Abstract: Background: Thoracic aortopathy includes conditions like aortic aneurysms and dissections, posing significant management challenges. In India, care delivery is complicated by geographic... Show moreAbstract: Background: Thoracic aortopathy includes conditions like aortic aneurysms and dissections, posing significant management challenges. In India, care delivery is complicated by geographic vastness, financial constraints, and healthcare resource disparities. Telemedicine and digital health technologies offer promising solutions. Methods: A comprehensive review of literature and clinical experiences was conducted to explore the implementation of remote care strategies for thoracic aortopathy in India. The review included studies from 2000 to 2023 and insights from cardiothoracic specialists. Results: Remote care benefits include improved access to specialized expertise, enhanced patient engagement, and optimized resource utilization. Telemedicine enables consultations without travel, and remote monitoring facilitates early intervention. However, challenges like technology integration, digital literacy, patient engagement, privacy concerns, and regulatory compliance need addressing. Discussion: Telemedicine offers significant advantages but requires overcoming challenges to ensure effective, secure care. Careful planning for technology integration, patient education, robust privacy measures, and supportive regulatory policies are essential. Addressing these issues can bridge the healthcare access gap and improve outcomes in India’s diverse landscape. Show less
BackgroundNumerous studies have shown that older women with endometrial cancer have a higher risk of recurrence and cancer-related death. However, it remains unclear whether older age is a causal p...Show moreBackgroundNumerous studies have shown that older women with endometrial cancer have a higher risk of recurrence and cancer-related death. However, it remains unclear whether older age is a causal prognostic factor, or whether other risk factors become increasingly common with age. We aimed to address this question with a unique multimethod study design using state-of-the-art statistical and causal inference techniques on datasets of three large, randomised trials.MethodsIn this multimethod analysis, data from 1801 women participating in the randomised PORTEC-1, PORTEC-2, and PORTEC-3 trials were used for statistical analyses and causal inference. The cohort included 714 patients with intermediate-risk endometrial cancer, 427 patients with high-intermediate risk endometrial cancer, and 660 patients with high-risk endometrial cancer. Associations of age with clinicopathological and molecular features were analysed using non-parametric tests. Multivariable competing risk analyses were performed to determine the independent prognostic value of age. To analyse age as a causal prognostic variable, a deep learning causal inference model called AutoCI was used.FindingsMedian follow-up as estimated using the reversed Kaplan-Meier method was 12·3 years (95% CI 11·9–12·6) for PORTEC-1, 10·5 years (10·2–10·7) for PORTEC-2, and 6·1 years (5·9–6·3) for PORTEC-3. Both overall recurrence and endometrial cancer-specific death significantly increased with age. Moreover, older women had a higher frequency of deep myometrial invasion, serous tumour histology, and p53-abnormal tumours. Age was an independent risk factor for both overall recurrence (hazard ratio [HR] 1·02 per year, 95% CI 1·01–1·04; p=0·0012) and endometrial cancer-specific death (HR 1·03 per year, 1·01–1·05; p=0·0012) and was identified as a significant causal variable.InterpretationThis study showed that advanced age was associated with more aggressive tumour features in women with endometrial cancer, and was independently and causally related to worse oncological outcomes. Therefore, our findings suggest that older women with endometrial cancer should not be excluded from diagnostic assessments, molecular testing, and adjuvant therapy based on their age alone. Show less
The recommended immunosuppressive treatment after kidney transplantation consists of tacrolimus, mycophenolate mofetil, and low-dose corticosteroids. Drug concentrations are monitored using... Show moreThe recommended immunosuppressive treatment after kidney transplantation consists of tacrolimus, mycophenolate mofetil, and low-dose corticosteroids. Drug concentrations are monitored using therapeutic drug monitoring (TDM), which does not necessarily correlate with pharmacodynamic activity. To find the balance between optimal efficacy and minimal toxicity, it might be more informative to monitor patients' immunological status rather than drug concentrations. We selected a panel of T-cell-based immune assays, which were used for immunomonitoring of 14 stable kidney transplantation patients. Whole blood was incubated with a T-cell stimulus, after which T-cell proliferation, T-cell activation marker expression and cytokine production were measured to study residual immune activity in vitro (before drug intake; drug added to the incubation) and ex vivo (after drug intake). T-cell proliferation was completely suppressed in all patients over the full day, while IL-2, IFN-γ, CD71, and CD154 showed fluctuations over the day with a strong inhibition (75%-25%) at 2 h post-dose. The level of inhibition was variable between patients and could not be related to pharmacokinetic parameters or the presence of regulatory or senescence immune cells. Moreover, the level of inhibition did not correlate with the in vitro tacrolimus drug effect as studied by incubating pre-dose blood samples with additional tacrolimus. Overall, IL-2, IFN-γ, CD71, and CD154 seem to be good markers to monitor residual immune activity of transplantation patients. To evaluate the correlation between these pharmacodynamic biomarkers and clinical outcome, prospective observational studies are needed. Show less
De volledige titel van de scriptie is "Positie verkenner, functie regels: De haalbaarheid, vorm en inhoud van een regeling van de verkenningsfase in de kabinetsformatie". De scriptie is te... Show moreDe volledige titel van de scriptie is "Positie verkenner, functie regels: De haalbaarheid, vorm en inhoud van een regeling van de verkenningsfase in de kabinetsformatie". De scriptie is te raadplegen via NJB Blog: https://www.njb.nl/blogs/positie-van-de-verkenner/ Show less
The thesis explores Ghanaian Sign Language (GSL), the national sign language of Ghana within urban deaf communities. Using historical, linguistic and ideological data, the research discovered GSL... Show moreThe thesis explores Ghanaian Sign Language (GSL), the national sign language of Ghana within urban deaf communities. Using historical, linguistic and ideological data, the research discovered GSL is a cover term for various signing forms (e.g., ENGLISH, BROKEN, LOCAL). Tracing GSL roots back to the introduction of American Sign Language (ASL) in 1957 by an American missionary, this research unveils a lasting connection between ASL signs and GSL. The thesis presents GSL's historical journey amidst significant challenges such as discrimination and sign language bans (oralism). It sheds light on signers' resilience and contributions to GSL's evolution. This exploration also highlights the emergence of local signing varieties (e.g., school-lects) alongside foreign-based signing forms within a triglossic framework that resembles the distribution and use of spoken languages in Ghana and other African countries. The thesis unearths lexical relationships, examining variants of GSL’s connections not only with ASL but also with locally evolved village sign languages like Adamorobe SL and Nanabin SL. Moreover, the study investigates the expression of Size and Shape Specifiers (SASS) within GSL and Ghanaian gestural communication, offering valuable insights into the susceptibility of sign languages to their gestural environment throughout their life spans. Beyond linguistics, the book explores social landscapes and language ideologies of sign languages in the Ghanaian urban deaf communities. It reveals a pluridimensional continuum of GSL usage and the interplay between high- and low-prestige variants. As an invaluable resource, this thesis enhances the understanding of African national sign languages, providing essential insights for researchers, teachers, and learners Show less
Silva, A.B. da; Ramiro, S.; Boel, A.; Lunteren, M. van; Marques, M.L.; Sande, M. van de; ... ; Gaalen, F. van 2024
Objective: The objective of this study was to compare health-related quality of life (HRQoL) and work productivity in axial SpA (axSpA) and nonaxSpA patients with chronic back pain of <2 years.... Show moreObjective: The objective of this study was to compare health-related quality of life (HRQoL) and work productivity in axial SpA (axSpA) and nonaxSpA patients with chronic back pain of <2 years. Methods: Baseline and 2-year data for patients included in the SPondyloArthritis Caught Early cohort were analysed. HRQoL was assessed by the physical (PCS) and mental component summary (MCS) scores of the 36-Item Short-Form Health Survey, and presenteeism, absenteeism, work productivity loss (WPL) and activity impairment (AI) by the Work Productivity and Activity Impairment questionnaire. Linear or zero-inflated negative binomial regression was conducted to compare 2-year outcomes between groups (axSpA and non-axSpA), adjusting for the baseline value, sex, age and use of NSAIDs. Results: There were 265 axSpA and 108 non-axSpA patients: males 52% vs 26%, mean age 29 vs 31 years, respectively. At baseline, nonaxSpA patients showed worse PCS (mean 28.6 axSpA vs 26.6 non-axSpA), presenteeism (31.1% vs 37.3%), absenteeism (8.2% vs 10.3%), WPL (34.7% vs 44.1%) and AI (39.6% vs 48.5%). MCS was not impaired in either group. After 2 years, PCS, presenteeism, WPL and AI significantly improved in both groups; absenteeism only improved in axSpA. In multivariable analysis, axSpA (vs non-axSpA) was associated with 22% less WPL [incidence rate ratio (95% CI): 0.78 (0.62; 0.98)] and 18% less AI [0.82 (0.69; 0.97)]. Conclusion: HRQoL and work productivity are more impaired in non-axSpA (vs axSpA) at baseline and also after 2 years. Although most outcomes improve in both groups, axSpA is associated with larger reductions in WPL and AI. Show less
In the 19th century an African possession cult called zār arrived in Egypt and became hugely popular. Jewellery formed an integral part of this cult. Currently, zār jewellery items are sought-after... Show moreIn the 19th century an African possession cult called zār arrived in Egypt and became hugely popular. Jewellery formed an integral part of this cult. Currently, zār jewellery items are sought-after collectors’ items for both private collectors and museums. Silver of the Possessed places jewellery of the Egyptian zār in its cultural and historical context and addresses Egyptian zār jewellery from multiple angles. First, it analyses how our current understanding of this jewellery has evolved through collecting and publishing. Examining its cultural background in African possession cults results in a new insight of the many roles jewellery played in zār, observing jewellery as a financial asset allows us to grasp its implications for household economy dynamics, while looking at jewellery in a diachronic perspective may even reveal changes in the ritual itself. Finally, this study explores its potential as an actual historic source: these jewellery items shed light on the world view of their wearers, and as such form an unexpected additional source for late 19th and early 20th century Egypt. Show less
Retinopathy of prematurity (ROP) is the most important cause of vision loss premature infants. With a continuous growth in this vulnerable population, the number of newborns at risk for severe,... Show moreRetinopathy of prematurity (ROP) is the most important cause of vision loss premature infants. With a continuous growth in this vulnerable population, the number of newborns at risk for severe, sight threatening ROP increases. In this thesis the results of the national Dutch inventory on risk factors, screening, treatment and sequelae of ROP are presented. The principal aims of the study were to determine characteristics of newborns who are at highest risk to develop severe ROP to assess quality of screening and treatment and to evaluate the national ROP guideline. Following these studies together with extensive cost-effectiveness analyses, the current Dutch ROP screening and treatment guideline was adapted and implemented in November 2023. The NEDROP 2 allowed for more stringent screening inclusion criteria, lowering the number of infants that need to undergo burdensome screening under the precondition that no severe ROP would be missed. Annually, this will lower the screening costs by nearly 60,000 euros. Show less
Protein posttranslational modifications by small ubiquitin-like modifiers (SUMOs) are critical for regulating a variety of cellular processes. Dysregulation of SUMOylation is increasingly... Show moreProtein posttranslational modifications by small ubiquitin-like modifiers (SUMOs) are critical for regulating a variety of cellular processes. Dysregulation of SUMOylation is increasingly associated with cancer and inhibitors that block SUMOylation are currently being explored as cancer treatment. We aimed to gain a better understanding of how the SUMO system governs the integrated network of nuclear signaling pathways, with a specific focus on genome maintenance. For this, we combined unbiased global mass spectrometry-based proteomics approaches with mechanistic follow-up studies. We found that the SUMO protease SENP6 maintains genome stability by ensuring the timely removal of SUMO chains on proteins involved in the response to DNA damage, affecting their localization, kinetics and nuclear condensation state. In addition, we found that noncovalent protein interactions with SUMOs mediated by SUMO-interaction motifs (SIMs) are also critical in maintaining genome stability, by facilitating the recruitment of DNA damage response proteins to the sites of damage. Lastly, we offer valuable new insights on noncovalent SUMO interactions by providing a comprehensive dataset of proteins that bind SUMO independently of the classical SUMO-SIM interaction. This suggests that the relevance of alternate modes of SUMO interactions is currently underestimated by the field and opens up new avenues for future research. Show less
Posttraumatic stress disorder (PTSD) is a psychological disorder that develops following exposure to perceived life-threatening trauma. Characteristic features include behavioral changes caused by... Show morePosttraumatic stress disorder (PTSD) is a psychological disorder that develops following exposure to perceived life-threatening trauma. Characteristic features include behavioral changes caused by heightened arousal, including fear and anxiety. Glucocorticoid receptor (GR) hypersensitivity, as defined by strong negative feedback, has been one of the most robust findings of altered HPA axis function in PTSD. In this thesis, we evaluated GR-related changes that were exposed to the three consecutive stressors of the single prolonged stress (SPS) animal model for PTSD. We tested the potential of the GR antagonist RU486 treatment in reversing these stress-induced effects. We found that GR antagonism can normalize some stress-induced parameters. We demonstrated that varying the timing of RU486 administration and evaluation gave different behavioral results and dynamics of gene expression, that revealed complex interactions between stress and RU486 over time. We also tested the GR sensitivity after administered the exogenous corticosterone. Our data suggest the enhanced stress responsiveness after SPS to moderate but not mild stressors and a sensitization of brain GR signaling that extends beyond direct negative feedback regulation. Lastly, we provide evidence for a role of β-arrestin-2 as a modulator of regulating amygdala activity in response to fear/anxious memory of PTSD. Show less
In this thesis, we have studied cell images from two types of cells, including pollen grains and the immune cells, neutrophils. These images are captured using a bright field microscope and a... Show moreIn this thesis, we have studied cell images from two types of cells, including pollen grains and the immune cells, neutrophils. These images are captured using a bright field microscope and a confocal microscope. We aim to analyze the insight in the understanding of the content of these images. In order to do these analyses, we need computational methods. The two main tasks are the classification of pollen images and the dynamic analysis of neutrophils through tracking in time-lapse sequences. In this study, we have demonstrated the use of deep learning methods for different kinds of cell imagery and shown the potential for future use while illustrating pitfalls, but also presenting efficient new algorithmic approaches. Show less
The circadian system has evolved to benefit the fitness of the organism. A properly functioning clock improves overall performance and promotes health. By gaining more knowledge about how the... Show moreThe circadian system has evolved to benefit the fitness of the organism. A properly functioning clock improves overall performance and promotes health. By gaining more knowledge about how the system works and responds to changes, therapies can be developed to promote the functioning of the circadian system. In this thesis, the response of the circadian system to changes in daylength (e.g. long summer days and short winter days was investigated. In addition the functioning of the circadian system with aging was investigated. This is relevant since aging is known to be accompanied by a weakening of the circadian system in humans, which has been associated with deterioration of a number of age-related conditions such as arteriosclerosis, type 2 diabetes and neurodegenerative diseases such as Parkinson's and Alzheimer's disease. In addition, a large proportion of the elderly will experience fragmentation of sleep, meaning that people have difficulty sleeping at night, while during the day they are very sleepy. Promoting the circadian rhythm with relatively simple interventions, such as correctly timed exposure to (day) light, physical activity and food intake can support the circadian system and promote general health. Show less
Lymphovascular space invasion (LVSI) is an important prognostic parameter in endometrial carcinoma (EC) and has gained increasing interest in recent years due to an expanding body of evidence of... Show moreLymphovascular space invasion (LVSI) is an important prognostic parameter in endometrial carcinoma (EC) and has gained increasing interest in recent years due to an expanding body of evidence of its independent prognostic value, especially when the presence of LVSI is quantified. A key strength of LVSI as a prognostic factor is that it can be detected on routine microscopic examination, without ancillary tests, and thus can be used in low-resource settings. A weakness, however, is the lack of uniformly applied criteria for assessment and quantification of LVSI, resulting in interobserver variation in diagnosis. This is confounded by artefacts and other morphological features that may mimic LVSI (commonly referred to as pseudo-LVSI). Despite these issues, multiple studies have shown that LVSI is strongly associated with lymph node (LN) metastasis and is an independent risk factor for LN recurrence and distant metastasis. Consequently, the presence of substantial/extensive LVSI has become an important consideration in formulating adjuvant treatment recommendations in patients with EC, and this has been incorporated in the recent International Federation of Gynecology and Obstetrics (FIGO) 2023 staging system. Herein, we review the current literature on LVSI in EC and discuss its role as a prognostic marker, the reproducibility of LVSI assessment and distinction between LVSI and its mimics. We provide illustrations of key diagnostic features and discuss the two-tiered (none/focal versus substantial) system of LVSI classification. This work is intended to provide guidance to practising pathologists and unify the approach towards LVSI assessment in EC. Show less
The paper explores the relationship between national and subnational authorities in Chile in the context of the government’s response to the COVID-19 pandemic, particularly analyzing the principle... Show moreThe paper explores the relationship between national and subnational authorities in Chile in the context of the government’s response to the COVID-19 pandemic, particularly analyzing the principle of coordination and the complexities of the state of emergency. The analysis is carried out in light of the constitutional provisions of the Chilean political system. Although subnational authorities developed significant activities to address the effects of the pandemic in their respective territories, particularly the local mayors, this was not accompanied by legal or practical reforms to integrate institutional or procedural changes to incorporate the subnational levels of government in the decision-making processes. During this state of emergency, the formal and informal institutions failed to be accountable for the necessary coordination of their competences at national, regional and local levels. Therefore, the COVID-19 pandemic, occurring during a nationwide constitution-making debate in Chile, opened the opportunity to discuss institutions and arrangements that could lead to an effective and legitimate system of intergovernmental relations in a decentralized unitary state. Show less
