13 research outputs found
Basic research in cardiovascular disease : from stem cells to immunomodulation
This thesis addresses basic questions on cellular based and non-cellular (molecular) based therapeutic angiogenesis and provides valuable information on the resident vascular stem cell niche. As the world population ages, the incidence of cardiovascular diseases and its morbidity and mortality are expected to rise. Traditional treatment of cardiovascular diseases such as minimizing risk factors (e.g. smoking cessation), exercise in case of PAD to promote collateral blood flow, pharmaceutical vasodilatation, and surgical revascularization, clearly does not suffice. Therefore, basic cardiovascular research from stem cells to immunomodulation is of utmost importance, eventually leading to further mechanistic insights and a broader range of therapeutic options for patients with cardiovascular disease.ZonMW Fulbright Foundation Prof. Michael-van Vloten Foundation Hendrik Muller Foundation Schuurman Schimmel-van Outeren Foundation Leids Universitair FondsUBL - phd migration 201
Protocol for a prospective, longitudinal cohort study on the effect of arterial disease level on the outcomes of supervised exercise in intermittent claudication: the ELECT Registry
Introduction Despite guideline recommendations
advocating conservative management before
invasive treatment in intermittent claudication, early
revascularisation remains widespread in patients with
favourable anatomy. The aim of the Effect of Disease
Level on Outcomes of Supervised Exercise in Intermittent
Claudication Registry is to determine the effect of the
location of stenosis on the outcomes of supervised
exercise in patients with intermittent claudication due to
peripheral arterial disease.
Methods and analysis This multicentre prospective
cohort study aims to enrol 320 patients in 10 vascular
centres across the Netherlands. All patients diagnosed
with intermittent claudication (peripheral arterial disease:
Fontaine II/Rutherford 1–3), who are considered candidates
for supervised exercise therapy by their own physicians
are appropriate to participate. Participants will receive
standard care, meaning supervised exercise therapy first,
with endovascular or open revascularisation in case of
insufficient effect (at the discretion of patient a
In vivo visualization of transplanted bone marrow mononuclear cell behavior in murine peripheral artery occlusive disease
Vascular Surger
Short Hairpin RNA Gene Silencing of Prolyl Hydroxylase-2 with a Minicircle Vector Improves Neovascularization of Hindlimb Ischemia
Vascular Surger
Molecular Imaging of Bone Marrow Mononuclear Cell Survival and Homing in Murine Peripheral Artery Disease
Vascular Surger
Objective Assessment of Fitness to Perform (FTOP) After Surgical Night Shifts in the Netherlands An Observational Study Using the Validated FTOP Self-test in Daily Surgical Practice
Background: Surgical skills and decision making are influenced by alertness, reaction time, eye-hand coordination, and concentration. Night shift might impair these functions but it is unclear to what extent. The aim of this study was to investigate whether a night shift routinely impairs the surgeon's fitness to perform and whether this reaches a critical limit as compared to relevant frames of reference.Methods: Consultants (n = 59) and residents (n = 103) conducted fitness to perform measurements at precall, postcall, and noncall moments. This validated self-test consists of an adaptive tracker that is able to objectively measure alertness, reaction time, concentration, and eye-hand coordination, and multiple visual analog scales to subjectively score alertness. Results are compared to sociolegal (ethanol) and professional (operative skills) frames of reference that refer to a decrease under the influence of 0.06% ethanol.Results: Residents spent 1.7 call hours asleep on average as compared to 5.4 for consultants. Subjective alertness decreased in residents after night shifts (-13, P < 0.001) but not in consultants (-1.2, P = NS). The overnight difference in tracker score was -1.17 (P < 0.001) for residents and 0.46 (P = NS) for surgeons. Postcall subjective alertness only correlated to objective alertness in consultants. For residents, hours slept on-call correlated to objective alertness. For consultants, subsequent night calls significantly correlated to objective alertness, with the third subsequent call related to performance below the reference.Conclusions: Consultants remain fit to perform after night call, but subsequent calls may compromise clinical activities. This study provides insight and awareness of individual performance with clear frames of reference.Vascular Surger
Protocol for a prospective, longitudinal cohort study on the effect of arterial disease level on the outcomes of supervised exercise in intermittent claudication: the ELECT Registry
textabstractIntroduction Despite guideline recommendations
advocating conservative management before
invasive treatment in intermittent claudication, early
revascularisation remains widespread in patients with
favourable anatomy. The aim of the Effect of Disease
Level on Outcomes of Supervised Exercise in Intermittent
Claudication Registry is to determine the effect of the
location of stenosis on the outcomes of supervised
exercise in patients with intermittent claudication due to
peripheral arterial disease.
Methods and analysis This multicentre prospective
cohort study aims to enrol 320 patients in 10 vascular
centres across the Netherlands. All patients diagnosed
with intermittent claudication (peripheral arterial disease:
Fontaine II/Rutherford 1–3), who are considered candidates
for supervised exercise therapy by their own physicians
are appropriate to participate. Participants will receive
standard care, meaning supervised exercise therapy first,
with endovascular or open revascularisation in case of
insufficient effect (at the discretion of patient and vascular
surgeon). For the primary objectives, patients are grouped
according to anatomical characteristics of disease (aortoiliac,
femoropopliteal or multilevel disease) as apparent on the
preferred imaging modality in the participating centre (either
duplex, CT angiography or magnetic resonance angiography).
Changes in walking performance (treadmill tests, 6min walk
test) and quality of life (QoL; Vascular QoL Questionnaire-6,
WHO QoL Questionnaire-Bref) will be compared between
groups, after multivariate adjustment for possible
confounders. Freedom from revascularisation and major
adverse cardiovascular disease events, and attainment of the
treatment goal between anatomical groups will be compared
using Kaplan-Meier survival curves.
Ethics and dissemination This study has been exempted
from formal medical ethical approval by the Medical
Research Ethics Committees United ‘MEC-U’ (W17.071).
Results are intended for publication in peer-reviewed
journals and for presentation to stakeholders nationally
and internationally.
Trial registration number NTR7332; Pre-results
Saccular Abdominal Aortic Aneurysms Patient Characteristics, Clinical Presentation, Treatment, and Outcomes in the Netherlands
Objective: The aim of this was to analyze differences between saccularshaped abdominal aortic aneurysms (SaAAAs) and fusiform abdominal aortic aneurysms (FuAAAs) regarding patient characteristics, treatment, and outcome, to advise a threshold for intervention for SaAAAs.Background: Based on the assumption that SaAAAs are more prone to rupture, guidelines suggest early elective treatment. However, little is known about the natural history of SaAAAs and the threshold for intervention is not substantiated.Methods: Observational study including primary repairs of degenerative AAAs in the Netherlands between 2016 and 2018 in which the shape was registered, registered in the Dutch Surgical Aneurysm Audit (DSAA). Patients were stratified by urgency of surgery; elective versus acute (symptomatic/ruptured). Patient characteristics, treatment, and outcome were compared between SaAAAs and FuAAAs.Results: A total of 7659 primary AAA-patients were included, 6.1% (n = 471) SaAAAs and 93.9% (n = 7188) FuAAAs. There were 5945 elective patients (6.5% SaAAA) and 1714 acute (4.8% SaAAA). Acute SaAAApatients were more often female (28.9% vs 17.2%, P = 0.007) compared with acute FuAAA-patients. SaAAAs had smaller diameters than FuAAAs, in elective (53.0mm vs 61 mm, P = 0.000) and acute (68mm vs 75 mm, P = 0.002) patients, even after adjusting for sex. In addition, 25.2% of acute SaAAA-patients presented with diameters <55mm and 8.4% <45 mm, versus 8.1% and 0.6% of acute FuAAA-patients (P = 0.000). Postoperative outcomes did not significantly differ between shapes in both elective and acute patients.Conclusions: SaAAAs become acute at smaller diameters than FuAAAs in DSAA patients. This study therefore supports the current idea that SaAAAs should be electively treated at smaller diameters than FuAAAs. The exact diameter threshold for elective treatment of SaAAAs is difficult to determine, but a diameter of 45mm seems to be an acceptable threshold.Vascular Surger