De Do-Not-Reanimate-code in het medisch handelen rond de uitbehandelde patiënt. Een brug van cure naar comfort.

Intensieve Geneeskunde is het specialisme dat zich toelegt op de behandeling en observatie van kritiek zieke patiënten. Bij patiënten met een slechte prognose kan een ‘Do-Not-Reanimate-code’ (DNR-code) worden ingesteld. Er wordt dan op een zo objectief mogelijke manier een schatting gemaakt van de toekomstperspectieven waarbij wordt gekeken of bepaalde bijkomende behandelingen nog zinvol zijn of therapeutische hardnekkigheid in de hand werken. Belangrijk in deze discussie is het verschil in het onthouden versus onttrekken van therapie. Het onttrekken van reeds begonnen levensondersteunende behandeling (withdrawal of therapy) is niet hetzelfde als het onthouden (withholding) van nog niet begonnen therapie. Het eerste is een actieve en het tweede een passieve daad. Het gevaar bestaat dat het objectieve beeld van de pathologie de overhand heeft in de beslissing tot het uitschrijven van de DNR-code, waarbij het individuele (subjectieve) aspect van de zieke verloren gaat. In de praktijk wordt een DNR-code meestal toegekend aan de oudere en ziekere patiënt. Vanuit het medisch gezichtspunt moet duidelijkheid bestaan over het doel van een DNR-code: het is in de ‘care’ een overgang van ‘cure’ naar ‘comfort’. In het medisch handelen van de eenentwintigste eeuw behoren de factoren ‘cure’, ‘care’ en ‘comfort’ samen te gaan.Karin Janssen van Doorn (Zetten 1968) studeerde geneeskunde aan de VU Brussel en specialiseerde zich in interne geneeskunde (nefrologie) en intensieve geneeskunde. Haar doctoraatswerk omvat onderzoek naar acuut nierfalen bij kritiek zieke patiënten. Sinds 2003 studeert zij moraalwetenschappen aan dezelfde universiteit. In het kader van het vak ‘Ethische problemen; medicalisering van de dood’ deed zij onderzoek naar het gebruik van de Do-Not-Reanimate-code op de afdeling Intensieve Geneeskunde

Population Impact of Girls-Only Human Papillomavirus 16/18 Vaccination in the Netherlands: Cross-Protective and Second-Order Herd Effects

Background: Human papillomavirus (HPV) vaccination programs achieve substantial population-level impact, with effects extending beyond protection of vaccinated individuals. We assessed trends in HPV prevalence up to 8 years postvaccination among men and women in the Netherlands, where bivalent HPV vaccination, targeting HPV types 16/18, has been offered to (pre)adolescent girls since 2009 with moderate vaccination coverage. Methods: We used data from the PASSYON study, a survey initiated in 2009 (prevaccination) and repeated biennially among 16-to 24-year-old visitors of sexual health centers. We studied genital HPV positivity from 2009 to 2017 among women, heterosexual men, and unvaccinated women using Poisson generalized estimating equation models, adjusted for individual-and population-level confounders. Trends were studied for 25 HPV types detected by the SPF10-LiPA25 platform. Results: A total of 6354 women (64.7% self-reported unvaccinated) and 2414 heterosexual men were included. Percentual declines in vaccine types HPV-16/18 were observed for all women (12.6% per year [95% confidence interval {CI}, 10.6-14.5]), heterosexual men (13.0% per year [95% CI, 8.3-17.5]), and unvaccinated women (5.4% per year [95% CI, 2.9-7.8]). We observed significant declines in HPV-31 (all women and heterosexual men), HPV-45 (all women), and in all high-risk HPV types pooled (all women and heterosexual men). Significant increases were observed for HPV-56 (all women) and HPV-52 (unvaccinated women). Conclusions: Our results provide evidence for first-order herd effects among heterosexual men against HPV-16/18 and cross-protective types. Additionally, we show second-order herd effects against vaccine types among unvaccinated women. These results are promising regarding population-level and clinical impact of girls-only bivalent HPV vaccination in a country with moderate vaccine uptake

Artificial intelligence (AI): multidisciplinary perspectives on emerging challenges, opportunities, and agenda for research and practice

As far back as the industrial revolution, great leaps in technical innovation succeeded in transforming numerous manual tasks and processes that had been in existence for decades where humans had reached the limits of physical capacity. Artificial Intelligence (AI) offers this same transformative potential for the augmentation and potential replacement of human tasks and activities within a wide range of industrial, intellectual and social applications. The pace of change for this new AI technological age is staggering, with new breakthroughs in algorithmic machine learning and autonomous decision making engendering new opportunities for continued innovation. The impact of AI is significant, with industries ranging from: finance, retail, healthcare, manufacturing, supply chain and logistics all set to be disrupted by the onset of AI technologies. The study brings together the collective insight from a number of leading expert contributors to highlight the significant opportunities, challenges and potential research agenda posed by the rapid emergence of AI within a number of domains: technological, business and management, science and technology, government and public sector. The research offers significant and timely insight to AI technology and its impact on the future of industry and society in general

Determination of muscle fiber orientation using diffusion-weighted MRI

Biomechanical studies have shown that the distribution of stress and strain in biological tissue is strongly dependent on fibre orientation. Therefore, to analyze the local mechanical load, accurate data on muscle fibre orientation are needed. Traditional techniques to determine fibre orientation are inherently invasive. Here we used Diffusion Weighted MRI to non-invasively determine, in each image voxel of 0.23 x0.23 mm, the diffusion tensor of water in the cat semimembranosus muscle. The direction corresponding to the largest eigenvector of this tensor was calculated. This direction was found to correspond qualitatively to the muscular fibre direction, as determined by visual inspection

Determination of muscle fiber orientation using diffusion-weighted MRI

Biomechanical studies have shown that the distribution of stress and strain in biological tissue is strongly dependent on fibre orientation. Therefore, to analyze the local mechanical load, accurate data on muscle fibre orientation are needed. Traditional techniques to determine fibre orientation are inherently invasive. Here we used Diffusion Weighted MRI to non-invasively determine, in each image voxel of 0.23 x0.23 mm, the diffusion tensor of water in the cat semimembranosus muscle. The direction corresponding to the largest eigenvector of this tensor was calculated. This direction was found to correspond qualitatively to the muscular fibre direction, as determined by visual inspection

Maternal exposure to genistein during pregnancy and oxidative DNA damage in testes of male mouse offspring

BACKGROUND: Genistein is a dietary supplement with phyto-estrogenic properties. Therefore, high intake of genistein during pregnancy may have adverse effects on the genetic integrity of testes and germ cells of male offspring. In this study, we examined whether maternal exposure to genistein during pregnancy induced oxidative DNA damage in the male germline at adolescence. METHODS: Atm-ΔSRI mice have lower glucose-6-phosphate dehydrogenase (G6PDH) activity, which is important for maintaining levels of reduced glutathione and therefore these mice have an increased susceptibility to oxidative stress. Parental heterozygous Atm-ΔSRI mice received a genistein-rich or control diet, after which they were mated to obtain offspring. During pregnancy, mothers remained on the respective diets and after delivery all animals received control diets. Redox status and oxidative DNA damage were assessed in testes and sperm of 12 weeks old male offspring. Gene expression of Cyp1b1, Comt, and Nqo1 was assessed in testes, and DNA methylation as possible mechanism for transmission of effects to later life. RESULTS: Intake of genistein during pregnancy increased oxidative DNA damage in testes of offspring, especially in heterozygous Atm-ΔSRI mice. These increased DNA damage levels coincided with decreased expression of Comt and Nqo1. Heterozygous Atm-ΔSRI mice had higher levels of DNA strand breaks in sperm compared to wild type littermates, and DNA damage was further enhanced by a genistein-rich maternal diet. G6PDH activity was higher in mice with high maternal intake of genistein compared to control diets, suggesting compensation against oxidative stress. A positive correlation was observed between the levels of DNA methylation and oxidative DNA damage in testes. CONCLUSION: These data indicate that prenatal exposure to genistein altered gene expression and increased DNA damage in testes and sperm of adolescent male offspring. These effects of genistein on DNA damage in later life coincided with alterations in DNA methylation

Maternal exposure to genistein during pregnancy and oxidative DNA damage in testes of male mouse offspring

BackgroundGenistein is a dietary supplement with phyto-estrogenic properties. Therefore, high intake of genistein during pregnancy may have adverse effects on the genetic integrity of testes and germ cells of male offspring. In this study, we examined whether maternal exposure to genistein during pregnancy induced oxidative DNA damage in the male germline at adolescence. MethodsAtm-Delta SRI mice have lower glucose-6-phosphate dehydrogenase (G6PDH) activity, which is important for maintaining levels of reduced glutathione and therefore these mice have an increased susceptibility to oxidative stress. Parental heterozygous Atm-Delta SRI mice received a genistein-rich or control diet, after which they were mated to obtain offspring. During pregnancy, mothers remained on the respective diets and after delivery all animals received control diets. Redox status and oxidative DNA damage were assessed in testes and sperm of 12 weeks old male offspring. Gene expression of Cyp1b1, Comt, and Nqo1 was assessed in testes, and DNA methylation as possible mechanism for transmission of effects to later life. ResultsIntake of genistein during pregnancy increased oxidative DNA damage in testes of offspring, especially in heterozygous Atm-Delta SRI mice. These increased DNA damage levels coincided with decreased expression of Comt and Nqo1. Heterozygous Atm-Delta SRI mice had higher levels of DNA strand breaks in sperm compared to wild type littermates, and DNA damage was further enhanced by a genistein-rich maternal diet. G6PDH activity was higher in mice with high maternal intake of genistein compared to control diets, suggesting compensation against oxidative stress. A positive correlation was observed between the levels of DNA methylation and oxidative DNA damage in testes. ConclusionThese data indicate that prenatal exposure to genistein altered gene expression and increased DNA damage in testes and sperm of adolescent male offspring. These effects of genistein on DNA damage in later life coincided with alterations in DNA methylation