Academic Ceremonies June 2010

“The protective effect of Moderate Alcohol Consumption against Cardiovascular disease and total Mortality: Epidemiological evidence”

“A nutritional approach to prevent cardiovascular disease: from single foods to complex dietary pattern”

Nutrition plays a crucial role in prevention of cardiovascular disease (CVD). In this thesis, two approaches were followed. One regards single foods and nutrients: one study shows that regular intake of small quantities of dark chocolate might have benefits in primary prevention of CVD. Another one shows how alcohol and wine polyphenols are capable, in moderate drinkers, of modulating omega-3 polyunsaturated fatty acids in blood, a cardioprotective effect referred to as ‘‘fish-like”. The second approach regards dietary patterns and has explored ongoing modifications in adhesion to Mediterranean diet. This thesis highlights the need of parallel research in nutrition, exploring the role of single foods/nutrients as well as embracing a “pattern” vision, focusing on real life combination of elements in diet.

Key words:

nutrition, cardiovascular disease, diet

“Modulation of tissue factor expression in vascular cells”

Tissue factor (TF) is the trigger of blood coagulation. Although TF duty is to limit the loss of blood following vessel damage, it has been shown that its aberrant expression could play a key role in pathological conditions such as cardiovascular diseases and cancer. This thesis explores the role of TF in various scenarios. It shows that leptin, an hormone released form of adipose tissue, upregulates TF in blood monocytes, a phenomenon which may account for the thromboembolic episodes frequently associated with obesity. By contrast, a downregulation of TF was observed in cells exposed to drugs such as angiotensin converting inhibitors or clopidogrel, suggesting an additional mechanism by which these compounds exert their protective effect against cardiovascular diseases. Not only drugs but also natural substances, namely polyphenolic compounds found in grapes and red wine, could downregulate TF expression, a new mechanism to explain their role in prevention of cardiovascular disease.

Key words:

tissue factor, cardiovascular diseases

“The what and when in brain stimulation.Studying language production and deception with optimised neuronavigated transcranial magnetic stimulation”

“Online flow measurement in hemodialysis”

For haemodialysis patients there is always a risk of a blockage of the access to the bloodstream. Periodical measuring of the blood flow can timely signal an imminent blockage, upon which a dotter procedure can prevent complete blockage. This strategy is already successfully applied at the MUMC+, although the available scientific literature does not confirm this success yet. The described strategy could possibly be improved by increasing the measuring frequency by means of using innovative, in the dialysis equipment integrated techniques. Two techniques were studied: one of these turned out comparable to the present golden standard measuring method with regard to reliability.  

Key words:

haemodialysis, bloodstream, blockage, monitoring

“Remodeling of intracellular calcium handling in fibrillating atria”

“Earnings dynamics in Europe”

“Multispecies probiotics and antibiotic-associated side effects – pathophysiological and clinical evidence”

“Costs and effects of implementation of a short admission programme following breast cancer surgery in the Netherlands”

This dissertation investigates if short-stay breast cancer surgery (day or 24 hour case) is safe and efficient, studying the experiences of patients. A short stay programme was implemented in four Dutch hospitals. The proportion of patients who had short-stay treatment significantly increased after implementation from 45% to 82%, while the number of complications, rehospitalisation, reoperations or number of visits to the emergency department did not increase.  The programme is less expensive than the usual care, even if the costs of implementation are taken into account.  Research into the experiences of patients showed that especially the information provision needed to be improved. On the basis of these research results large-scale implementation of the programme is recommended.

Key words:

breast cancer surgery, short hospitalization, quality care

“Innovatief Onderwijs Ontwerpen in het Gezondheidsdomein”

“Het inzagerecht; Artikel 843a van het Wetboek van Burgerlijke Rechtsvordering”

In a civil procedure, documents that can allow party A to prove that he/she is right, can be in the hands of someone else.  Article 843a of the Code of Civil Procedure offers A, under certain conditions, the possibility to copy those documents. This dissertation studies the question of how strictly these conditions should be taken. It turns out that this also depends on the fundamental question to what extent finding the truth is important. Sijmonsma thinks that finding the truth is important and therefore pleads that these conditions in article 843a are generously applied for A. An amendment of the law should be recommended.  

Key words:

article 843a, truth finding 

“Cognitive Aging and Functional Compensation; Evidence from Brain Imaging Studies”

When people age, their cognition starts to decline. Elderly people can get round these unfavourable effects by functional compensation, which means by adjusting the way they use their brains. When in elderly people brain activity is perceived in brain areas that are specific for the function they perform and in extra brain areas in the prefrontal cortex, this has a positive effect on cognitive task performance.  These types of activity patterns indicate functional compensation. When the cognitive task becomes very difficult (for example when they have to memorize 7 to 10 items in the short term), elderly people show no longer an increased brain activity and they perform less well. This indicates that elderly people can no longer compensate. Remarkable is furthermore that elderly people with strong fibre tracts in the brains are best capable of compensating the effects of aging. 

Key words:

aging, cognition, brain activity

“Chemotherapy dose-intensification in breast cancer: is more better?”

“Kidney transplantation from donors after cardiac death; studies on the pathophysiology and prevention of ischemic acute kidney injury and on the long-term outcome after transplantation”

Kidney transplantation is the best treatment for patients with terminal kidney insufficiency, but due to a shortage of donor kidneys many people are deprived from this optimal care. Organ donation after a cardiac arrest can make the number of kidney transplantations rise and shorten or even eliminate the waiting list for kidney transplantations. However, because these donor kidneys are damaged by ischemia in the period between the cardiac arrest and organ preservation, there is a reticence to accept these donor kidneys.  For this reason this dissertation closely studies the entire transplantation process from donor to receiver to find clinically usable methods that can prevent this primary non-function of donor kidneys after a cardiac arrest. The research shows that kidney transplantations from donors after cardiac arrest lead to a longer life expectancy. Furthermore, in the transplantation process a series of clinically usable methods was found to lower the risk of non-functional transplantation kidneys.

“Bridging boundaries: Transnationalism and migrants’ lives in a globalizing world”

“Chlamydia trachomatis; identifying women with tubal factor subfertility”

“Home or home-like hospital birth for low-risk nulliparae: does it matter?”

The organization of obstetrics has been under great pressure for a number of years. This dissertation gives insight in differences between women who are pregnant with their first child and their partners with regard to the location of the delivery (at home versus polyclinic) and the effectiveness and efficiency of the care. Both pregnant women and their partners find it important that they can influence the decision process. Women, on the other hand, value a home-like environment for the delivery and partners prefer the possibility of pain reduction. Women who wish to give birth at home have a lesser chance of being referred and an unplanned caesarian, without a difference in neonatal outcomes and total costs of the care.

Key words:

home delivery versus policlinic, efficiency of care

“Positieve maar ook negatieve effecten van etnische diversiteit in scholen op onderwijsprestaties?”

“In search of neurobiological intermediate phenotypes of aberrant information processing in psychosis”

In the case of a psychosis the information processing is deregulated. This dissertation studies how disturbed information processing is related to psychotic symptoms, genetic influences and brain processes. It turns out that delayed information processing is related to so-called negative symptoms and that genetic influences underlie this. In people with an increased genetic risk of psychosis (relatives of patients) there are indications at the brain level that the auditory information processing is delayed. A bad memory turns out to be a risk factor for depressive symptoms. It was also shown that genetic variation in the COMT gene is involved in mild psychotic reactions to ordinary stress. Moreover, the research provides indications for deregulated processing of inner speech in the brains of schizophrenia patients. 

Key words:

psychosis, information processing

“Ethics at the interface of reproductive medicine and genetic technology: the case of mitochondrial disorders”​

“R&D alliances, knowledge flows, and innovation: Three studies on the value of collaborative R&D”

“screenen? Ja, maar hoe?”

“Capturing the dynamics of commitment”

“To drain or not to drain; quantification of drainable intravascular venous volume during extracorporeal life support”

“Motor learning in neurological rehabilitation: practicing skills with movement imagery”

For decades already, athletes have been improving their performance by practicing movements in imagination (movement imagery).  This research studied if this ‘dry exercise’ also has an effect in rehabilitation. Physiotherapists and occupational therapists have examined this in patients with Parkinson’s disease and in patients after a stroke (CVA). In our (relatively small) studies we could not show that the use of movement imagery is better than regular therapy. Patients indicated, however, that exercising in imagination motivated them and made them less afraid. They also liked being able to exercise safely whenever they wanted. More research and larger studies are necessary to investigate if there are groups of patients that possibly will benefit from movement imagery and to find out the physical, emotional and cognitive effects.

Key words:

movement imagery, rehabilitation, neurological disorders

“Fact-finding in civil litigation; a comparative perspective”

In civil procedures, the facts are often decisive. During a legal procedure the facts are collected, principal and secondary issues are separated and proof is brought forward.  The procedure often ends with a final judgement. This dissertation compares civil procedures in the Netherlands with those in Austria and the United States. It also discusses the historical background of the regulations regarding the investigation of the facts.  Striking is that there are very big differences between the Austrian and the Dutch system on the one hand, and the American system on the other hand. This partly is a result of the different demands that are made on the civil jurisdiction. The use of trial by jury in the United States, for example, explains many differences between jurisdictions. 

Key words:

civil procedure, comparative law, Netherlands, Austria, US.

“Promoter methylation based biomarkers for the detection of colorectal cancer”

Colorectal cancer is a very common health problem. In an early stage, this disease can be easily treated and often be cured by surgery. Currently, colonoscopy and the detection of blood in the faeces are used to detect colorectal cancer. The first method has high sensitivity, but is invasive and expensive, whereas the second is simple to use, but not sensitive enough. The limitations of these techniques initiated the development of new non-invasive biomarkers for colorectal cancer. This dissertation describes various new potential non-invasive epigenetic biomarkers (DNA markers) in faeces and blood for the detection of intestinal cancer. Also, the biological relevance of these biomarkers in intestinal cancer was studied. From these data we conclude that promoter methylation can be used for the non-invasive detection of intestinal cancer.

Key words:

detection colorectal cancer, biomarkers

“From algorithms to interactions; an Investigation of effective communication and design of Interactive decision Aids”

“Dikke kinderen, uitgebluste werknemers en vreemde virussen. Filosofie van de publieke gezondheidszorg in de 21e eeuw”

“Imaging in Oncology, a new beginning has just begun …..”

“Essays on international financial integration”

This dissertation studies the effects of international financial integration.  The research shows that because of growing international trade as well as financial integration the probability of a joint crash of international stock markets has strongly increased. This makes effective international stock diversification more difficult.  Results from study into the investors’ true stock positions show that investors do not move out of markets that jointly crash with their domestic market. Surprisingly enough, they do move out of those markets that jointly boom with their domestic market. Another effect of international financial integration is that value changes in private properties have effect on the trade balance. A value increase of, for example, the house, leads to an increase in consumption.  When foreign acquisitions rise, there is an increasing import of goods and services. This explains, for example, the trade deficits in the United Kingdom and the United States. Finally, the dissertation shows how migrant remittances to their family in the home country positively influence the financial policy of the migrant’s home country.

Key words:

financial markets, international trade, effects of globalisation 

“The elusive particle hazard; inflammatory and Oxidative stress responses”

Inhalation of fine dust particles creates a health danger. Two central, mutually connected phenomena that are assumed to play an important role here are (1) inflammation and (2) oxidative stress. This dissertation shows that the ‘dusty danger’ cannot be so easily defined: particles can cause inflammation related effects without causing oxidative stress or activating the main inflammation switch NF-κB. Indirect effects via stimulation of immune cells appear to be important. Moreover, this dissertation shows that fine dust particles can cause effects in the brains. This has consequences for the risk assessment of fine dust particles.  

Key words:

dust particles, immune cells, risk assessment