member State. After all, people have rights; especially when extradition is requested for minor offenses or in the event of poor prison conditions in the issuing Member State. If we hope to improve human and civil rights in Europe, judges should intervene when these rights are in danger of being violated.

“The thymus: when a rudimentary organ becomes active”

Maastricht University Medical Centre is a specialist centre for the surgical treatment of thymomas and the treatment of the muscular disorder myasthenia gravis (MG). Thymoma removal by means of robotic surgery proved to be a safe and reliable treatment option based on an analysis of all patients who underwent a robotic thymectomy between April 2004 and April 2012. The study also examined the role of robotic thymectomy in the treatment of MG among 125 patients. This form of treatment appeared to be safe, with a low morbidity rate and mortality rate of zero. After a median follow-up study 33 months later, 77% of MG patients had improved neurological function and nearly 33% of patients were in remission. This study also describes the discovery of the human polyomavirus in 39 thymomas.

“The Margins of Discretion in European Expulsion Decisions”

Foreigners who have been convicted of crimes and are subsequently issued with an expulsion decision have to leave a state which might have become their home and are often barred from returning to this state for a considerable period of time. An expulsion decision can constitute a severe interference with the private and family life of the individual and has the potential to destroy his or her personal, cultural, social and economic ties in that state. In light of these serious consequences, an expulsion decision should only be issued if it meets certain requirements. This research assesses whether the national (German and Dutch) law on expulsion complies with the standards set by European law. It identifies shortcomings in national statutory provisions on expulsion and provides recommendations for its reorganisation. 

“High-sensitivity cardiac troponins in heart and kidney diseases: from lab to clinic”