Long-Term Locoregional Vascular Morbidity After Isolated Limb Perfusion and External-Beam Radiotherapy for Soft Tissue Sarcoma of the Extremity

Background: Isolated limb perfusion (ILP) with tumor necrosis factor alpha (TNF-alpha) and melphalan, followed by delayed surgical resection and adjuvant external-beam radiotherapy is a limb salvage treatment strategy for locally advanced soft tissue sarcomas. The long-term vascular side effects of this combined procedure were evaluated. Methods: Thirty-two patients were treated for a locally advanced sarcoma of the upper (n = 5) or lower limb (n = 27). All patients underwent a noninvasive vascular work-up. Results: Five patients underwent a leg amputation, in two cases due to critical leg ischemia 10 years after ILP. With a median follow-up of 88 (range, 17-159) months, none of the patients with a salvaged lower leg (n = 22) experienced peripheral arterial occlusive disease. Ankle-brachial index (ABI) measurements in the involved leg (median, 1.02; range, .50-1.20) showed a significant decrease compared with the contralateral leg (median, 1.09; range, .91-1.36, P = .001). Pulsatility index (PI) was decreased in the treated leg in 17 of 22 patients at the femoral level (median, 6.30; range, 2.1-23.9 vs. median, 7.35; range, 4.8-21.9; P = .011) and in 19 of 20 patients at popliteal level (median, 8.35; range, 0-21.4 vs. median, 10.95; range, 8.0-32.6; P <.0005). In patients with follow-up of > 5 years, there was more often a decrease in ABI (P = .024) and PI at femoral level (P = .011). Conclusions: ILP followed by resection and external-beam radiotherapy can lead to major late vascular morbidity that requires amputation. Objective measurements show a time-related decrease of ABI and femoral PI in the treated extremity

Ran-dependent docking of importin-β to RanBP2/Nup358 filaments is essential for protein import and cell viability

RanBP2 captures RanGTP–importin-β complexes at cytoplasmic fibrils to ensure adequate classical NLS–mediated protein import and cell viability

Quantitative Easing in the Eurozone

In response to the outbreak Global Financial Crisis and European Debt Crisis, major central banks took very accommodative monetary policy stances. By slashing interest rates to the zero-lower bound and introducing unconventional monetary policy in the form of quantitative easing they hoped to boost aggregate demand and inflation. This paper investigates the workings of QE, money creation, potential macroeconomic- and other side-effects- of the ECB’s QE programme: “the expanded asset purchasing programme”, and its transmission channels. Though it seems that QE mainly works through portfolio rebalancing, limited evidence has been found on real macroeconomic effects and negative side-effects such as asset bubble inflation. This puts the effectiveness of the ECB’s APP into question

En dan naar school...

Hoofdstuk in het boek: Van baby tot kleuter. De veelzijdige en indrukwekkende ontwikkeling van kinderen van 0-4 jaar

Taalontwikkeling

Meestal verloopt de taalontwikkeling van kinderen vanzelfsprekend. Sommige kinderen echter hebben problemen in de spraak- en taalontwikkeling. Deze kunnen grote impact hebben op het leven van een kind. In dit hoofdstuk worden de mijlpalen in de taalontwikkeling en de verschillende taalgebieden van kinderen van nul tot vier jaar beschreven. Om taal te leren, is het noodzakelijk dat een ‘taallerend’ kind zich motorisch, cognitief, auditief sociaal en emotioneel goed ontwikkelt. Daarom wordt een aantal problemen in de taalontwikkeling nader besproken. Zo komt de vraag aan de orde op welke wijze samen met ouders gezocht kan worden naar mogelijkheden om de taalontwikkeling van kinderen te optimaliseren

Relation between B-mode Gray-scale Median and Clinical Features of Carotid Stenosis Vulnerability

Background Vulnerability of the carotid plaque might be useful as a predictor for ischemic stroke risk. The gray-scale median (GSM) of the carotid plaque at B-mode imaging has been described as an objective tool to quantify vulnerability. However, its use is disputed in the published literature. This study sought to validate the GSM as a predictor for carotid plaque vulnerability. Methods We included 89 consecutive patients (64 men; mean ± SD age: 68 ± 1 years) who were evaluated for carotid endarterectomy. The GSM was derived from preoperative B-mode images and related to the presence of clinical symptoms, the presence of ipsilateral infarction on neuroimaging, and to the number of intraoperative ipsilateral microemboli (ME) detected by transcranial Doppler ultrasonography. In addition, we combined the GSM with its standard deviation (GSM-SD), which we hypothesized to be a measure for plaque heterogeneity and thereby vulnerability. Results B-mode imaging revealed a wide variety in GSM among all plaques (median: 36; range: 6–89). The GSM could not be related to cardiovascular risk factors and was not different between symptomatic and asymptomatic patients (37.8 ± 8.9 vs 37.6 ± 17.1; P = 0.97). The GSM of plaques in patients with ipsilateral ischemic lesions on neuroimaging did also not differ from plaques in patients without (36.0 ± 14.6 vs 37.8 ± 16.9; P = 0.64). Finally, no relation between GSM and the presence of intraoperative ME (Spearman correlation; n = 73; ρ = 0.039; P = 0.75) was found. Combining GSM with its GSM-SD also could not identify more vulnerable plaques. Conclusions No relation was found between the GSM and any clinical, radiologic, or intra- and postoperative neurologic phenomena. These data showed no additional value of the use of GSM in evaluating plaque vulnerabilit

Patient-related factors influencing patency of autogenous brachiocephalic haemodialysis fistulas

Objective: The objective of this study was to analyse the outcome of autogenous brachiocephalic fistula for dialysis purposes and to determine modifiable and non-modifiable patient-related factors of influence on the patency of a newly created fistula. Design of study: A single-centre retrospective cohort study with the aim of determining patient-related factors of influence on primary failure, primary, primary assisted and secondary patency of autogenous brachiocephalic fistulas. Seventeen patient-related variables were determined by means of univariate analysis, variables reaching significance were then entered in a multivariate Cox-regression model. Results: Between October 2005-October 2015, 231 autogenous brachiocephalic fistulas were created in 228 patients. Mean age was 61.3 years (20.3-88.2 years). Patency was calculated using Kaplan-Meier analysis. Primary failure occurred in 38 out of 231 created fistulas (16.5%). The primary, primary assisted and secondary patency rates at six months were 78 +/- 3%, 93 +/- 2%, and 95 +/- 1%, respectively. At 12 months, they were 63 +/- 3%, 89 +/- 2%, and 92 +/- 2%, and at 24 months 47 +/- 4%, 84 +/- 3%, and 89 +/- 2%. The non-modifiable factors, diabetes mellitus and mean cephalic vein diameter were identified as a predictor for failure influencing primary and secondary patency. The preoperative use of anticoagulation was identified as a modifiable factor for failure. Conclusions: This study identified several non-modifiable and modifiable factors of interest to the clinician deciding on which type of haemodialysis fistula is most suitable for an individual patient. Meticulous preoperative work-up, a surveillance programme, and a dedicated multidisciplinary team can be of great importance in achieving better patency rates

Overestimation of contralateral internal carotid artery stenosis before ipsilateral surgical endarterectomy

Objective: The aim of this study was to investigate a possible overestimation of the degree of contralateral carotid artery stenosis by duplex in patients with significant bilateral carotid stenoses who are to undergo carotid endarterectomy (CEA). Methods: A retrospective analysis was performed of all patients undergoing CEA in our center over a period of 11 years. Pre- and postoperative duplex ultrasonography measurements of peak systolic velocity (PSV) and end diastolic velocity (EDV) were compared and used to classify the degree of stenosis. Univariate analysis was performed to indicate possible predictors for contralateral stenosis overestimation. Results: A total of 384 CEA procedures in 357 patients were performed in our hospital. Pre- and postoperative bilateral duplex measurements were available in 135 patients. Forty-four out of 135 patients (33%) were preoperatively identified as having significant stenosis (>60%) of the internal carotid artery on both sides. In these patients, postoperative duplex measurements of the contralateral carotid showed a decrease in mean (SD) PSV from 2.53 (1.11) m s(-1) to 1.97 (0.87) m s(-1) (P <0.01) and a decrease in EDV from 0.87 (0.60) m s(-1) to 0.60 (0.36) m s(-1) (P <0.01). The absolute changes in contralateral PSV and EDV after CEA were larger among patients with a higher degree of stenosis preoperatively. These changes led to reclassification of stenosis to a lesser degree in 24 (55%) patients. In 16 cases (36%), this resulted in a measured stenosis on the contralateral side of less than 60%. Conclusions: One-third of the patients with duplex measurements consistent with bilateral significant carotid stenosis did not have a significant contralateral stenosis by duplex after CEA. Therefore, additional postoperative duplex measurement is advisable before planning contralateral CEA. (C) 2009 Elsevier Ireland Ltd. All rights reserved