Academic Ceremonies March 2012

“Personalized computational modeling of vascular access creation”

To be able to connect haemodialysis patients to an artificial kidney a connection is surgically made between a coronary artery and vein in the arm (AVF). The exact location of this new vessel access is crucial for success. If an AVF is not made on the location that is optimal for the patient, this can result in a too low blood stream, which makes the vessel access not usable for haemodialysis, or, on the opposite, in a too high blood stream which results in heart problems or insufficient blood flow  in the hand. Additional interventions are then necessary to realize a usable vessel access. The researchers developed a computer model that can predict the blood stream after placement of an AVF and that can thus help select the optimal location. The computer model was capable of selecting in 16 out of 21 patients before the operation the same vessel access as a very experienced surgeon. The model could be valuable during the determination of the optimal AVF location, especially for an inexperienced surgeon.

Key words:

hemodialyse, AVF, locatiebepaling, computermodel

“Being” in Pain; the role of self-discrepancies in explaining emotional well-being and activity patterns in chronic pain”

Patients with chronic pain are not only confronted with the pain and its influence on their doings, but also with its influence on their ‘being’. Kindermans studied the role of self-discrepancies in chronic pain. Self-discrepancies are differences people experience between who they are and who they would ideally want to be (ideal self), who they think they should be (imposed self), and who they fear to be (feared self). These discrepancies can lead to depression or anxiety complaints. It turned out that the greater discrepancies patients with chronic pain experienced between their true self and the other self-images, the more they suffered from depression and anxiety complaints. Patients who could more flexibly deal with their objectives experienced fewer negative emotions in spite of present self-discrepancies. The closer patients felt to their feared self, the more they reported avoidance, which resulted in more limitations and a reduced quality of life.

Key words:

chronic pain, self-discrepancies, depression, fear

“Celebral Small Vessel Disease: Endothelial Progenitor Cells and Markers of Vascular Inflammation”

“Vascular endothelial function and genetic epidemiology in lacunar stroke subtypes”

The lacunar stroke (15% of all strokes) is caused by blockage of a small (perforating) blood vessel in the brain.  Recent research suggests that activation of the blood vessel wall initiates the syndrome. This PhD research shows raised concentrations of proteins (tissue factor pathway inhibitor and plasminogen activator inhibitor) that are excreted by the blood vessel wall, as a sign of activation of the blood vessel wall. It also turned out that first-degree relatives of patients with lacunar stroke also frequently suffered a stroke. This indicates a role of genetic factors in its origin. To further unravel the underlying mechanisms of the lacunar stroke, research should be conducted into genes that are involved in the function of the blood vessel wall.

Key words:

lacunar stroke, blood vessel wall, genetics

“Improving Procedural Sedation and/or Analgesia in Children: from practice over evidence to practice”

Sick children regularly resist medical procedures that are painful and/or stressful, or that require that the child lies still. Therefore Procedural Sedation and/or Analgesia (PSA), known as ‘light sedation’, is often necessary. Recently in the Netherlands serious (sometimes fatal) incidents were reported during PSA in children. This research confirms that PSA in the Netherlands is badly organized: the safety is inadequate and too little use is made of effective techniques. As a result, medical procedures unnecessarily often fail or are uncomfortable. On the basis of literature studies and ethical/legal considerations, the researchers formulated solutions in form of an evidence-based directive. This directive will be implemented from 2012, which will improve the quality of medical care for children.

Key words:

light sedation, children, safety, pain and fear free, new directive

“The silence of the Genes”

“BDNF signaling and cellular plasticity implications for depression”

One of the possible causes of depression is reduced plasticity in the brain as a consequence of a shortage of neutrophines. Neurotrophines (such as brain-derived neurotrophic factor, BDNF) are involved in the production, survival and integration of new neurones in certain brain structures, and thus contribute to their plasticity. BDNF is therefore considered a promising target for the development of new antidepressants. In this PhD research an innovative technique was developed,   in vivo micro-electroporation, which activates or deactivates genes in specific brain structures.  This technique, that paves the way for a safer use of gene therapy, was used to show that the neutrophic system plays an essential role in depression and in the molecular effect of antidepressants. Moreover, there appears to be a strong correlation between the neutrophic system and other systems that are also disordered in the case of depression.

Key words:

depression, neurotrophines, gene therapy, electroporation

“Epigenetics in mental health & psychiatry; bringing the genome to the environment”

“Corporate Social Responsibility Disclosure: Management, Commitment, and Stakeholder Influence”

“Immunotherapy in the battle against cancer: David versus Goliath?”

Today’s conventional anti-cancer therapy not only attacks cancer cells, but also damages healthy cells. We would rather attack the tumour in a more sophisticated way, such as David who struck the giant Goliath at exactly the right spot with his sling.  Immunotherapy makes it possible to attack tumour cells in a specific way. This research identifies proteins that are specifically presented by tumours.  A vaccine was developed that stimulates protein-presenting cells in such a way that they can activate killer cells, which in turn can kill cancer cells. The entire immune system will have to collaborate to strike tumours in their weak spots and to ultimately gain just like David.

Key words:

immune therapy, Mucine 1, cancer, tumour-specific proteins, vaccine. 

“New Developments in the Field of Retinal Detachment”

Proliferatieve vitreoretinopathie (PVR), dat gekenmerkt wordt door de vorming van littekenweefsel op en onder het netvlies, is de belangrijkste reden voor het falen van chirurgie voor netvliesloslating (rhegmatogene ablatio retinae). Het herstel van het gezichtsvermogen is daardoor vaak zeer gering, zelfs na een succesvolle oogoperatie.

Dit promotieonderzoek laat zien dat al in een zeer vroege fase van PVR – nog voordat het littekenweefsel gevormd is – allerlei eiwitten verhoogd aanwezig zijn in oogvochten van patiënten met een netvliesloslating. Hierdoor hebben we meer inzicht in de vroege ontstaansmechanismen van dit ziektebeeld en kunnen we voorspellen welke patiënten PVR gaan ontwikkelen. Bovendien is een medicamenteuze behandeling ter voorkóming van het littekenweefsel dichterbij gekomen.

Key words:

PVR, littekenweefsel, netvliesloslating

“PEPPER: Persistent Ear Problems, Providing Evidence for Referral”

This PhD research describes the first steps to develop an instrument for children with glue ears (otitis media) and impaired hearing, who need referral and perhaps treatment with tympanotomy tubes. For this purpose a questionnaire is used with risk factors for glue ears (the existing PEPPER questionnaire, 'Persistent Ear Problems, Providing Evidence for Referral'). A score form has been developed that predicts on the basis of a model with ten risk factors which children in the PEPPER study have been treated with tubes. The score form seems promising, but further research will have to investigate among others the practical usability.

Key words:

slechthorendheid, kinderen, trommelvliesbuisjes, scoreformulier

“The value of catheter-based cryoablation for the management of cardiac arrhytmias”

“Osteoporosis in Chronic Obstructive Pulmonary Disease”

Patients with chronic obstructive pulmonary diseases (COPD) not only have a disease that disorders the lung function, but they always run a higher risk of getting other diseases, such as osteoporosis.  . Half of all COPD patients that are monitored by a lung specialist turn out to have osteoporosis, independently from the seriousness of the COPD. Most COPD patients with osteoporosis, however, do not take medication to reduce the risk of fractures, which indicates unfamiliarity with the phenomenon among (lung) specialists. This awareness has to be awakened. The underlying factors that increase the risk of osteoporosis in COPD patients have not yet been clarified. This dissertation points among others in the direction of a lower body weight and lower fat free mass, vitamin D shortage and a lower bone density of the hip. Follow-up research, however, will have to confirm or invalidate this.

Key words:

Chronic Obstructive Pulmonary Diseases (COPD), osteoporosis

“Multidisciplinary treatment of anal leakage”

“Gekkenwerk. De ontwikkeling van het beroep ‘psychiatrisch verpleegkundige’ in Nederland 1830-1980”

This historical dissertation describes the development of the profession ‘psychiatric nurse’ in the Netherlands between 1830 and 1980, including the early rise of socio-psychiatric nursing.  All handbooks that were published before 1980 are discussed, as well as the legal and regulatory framework regarding the profession and the numbers of psychiatric health professional. Moreover, former nurses speak about their training en how they approached psychiatric patients, particularly concerning matters of sexuality, means of coercion and suicide. The author explains why psychiatric nursing has often been associated with illiteracy or poverty and proves that psychiatric nurses (as well as psychiatrists) have contributed remarkably much to the emancipation of nursing at large.

Key words:

psychiatric nurse, history

“Internal quality management and organisational values in higher education”

“Towards personalized antiplatelet therapy”

“Palliative care needs of patients with advanced chronic organ failure”

The number of patients with chronic life threatening diseases, such as heart or kidney failure is increasing. Today’s health care does not sufficiently meet the need for care of these patients, both physically and psychologically. Patients have clear preferences for reanimation and resuscitation, but doctors rarely inquire about these preferences. Patients were dissatisfied with the quality of the communication about care with their medical specialist in the last stage of life. This research identified many needs for care in patients with advanced chronic organ failure and these needs should be attended to in the care for these patients.

Trefwoorden:

Palliatieve zorg, behandelvoorkeuren, communicatie

“The renal cell cancer methylome: tumor biology and clinical applications”​

“Antithrombotic management of patients with atrial fibrillation”​

“The graphity of cognitive problems in epilepsy” 

“New Developments in Peritoneal Dialysis”

“Cross-retaliation in IP rights: addressing member assymmetries and compliance at the WTO”

“Sports nutrition to promote post-exercise recovery”

The intake of sports nutrition during the recovery period after intensive exertion is important for supplementing the energy reserves in the body and for stimulating muscle growth. This dissertation studies the effects of carbohydrate and protein intake on muscle repair. The conclusions are that endurance sportsmen benefit most from recovery drinks that contain both carbohydrates and protein. This supplements the carbohydrate reserves in the muscle and stimulates muscle growth. Power sportsmen should predominantly focus on the intake of proteins to enhance muscle growth, but they can inhibit protein decomposition by supplementing a small quantity of carbohydrates and supplement the carbohydrate reserves in the muscle. Moreover, both types of sportsmen can prolong the recovery period by taking the recovery drink already during exertion and/or shortly before going to sleep.

Key words:

sports nutrition, muscle building, endurance training, power training 

“Doctor-patient communication in a culturally hierarchical context of Southeast Asia: A partnership approach”