Portal vein thrombosis and hemostatic alterations in patients with advanced liver diseases

In patients with liver diseases, the liver has a reduced capacity to produce pro- and antihemostatic proteins. This results in a rebalanced hemostatic system, which remains stable in patients with stable liver diseases but can be fragile in those with additional disease complications, such as inflammation or renal failure. Although liver diseases were long associated with an increased risk of bleeding, hemostasis-related bleeding is rare in patients with liver diseases. With increasing insights, it becomes evident that patients with liver diseases have an elevated risk of thrombotic complications, with portal vein thrombosis being the primary concern. The pathophysiology of portal vein thrombosis is not fully understood. The studies described in this thesis aimed to gain more insights into the development of portal vein thrombosis in patients with chronic liver diseases. The results showed that, in most patients with portal vein thrombosis, there is no classical thrombus consisting of fibrin, platelets, and red blood cells. Instead, the obstruction of the portal vein is caused by thickening of the vessel wall. Portal vein thrombosis may therefore be a misnomer and might be more accurately termed as 'portal vein stenosis' or 'portal vein intima hyperplasia.' Additionally, we investigated whether blood in the portal vein of liver patients has locally elevated levels of markers of activation of coagulation or inflammation, due to drainage from the intestines. This could potentially lead to a locally increased risk of thrombosis. However, no differences were found in samples taken from the systemic circulation and the portal vein. Furthermore, there was no correlation between elevated levels of markers of activation of coagulation or inflammation in the systemic circulation and the development of portal vein thrombosis in patients with chronic liver diseases. Factors related to the development of portal vein thrombosis were factors that are associated with portal hypertension and changes in portal blood flow. The findings described may explain why treatment with anticoagulants is not always effective in the treatment of portal vein thrombosis in cirrhosis. The insights described in this thesis pave the way for exploring new treatment strategies. Future studies should focus on investigating safe and effective pharmacotherapeutic interventions for the prevention and treatment of portal vein thrombosis or portal vein intima hyperplasia in patients with chronic liver diseases

Demographic and Census Trends of Latinos in the Kansas City Area

Presentation made at Latinos in Missouri (2nd : 2007 : Kansas City, Mo.) and published in the annual conference proceedings

Shared decision making in hospital care:what happens in practice

Shared decision making (SDM) is presented by the government, and by patient and healthcare organizations, as the preferred model of decision making in medical consultations. SDM can improve therapy adherence and patient outcomes. SDM allows the physician’s medical expertise to be coupled to the patient’s unique situation, views and preferences.Most healthcare providers and patients want to make decisions about diagnostics and treatment together with each other. This thesis examines how doctors think about SDM, and how they apply it in daily clinical practice. We videotaped 781 consultations between hospital-based consultants and their patients, and analyzed the decision-making process. In these consultations, doctors applied less SDM than they prefer and they thought they did. They presented different options, then made a proposal and asked the patient to consent with this treatment. However, they skipped a key SDM step: choice awareness. Making it clear that a choice has to be made, and that the physician and patient decide together, as a team, which option best fits the patient’s current situation.Our studies show that doctors need to be made aware of their own decision-making behavior, as they do not apply as much SDM as they think they do. In addition, skills training is required to support doctors to apply all SDM steps. In this dissertation, we propose an SDM training model to promote that doctors make decisions with their patients instead of for their patients

Information flow and optimization in transcriptional control

In the simplest view of transcriptional regulation, the expression of a gene is turned on or off by changes in the concentration of a transcription factor (TF). We use recent data on noise levels in gene expression to show that it should be possible to transmit much more than just one regulatory bit. Realizing this optimal information capacity would require that the dynamic range of TF concentrations used by the cell, the input/output relation of the regulatory module, and the noise levels of binding and transcription satisfy certain matching relations. This parameter-free prediction is in good agreement with recent experiments on the Bicoid/Hunchback system in the early Drosophila embryo, and this system achieves ~90% of its theoretical maximum information transmission.Comment: 5 pages, 4 figure

Effects of Inflammation on Hemostasis in Acutely Ill Patients with Liver Disease

Patients with liver diseases are in a rebalanced state of hemostasis, due to simultaneous decline in pro- and anticoagulant factors. This balance seems to remain even in the sickest patients, but is less stable and might destabilize when patients develop disease complications. Patients with acute decompensation of cirrhosis, acute-on-chronic liver failure, or acute liver failure often develop complications associated with changes in the hemostatic system, such as systemic inflammation. Systemic inflammation causes hemostatic alterations by adhesion and aggregation of platelets, release of von Willebrand factor (VWF), enhanced expression of tissue factor, inhibition of natural anticoagulant pathways, and inhibition of fibrinolysis. Laboratory tests of hemostasis in acutely-ill liver patients may indicate a hypocoagulable state (decreased platelet count, prolongations in prothrombin time and activated partial thromboplastin time, decreased fibrinogen levels) due to decreased synthetic liver capacity or consumption, or a hypercoagulable state (increased VWF levels, hypofibrinolysis in global tests). Whether these changes are clinically relevant and should be corrected with antithrombotic drugs or blood products is incompletely understood. Inflammation and activation of coagulation may cause local ischemia, progression of liver disease, and multiorgan failure. Anti-inflammatory treatment in acutely-ill liver patients may be of potential interest to prevent thrombotic or bleeding complications and halt progression of liver disease

Handleiding Paprika model “Cultivista” - Project Topmodel4all / 2010-2011

Abstract NL Deze handleiding is bedoeld voor telers die aan de slag willen met het paprika model “Cultivista”. Er wordt uitgelegd hoe met het interactieve paprika model “Cultivista” kan worden gewerkt. De installatie van het model en de verschillende in te voeren gegevens (inputs) van het model worden besproken. Vervolgens worden de werking van het model en de onderdelen van de interface besproken. Tevens worden de voorwaarden voor mogelijke automatisering van de inputs en het oplossen van de meest voorkomende problemen besproken. Abstract UK This manual is meant for growers who would like to work with the sweet pepper growth model “Cultivista”. This manual explains how the model works, how to install the model and which inputs are used. Furthermore, the different parts of the interface are explained. Finally, the conditions for automation of the inputs and troubleshooting of the most common problems are discussed

Welche Auswirkungen hat die Nutzung sozialer Medien auf die Wahrnehmung journalistischer Qualität und daraus folgend auf das Vertrauen in Medien? Am Beispiel von Facebook

In der modernen Gesellschaft ist der Journalismus das Fenster zur Welt, in dem sich Menschen über das Weltgeschehen informieren können. Da das Publikum die Berichterstattung jedoch meist nicht verifizieren kann, muss es darauf Vertrauen, dass die Berichterstattung eine möglichst genaue Darstellung des Geschehens ist. Durch die vielen Konflikte der letzten Jahre, allen voran die Flüchtlingskrise, sehen sich der Journalismus und die Medien vermehrt Lügenpresse-Vorwürfen ausgesetzt. Gerade in sozialen Medien wie Facebook, in der Menschen sich in Teilöffentlichkeiten zusammenschließen können, finden diese Vorwürfe einen Nährboden. Dadurch ist in den letzten Jahren eine Diskussion um das Vertrauen in die Medien und die Glaubwürdigkeit und Qualität ihrer Berichterstattung aufgekommen. Aus diesem Grund widmet sich die vorliegende Arbeit der Frage, welche Auswirkung die Nutzung sozialer Medien auf die Wahrnehmung journalistischer Qualität und daraus folgend auf das Vertrauen in Medien hat, wobei sich auf die Betrachtung des sozialen Netzwerks Facebook beschränkt wird. In der Arbeit werden zunächst die Begriffe Journalismus und Vertrauen näher definiert, ehe journalistische Qualitätsmerkmale identifiziert und ihre Wahrnehmung durch das Publikum näher betrachtet werden. In Verbindung mit der Nutzung sozialer Medien stellt sich dabei heraus, dass das Publikum vermehrt auf Heuristiken, also Erwartungen, Gefühlen und Hörensagen zurückgreift, als auf eine rationale Beurteilung der journalistischen Qualität. Um den Rahmen dieser Arbeit nicht zu sprengen, wird sich hier auf das soziale Netzwerk Facebook beschränkt. Dieses fördert dabei sowohl die Polarisierung bei der Wahrnehmung journalistischer Qualität als auch, daraus folgend, die Polarisierung beim Medienvertrauen