De schuld van het Nederlandse huishouden?

De afgelopen jaren bereikten de aandelenkoersen met grote regelmaat nieuwe recordhoogten en zijn de Nederlandse huizenprijzen flink gestegen. De hausse op de aandelen- en huizenmarkt hangt voor een belangrijk deel samen met het gunstige economische klimaat en de relatief lage rente in combinatie met een zeer gematigde inflatie. Het succes van de aandelenmarkt heeft veel huishoudens er de laatste jaren toe aangezet in effecten te gaan beleggen. In het licht van de scherpe prijsstijgingen van financiële activa zullen we hier de ontwikkeling van de financiële positie van Nederlandse huishoudens in het afgelopen decennium onder de loep nemen. We beginnen met een macro-analyse van de belangrijkste bestanddelen van het gezinsvermogen. Vervolgens stappen we over op een beschrijving van de situatie op een lager aggregatieniveau. Speciale aandacht gaat uit naar ontwikkelingen op de woning- en hypotheekmarkt.households, stock ownership, housing market, mortgage market

Cardiovascular molecular imaging

Moleculaire beeldvormingstechnieken zoals PET en SPECT maken biologische processen zichtbaar. Ze gebruiken radiotracers, die worden toegediend aan levende patiënten of proefdieren. Het scheuren van atherosclerotische plaque in een kransslagader is de hoofdoorzaak van het myocardinfarct en kan leiden tot hartfalen of het overlijden van de patiënt. In het eerste deel van dit proefschrift hebben we de nieuwe PET-radiotracer 18F-fluorodeoxymannose onderzocht. We hebben in cellen en konijnen met atherosclerose laten zien dat hiermee atherosclerotische plaques met een hoog risico op scheuren geïdentificeerd kunnen worden. Als dit wordt bevestigd in patiënten, zou 18F-fluorodeoxymannose uiteindelijk gebruikt kunnen worden voor optimale preventie van myocardinfarcten. Daarmee zou het bijdragen aan healthy aging, het motto van het UMCG. Het tweede deel van dit proefschrift is gericht op behandeling van het myocardinfarct. Voorgaande studies hadden laten zien dat minocycline (een antibioticum) celdood na het hartinfarct vermindert. Minocycline was in deze studies echter voorafgaand aan het hartinfarct toegediend, hetgeen in patiënten onmogelijk is. Wij hebben muizen en konijnen met hartinfarcten gebruikt, hen na het begin van het infarct behandeld met minocycline, en laten zien dat minocycline celdood vermindert. Als dit in patiënten wordt bevestigd, zou minocycline een (extra) behandeling voor het hartinfarct kunnen worden, en daarmee levens kunnen redden. Voor het optimaal meten van celdood, hebben we oude (99mTc-annexin A5) en nieuwe radiotracers (111In-GSAO) gebruikt. Eén van de hoofdstukken in dit proefschrift beschrijft de validatie van celdoodbeeldvorming middels 111In-GSAO. Een mogelijke toepassing voor deze radiotracer is de ontwikkeling van verdere behandelingen voor het myocardinfarct in proefdieren en patiënten

When arm’s length is too far. Relationship banking over the credit cycle

Using a novel way to identify relationship and transaction banks, we study how banks’ lending techniques affect credit constraints of small and medium-sized enterprises across emerging Europe. We link the lending techniques that banks use in the direct vicinity of firms to these firms’ credit constraints at two contrasting points of the credit cycle. We show that relationship lending alleviates credit constraints during a cyclical downturn but not during a boom period. The positive impact of relationship lending in a downturn is strongest for smaller and more opaque firms and in regions where the downturn is more severe. Additional evidence suggests that the reduction in credit constraints due to relationship lending helps to mitigate the adverse impact of an economic downturn on local firm growth and does not constitute evergreening of underperforming loans

Combining agro-ecological functions in grass-clover mixtures

Grass-clover mixtures show many benefits for sustainable agriculture. In the Netherlands, organic farmers often work together in a so-called partner farm concept, with the aim to close nutrient cycles on a regional level. In this system, arable farms grow one-year grass-clover leys, as fodder for a livestock farm, in exchange for, e.g., manure. This practice could also be used in the transition of conventional farms towards a more circular regenerative and nature inclusive agriculture. In the current experiment we assessed the effect of a range of grass (Lolium perenne: Lp, Lolium multiflorum: Lm) and clover (Trifolium pratense: Tp and Trifolium repens: Tr) monocultures and mixtures on both below- and aboveground parameters in light of benefits for livestock and arable farms, and biodiversity. The grass monocultures showed good weed suppression, high root density, and especially Lp had a positive effect on soil structure. Clover, on the other hand, showed high herbage dry matter yield (particularly Tp) and Nitrogen (N) yield, and Tr showed high digestibility. Moreover, clover had a positive effect on the soil mineral N, and earthworm abundance tended to be higher in the clover monocultures. When (some of) the four species were combined in grass-clover mixtures, they combined the positive effects of the species and often even outperformed the (best) monocultures. We concluded that grass-clover mixtures increased agro-ecological functions

A statistical analysis protocol for the time-differentiated target temperature management after out-of-hospital cardiac arrest (TTH48) clinical trial

Background The TTH48 trial aims to determine whether prolonged duration (48 hours) of targeted temperature management (TTM) at 33 (±1) °C results in better neurological outcomes compared to standard duration (24 hours) after six months in comatose out-of-hospital cardiac arrest (OHCA) patients. Methods TTH48 is an investigator-initiated, multicentre, assessor-blinded, randomised, controlled superiority trial of 24 and 48 hours of TTM at 33 (±1) ° C performed in 355 comatose OHCA patients aged 18 to 80 years who were admitted to ten intensive care units (ICUs) in six Northern European countries. The primary outcome of the study is the Cerebral Performance Category (CPC) score observed at six months after cardiac arrest. CPC scores of 1 and 2 are defined as good neurological outcomes, and CPC scores of 3, 4 and 5 are defined as poor neurological outcomes. The secondary outcomes are as follows: mortality within six months after cardiac arrest, CPC at hospital discharge, Glasgow Coma Scale (GCS) score on day 4, length of stay in ICU and at hospital and the presence of any adverse events such as cerebral, circulatory, respiratory, gastrointestinal, renal, metabolic measures, infection or bleeding. With the planned sample size, we have 80% power to detect a 15% improvement in good neurological outcomes at a two-sided statistical significance level of 5%. Discussion We present a detailed statistical analysis protocol (SAP) that specifies how primary and secondary outcomes should be evaluated. We also predetermine covariates for adjusted analyses and pre-specify sub-groups for sensitivity analyses. This pre-planned SAP will reduce analysis bias and add validity to the findings of this trial on the effect of length of TTM on important clinical outcomes after cardiac arrest. Trial registration ClinicalTrials.gov: NCT01689077, 17 September 201

Evaluation and management of leukolysis-mediated pseudohyperkalemia in paediatric leukemic samples

Leukolysis-related pseudohyperkalemia due to preanalytical procedures may lead to erroneous (or absence of) treatment based on an invalid lab test result. We aimed to obtain a leukocyte threshold above which leukolysis-related pseudohyperkalemia becomes clinical relevant. Secondly, temporal dynamics of treatment-induced leukocyte decrease were studied to allow tailored implementation of laboratory information system (LIS) decision rules based on the leukocyte threshold to avoid leukolysis-related pseudohyperkalemia. Potassium results of AU5811 routine chemistry (Beckman Coulter, Brea, California, USA) and iStat point of care (POC) (Abbott Diagnostics, Chicago, Illinois, USA) analysers were compared, the latter method being insensitive to leukolysis caused by pre-analytical procedures. Potassium results were combined with leukocyte counts obtained using a Cell-Dyn Sapphire haematology analyser (Abbott Diagnostics, Santa Clara, California, USA), resulting in 132 unique data triplets. Regression analysis was performed to establish a leukocyte threshold. The Reference Change Value (√2 x Z x √(CVa2 + CVi2)) was used to calculate maximum allowable difference between routine analyser and POC potassium results (deltamax + 0.58 mmol/L). Temporal analysis on the treatment-induced leukocyte decrease was performed by plotting leukocyte counts in time for all patients above the threshold leukocyte count (N = 41). Established leukocyte threshold was 63 x109/L. Temporal analysis showed leukocyte counts below the threshold within 8 days of treatment for all patients. Based on performed analyses we were able to implement LIS decision rules to reduce pseudohyperkalemia due to preanalytical procedures. This implementation can contribute to a reduction in erroneous (or absence of) treatments in the clinic

Malignant Transformation of an HNF1a-Inactivated Hepatocellular Adenoma to Hepatocellular Carcinoma

Hepatocellular adenomas (HCA) are rare benign tumors of the liver, occurring predominantly in females using oral contraceptives. Our case describes a 66-year-old woman presenting with a palpable mass in her upper abdomen. Contrast-enhanced computed tomography and magnetic resonance imaging showed a large exophytic mass protruding from the caudal border of liver segments IV and V, without visible metastases. Laparoscopic resection of the tumor and gallbladder was performed. Histopathological examination showed a hepatocellular carcinoma with areas of HNF1a-HCA (H-HCA). This case shows that malignant transformation is possible in H-HCA. We present our preoperative decision-making process, as well as the role of imaging techniques in this rare case