Extra-Intestinal Manifestations of Familial Adenomatous Polyposis

Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited disorder, which results from a germ line mutation in the APC (adenomatous polyposis coli) gene. FAP is characterized by the formation of hundreds to thousands of colorectal adenomatous polyps. Although the development of colorectal cancer stands out as the most prevalent complication, FAP is a multisystem disorder of growth. This means, it is comparable to other diseases such as the MEN syndromes, Von Hippel-Lindau disease and neurofibromatosis. However, the incidence of many of its clinical features is much lower. Therefore, a specialized multidisciplinary approach to optimize health care—common for other disorders—is not usually taken for FAP patients. Thus, clinicians that care for and counsel members of high-risk families should have familiarity with all the extra-intestinal manifestations of this syndrome. FAP-related complications, for which medical attention is essential, are not rare and their estimated lifetime risk presumably exceeds 30%. Affected individuals can develop thyroid and pancreatic cancer, hepatoblastomas, CNS tumors (especially medulloblastomas), and various benign tumors such as adrenal adenomas, osteomas, desmoid tumors and dental abnormalities. Due to improved longevity, as a result of better prevention of colorectal cancer, the risk of these clinical problems will further increase

Exposure-related cortisol predicts outcome of psychotherapy in veterans with treatment-resistant posttraumatic stress disorder

Background: Hypothalamic-pituitary-adrenal axis functioning has been related to treatment outcome in posttraumatic stress disorder (PTSD). Previous studies have primarily focused on cortisol levels before and after a course of therapy and findings have not been fully consistent. This study investigated session-related cortisol levels in veterans with treatment-resistant PTSD over the course of a novel motion-assisted virtual reality exposure therapy and aimed to determine whether cortisol levels were related to changes in PTSD symptom severity. Methods: Veterans (N = 22) received six exposure sessions during which salivary cortisol samples were collected pre-session, post-session and in the late afternoon following sessions. PTSD symptom severity was assessed by structured clinical interviews at pre- and post-treatment. Average cortisol levels were compared between responders and non-responders. Linear regression analyses were conducted with PTSD symptom change as criterion variable, average cortisol levels as predictor, and timing of sampling and baseline PTSD symptoms as covariates. Results: Responders to treatment tended to have higher average cortisol levels at pre-session (p = 0.064) and post-session (p = 0.050) compared to non-responders. Higher average pre-session and post-session cortisol levels predicted greater PTSD symptom improvement (pre: b = −1.83, p = 0.009; post: b = −3.57, p = 0.004). Conclusion: This study provides preliminary evidence for session-related cortisol as biomarker of response to exposure-based therapies for PTSD. Higher cortisol levels may have facilitated fear extinction and reconsolidation, and may indicate increased physiological stress activation necessary for appropriate treatment engagement. Further work involving comparable methodology is encouraged to establish session-related cortisol as biomarker and to determine the mechanisms through which it interacts with treatment outcome

Naar een Actieplan Heischrale graslanden : hoe behouden en herstellen we heischrale graslanden in Nederland?

Heischraal grasland is een van oorsprong soortenrijk ecosysteem in het zandlandschap, het heuvellandschap en de duinen. De staat van instandhouding van de habitattypen H6230 en H2130C (waar dit ecosysteem in Nederland wordt verdeeld) is slecht, met name de droge varianten. Dat is extra zorgelijk, omdat het om prioritaire habitattypen gaat, dat wil zeggen dat er extra aandacht moet zijn voor het zo spoedig mogelijk bereiken van een gunstige staat van instandhouding. Er is landelijk gezien nog maar 30-40 ha redelijk ontwikkeld heischraal grasland over. Veel heischrale graslanden, ook die er qua soortensamenstelling nog relatief goed uitzien, zijn sterk verzuurd. Door menselijke aanvoer van eerst zwavel en nu stikstof is de zuurbuffering in de bodem ernstig aangetast, en monitoring van de stikstofbelasting laat zien dat deze nog nauwelijks is verminderd

Zonneparken: Kansen voor biodiversiteit en andere landschapsfuncties?

The construction of solar parks in the Netherlands is experiencing strong growth. This leads to a discussion about the use of scarce space. What are the effects of solar parks on the soil, agriculture, biodiversity and the perception of the landscape? Are there opportunities for other functions in addition to power generation? This article reports on a literature review of this question. There certainly are opportunities for combining solar parks with biodiversity and agriculture. To achieve this, an optimum must be sought between maximum power production and other functions. What is the best way to design and manage a solar park? The most important conclusion is that much knowledge is still lacking in this area and that further research is urgently needed.</p

Zonneparken natuur en landbouw

The transition to sustainable energy is in full swing. There is a great challenge to meet our energy requirements with sustainable energy sources. Solar power and the construction of solar parks are currently experiencing strong growth. In 2018 the solar power installed has increased by 46%. The area of solar parks on the ground is growing faster than the surface solar panels on roofs. In the Netherlands there is discussion about the use of scarce space for installing solar panels. The use of roofs on new and existing buildings is an efficient use of space, but the outdoor area offers developers of solar parks many advantages, such as scale. Little research has been done into the effects of solar parks on nature, agriculture and landscape. Ground-based solar parks have effects on the soil, agriculture, the biodiversity and services that the landscape provides. Whether these effects are positive or negative depends on the initial situation at the location in question and on the design and management of the solar park. This study provides an overview of the literature on solar parks in relation to soil, agriculture, biodiversity and experience

Zonneparken: Kansen voor biodiversiteit en andere landschapsfuncties?

The construction of solar parks in the Netherlands is experiencing strong growth. This leads to a discussion about the use of scarce space. What are the effects of solar parks on the soil, agriculture, biodiversity and the perception of the landscape? Are there opportunities for other functions in addition to power generation? This article reports on a literature review of this question. There certainly are opportunities for combining solar parks with biodiversity and agriculture. To achieve this, an optimum must be sought between maximum power production and other functions. What is the best way to design and manage a solar park? The most important conclusion is that much knowledge is still lacking in this area and that further research is urgently needed.</p

Zonneparken natuur en landbouw

The transition to sustainable energy is in full swing. There is a great challenge to meet our energy requirements with sustainable energy sources. Solar power and the construction of solar parks are currently experiencing strong growth. In 2018 the solar power installed has increased by 46%. The area of solar parks on the ground is growing faster than the surface solar panels on roofs. In the Netherlands there is discussion about the use of scarce space for installing solar panels. The use of roofs on new and existing buildings is an efficient use of space, but the outdoor area offers developers of solar parks many advantages, such as scale. Little research has been done into the effects of solar parks on nature, agriculture and landscape. Ground-based solar parks have effects on the soil, agriculture, the biodiversity and services that the landscape provides. Whether these effects are positive or negative depends on the initial situation at the location in question and on the design and management of the solar park. This study provides an overview of the literature on solar parks in relation to soil, agriculture, biodiversity and experience

Costs and Its Determinants in Pituitary Tumour Surgery

Purpose: Value-based healthcare (VBHC) provides a framework to improve care by improving patient outcomes and reducing healthcare costs. To support value-based decision making in clinical practice we evaluated healthcare costs and cost drivers in perioperative care for pituitary tumour patients. Methods: We retrospectively assessed financial and clinical data for surgical treatment up to the first year after surgery of pituitary tumour patients treated between 2015 and 2018 in a Dutch tertiary referral centre. Multivariable regression analyses were performed to identify determinants of higher costs. Results: 271 patients who underwent surgery were included. Mean total costs (SD) were €16339 (13573) per patient, with the following cost determinants: surgery time (€62 per minute; 95% CI: 50, 74), length of stay (€1331 per day; 95% CI 1139, 1523), admission to higher care unit (€12154 in total; 95% CI 6413, 17895), emergency surgery (€10363 higher than elective surgery; 95% CI: 1422, 19305) and postoperative cerebrospinal fluid leak (€14232; 95% CI 9667, 18797). Intradural (€7128; 95% CI 10421, 23836) and combined transsphenoidal/transcranial surgery (B: 38494; 95% CI 29191, 47797) were associated with higher costs than standard. Further, higher costs were found in these baseline conditions: Rathke’s cleft cyst (€9201 higher than non-functioning adenoma; 95% CI 1173, 17230), giant adenoma (€19106 higher than microadenoma; 95% CI 12336, 25877), third ventricle invasion (€14613; 95% CI 7613, 21613) and dependent functional status (€12231; 95% CI 3985, 20477). In patients with uncomplicated course, costs were €8879 (3210) and with complications €17551 (14250). Conclusions: Length of hospital stay, and complications are the main drivers of costs in perioperative pituitary tumour healthcare as were some baseline features, e.g. larger tumors, cysts and dependent functional status. Costs analysis may correspond with healthcare resource utilization and guide further individualized care path development and capacity planning