PURPOSE: We evaluated the influence of knowledge of urine test outcome on the accuracy of cystoscopy (diagnostic review bias) during surveillance in patients with low grade, nonmuscle invasive... Show morePURPOSE: We evaluated the influence of knowledge of urine test outcome on the accuracy of cystoscopy (diagnostic review bias) during surveillance in patients with low grade, nonmuscle invasive urothelial carcinoma. MATERIALS AND METHODS: We performed a prospective, single-blind, randomized, multicenter clinical trial of surveillance by microsatellite analysis urine test in 448 patients with nonmuscle invasive (pTa, pT1, G1, G2) urothelial carcinoma. Positive or negative urine test results were only communicated to the urologist in the intervention arm of 226 patients, in which cystoscopy was done if the test was positive, and at 3, 12 and 24 months. Urine test results were not communicated in the control arm of 222 patients who underwent standard 3-month cystoscopy. The primary outcome measure was the number of histologically proven bladder cancer recurrences. RESULTS: At a median 34-month followup 218 recurrences were detected in the intervention arm compared to 163 in the control arm (p <0.001). Of 131 cystoscopies done with knowledge of a positive urine test 42 recurrences were detected. Only 6 recurrences were found in the 120 cystoscopies done without information on the positive test result (chi-square p <0.001). There was no difference in recurrence detection when urine test results were negative in the intervention and control arms (18 of 260 patients or 7% and 18 of 326 or 6%, respectively, p = 0.45). CONCLUSIONS: Diagnostic review bias should be considered in the evaluation of point of care urine tests for bladder cancer monitoring. Awareness of a positive urine test result significantly improves the urothelial carcinoma detection rate using cystoscopy. Show less
Prevalence of childhood obesity is increasing. Insulin resistance is a consequence of childhood obesity, and it has a keyrole in the development of cardiometabolic complications, such as... Show more Prevalence of childhood obesity is increasing. Insulin resistance is a consequence of childhood obesity, and it has a keyrole in the development of cardiometabolic complications, such as diabetes mellitus. In the first part of this thesis, the epidemiology of insulin resistance has been described. Since there is no clear definition for insulin resistance, the prevalence of IR remains unclear. In addition, the use of IR in the screening for diabetes mellitus in obese children was evaluated. In the second part of the thesis, treatment of obese children with insulin resistance is discussed. In a randomized controlled trial of 18 months, children were treated with either metformin or placebo in addition to lifestyle intervention. Body mass index in children treated with metformin remained stable during the 18 months, whereas placebo-treated children had an increase in body mass index. Finally, the treatment with metformin under the strict circumstances of the clinical trial was compared to treatment with metformin in daily practice during 18 months. Both groups showed similar results regarding body mass index during metformin treatment. Show less
In 2015, deadly incidents of migrant smuggling in the Mediterranean were daily covered by everyday newspapers. Empirical research has shown that migrants themselves may be involved in these... Show moreIn 2015, deadly incidents of migrant smuggling in the Mediterranean were daily covered by everyday newspapers. Empirical research has shown that migrants themselves may be involved in these smuggling operations. If they apply for refugee protection, they may be excluded from refugee status under Article 1F of the Refugee Convention. Article 1F(b) excludes asylum seekers from international protection if serious reasons exist to consider that they have committed serious non-political crimes. This contribution discusses whether migrant smuggling can be considered as such and whether various forms of participation in smuggling operations give rise to individual responsibility and trigger application of article 1F(b). Show less
The material selectivity test resembles a non–discrimination analysis, under which the Commission can assess whether undertakings, which operate under comparable legal and factual situations, are... Show moreThe material selectivity test resembles a non–discrimination analysis, under which the Commission can assess whether undertakings, which operate under comparable legal and factual situations, are treated unequally by general measures. The Commission has to establish whether measures confer “an advantage of general application” and if so, whether this advantage effectively results in unequal treatment. This contribution, celebrating the 15th jubilee of ESTAL, highlights the effect-based approach of the Gibraltar-judgment, as was commentated by Rossi-Maccanico (EStAL 2012/2), and places developments in case law on the notion of material selectivity in the context of this landmark judgment. Show less
