Venous and arterial thrombotic complications. Solutions in clinical practice

This thesis aimed to evaluate and improve therapeutic anticoagulation strategies in patients presenting with venous thromboembolism (VTE) and to prevent arterial thrombosis after heart valve surgery. Additionally, major bleeding management with idarucizumab for urgent dabigatran reversal was evaluated.Financial support by the Dutch Heart Foundation for the publication of this thesis is gratefully acknowledged. Additional financial support was kindly provided by de Federatie van Nederlandse Trombosediensten, Boehringer Ingelheim, Chipsoft, Servier, Bayer and Pfizer.LUMC / Geneeskunde Repositoriu

A classification of smooth embeddings of 3-manifolds in 6-space

We work in the smooth category. If there are knotted embeddings S^n\to R^m, which often happens for 2m<3n+4, then no concrete complete description of embeddings of n-manifolds into R^m up to isotopy was known, except for disjoint unions of spheres. Let N be a closed connected orientable 3-manifold. Our main result is the following description of the set Emb^6(N) of embeddings N\to R^6 up to isotopy. The Whitney invariant W : Emb^6(N) \to H_1(N;Z) is surjective. For each u \in H_1(N;Z) the Kreck invariant \eta_u : W^{-1}u \to Z_{d(u)} is bijective, where d(u) is the divisibility of the projection of u to the free part of H_1(N;Z). The group Emb^6(S^3) is isomorphic to Z (Haefliger). This group acts on Emb^6(N) by embedded connected sum. It was proved that the orbit space of this action maps under W bijectively to H_1(N;Z) (by Vrabec and Haefliger's smoothing theory). The new part of our classification result is determination of the orbits of the action. E. g. for N=RP^3 the action is free, while for N=S^1\times S^2 we construct explicitly an embedding f : N \to R^6 such that for each knot l:S^3\to R^6 the embedding f#l is isotopic to f. Our proof uses new approaches involving the Kreck modified surgery theory or the Boechat-Haefliger formula for smoothing obstruction.Comment: 32 pages, a link to http://www.springerlink.com added, to appear in Math. Zei

Bilevel optimization approach to design of network of bike lanes

A bike lane is an effective way to improve cycling safety and to decrease greenhouse gas emissions with the promotion of cycling. Improvements include high-quality off-road facilities and on-road bike lanes. Whereas construction of off-road lanes is not always possible because of urban land constraints and construction costs, on-road lanes can be a cost-effective alternative. An optimization framework for the design of a network of bike lanes in an urban road network was proposed. This framework identified links on which a bike lane could be introduced. Allocation of a lane to cyclists would increase the use of cycling, although it could disadvantage auto traffic. The presented approach balances the effects of a bike lane for all stakeholders. A bilevel optimization was proposed to encompass the benefits of cyclists and car users at the upper level and a model for traffic and bike demand assignment at the lower level. The objective function was defined by a weighted sum of a measure for private car users (total travel time) versus a measure for bike users (total travel distance on bike lanes). A genetic algorithm was developed to solve the bilevel formulation, which included introduction of a special crossover technique and a mutation technique. The proposed optimization will help transport authorities at the planning stage to quantify the outcomes of various strategies for active transport

Gain-of-Function Mutations in ZIC1 Are Associated with Coronal Craniosynostosis and Learning Disability

Human ZIC1 (zinc finger protein of cerebellum 1), one of five homologs of the Drosophila pair-rule gene odd-paired, encodes a transcription factor previously implicated in vertebrate brain development. Heterozygous deletions of ZIC1 and its nearby paralog ZIC4 on chromosome 3q25.1 are associated with Dandy-Walker malformation of the cerebellum, and loss of the orthologous Zic1 gene in the mouse causes cerebellar hypoplasia and vertebral defects. We describe individuals from five families with heterozygous mutations located in the final (third) exon of ZIC1 (encoding four nonsense and one missense change) who have a distinct phenotype in which severe craniosynostosis, specifically involving the coronal sutures, and variable learning disability are the most characteristic features. The location of the nonsense mutations predicts escape of mutant ZIC1 transcripts from nonsense-mediated decay, which was confirmed in a cell line from an affected individual. Both nonsense and missense mutations are associated with altered and/or enhanced expression of a target gene, engrailed-2, in a Xenopus embryo assay. Analysis of mouse embryos revealed a localized domain of Zic1 expression at embryonic days 11.5-12.5 in a region overlapping the supraorbital regulatory center, which patterns the coronal suture. We conclude that the human mutations uncover a previously unsuspected role for Zic1 in early cranial suture development, potentially by regulating engrailed 1, which was previously shown to be critical for positioning of the murine coronal suture. The diagnosis of a ZIC1 mutation has significant implications for prognosis and we recommend genetic testing when common causes of coronal synostosis have been excluded

Gain-of-Function Mutations in ZIC1 Are Associated with Coronal Craniosynostosis and Learning Disability

Human ZIC1 (zinc finger protein of cerebellum 1), one of five homologs of the Drosophila pair-rule gene odd-paired, encodes a transcription factor previously implicated in vertebrate brain development. Heterozygous deletions of ZIC1 and its nearby paralog ZIC4 on chromosome 3q25.1 are associated with Dandy-Walker malformation of the cerebellum, and loss of the orthologous Zic1 gene in the mouse causes cerebellar hypoplasia and vertebral defects. We describe individuals from five families with heterozygous mutations located in the final (third) exon of ZIC1 (encoding four nonsense and one missense change) who have a distinct phenotype in which severe craniosynostosis, specifically involving the coronal sutures, and variable learning disability are the most characteristic features. The location of the nonsense mutations predicts escape of mutant ZIC1 transcripts from nonsense-mediated decay, which was confirmed in a cell line from an affected individual. Both nonsense and missense mutations are associated with altered and/or enhanced expression of a target gene, engrailed-2, in a Xenopus embryo assay. Analysis of mouse embryos revealed a localized domain of Zic1 expression at embryonic days 11.5-12.5 in a region overlapping the supraorbital regulatory center, which patterns the coronal suture. We conclude that the human mutations uncover a previously unsuspected role for Zic1 in early cranial suture development, potentially by regulating engrailed 1, which was previously shown to be critical for positioning of the murine coronal suture. The diagnosis of a ZIC1 mutation has significant implications for prognosis and we recommend genetic testing when common causes of coronal synostosis have been excluded

Cellular interference in craniofrontonasal syndrome: Males mosaic for mutations in the x-linked EFNB1 gene are more severely affected than true hemizygotes

Craniofrontonasal syndrome (CFNS), an X-linked disorder caused by loss-of-function mutations of EFNB1, exhibits a paradoxical sex reversal in phenotypic severity: females characteristically have frontonasal dysplasia, craniosynostosis and additional minor malformations, but males are usually more mildly affected with hypertelorism as the only feature. X-inactivation is proposed to explain the more severe outcome in heterozygous females, as this leads to functional mosaicism for cells with differing expression of EPHRIN-B1, generating abnormal tissue boundariesa process that cannot occur in hemizygous males. Apparently challenging this model, males occasionally present with a more severe female-like CFNS phenotype. We hypothesized that such individuals might be mosaic for EFNB1 mutations and investigated this possibility in multiple tissue samples from six sporadically presenting males. Using denaturing high performance liquid chromatography, massively parallel sequencing and multiplex-ligation-dependent probe amplification (MLPA) to increase sensitivity above standard dideoxy sequencing, we identified mosaic mutations of EFNB1 in all cases, comprising three missense changes, two gene deletions and a novel point mutation within the 5 untranslated region (UTR). Quantification by Pyrosequencing and MLPA demonstrated levels of mutant cells between 15 and 69. The 5 UTR variant mutates the stop codon of a small upstream open reading frame that, using a dual-luciferase reporter construct, was demonstrated to exacerbate interference with translation of the wild-type protein. These results demonstrate a more severe outcome in mosaic than in constitutionally deficient males in an X-linked dominant disorder and provide further support for the cellular interference mechanism, normally related to X-inactivation in females. © The Author 2013. Published by Oxford University Press. All rights reserved

Molecular simulation of chevrons in confined smectic liquid crystals

Chevron structures adopted by confined smectic liquid crystals are investigated via molecular dynamics simulations of the Gay-Berne model. The chevrons are formed by quenching nematic films confined between aligning planar substrates whose easy axes have opposing azimuthal components. When the substrates are perfectly smooth, the chevron formed migrates rapidly towards one of the confining walls to yield a tilted layer structure. However, when substrate roughness is included, by introducing a small-amplitude modulation to the particle- substrate interaction well-depth, a symmetric chevron is formed which remains stable over sufficiently long runtimes for detailed structural information, such as the relevant order parameters and director orien- tation, to be determined. For both smooth and rough boundaries, the smectic order parameter remains non-zero across the entire chevron, implying that layer identity is maintained across the chevron tip. Also, when the surface-stabilised chevron does eventually revert to a tilted layer structure, it does so via surface slippage, such that layer integrity is maintained throughout the chevron to tilted layer relaxation process. </p

Scale-free static and dynamical correlations in melts of monodisperse and Flory-distributed homopolymers: A review of recent bond-fluctuation model studies

It has been assumed until very recently that all long-range correlations are screened in three-dimensional melts of linear homopolymers on distances beyond the correlation length $\xi$ characterizing the decay of the density fluctuations. Summarizing simulation results obtained by means of a variant of the bond-fluctuation model with finite monomer excluded volume interactions and topology violating local and global Monte Carlo moves, we show that due to an interplay of the chain connectivity and the incompressibility constraint, both static and dynamical correlations arise on distances $r \gg \xi$. These correlations are scale-free and, surprisingly, do not depend explicitly on the compressibility of the solution. Both monodisperse and (essentially) Flory-distributed equilibrium polymers are considered.Comment: 60 pages, 49 figure

SMAD6 variants in craniosynostosis: genotype and phenotype evaluation

Purpose: Enrichment of heterozygous missense and truncating SMAD6 variants was previously reported in nonsyndromic sagittal and metopic synostosis, and interaction of SMAD6 variants with a common polymorphism near BMP2 (rs1884302) was proposed to contribute to inconsistent penetrance. We determined the occurrence of SMAD6 variants in all types of craniosynostosis, evaluated the impact of different missense variants on SMAD6 function, and tested independently whether rs1884302 genotype significantl