[Linking mental healthcare- and Statistics Netherlands microdata to assess the effectiveness of care]. / Koppelen van ggz- en CBS-microdata om zorgeffectiviteit te meten.

BACKGROUND: The effectiveness of mental health care is currently monitored through routine quantitative symptom-driven measurements in most clinical settings. These measurements seem inadequate, especially for target groups with complex, multi-faceted problems. There is as yet no alternative method. AIM: 1. To describe why quantitative symptom-driven measurements are inadequate for measuring healthcare effectiveness; and 2. to introduce a new data platform that adjusts for socioeconomic and environmental factors to monitor the effectiveness of healthcare. METHOD: Overview of developments based on literature and introduction of a unique data platform. RESULTS: In the case of complex, multi-faced problems, such as in children with mild intellectual disability and comorbid psychopathology, mental health problems cannot be quantified, isolated, and individualized, i.e., decontextualized. To evaluate care for external benchmarking and scientific research, a shift is advised from measuring clinical symptoms within the treatment period to measuring longer-term group-level social functioning across multiple life domains, with a focus on socio-demographic differences. The Extramuraal LUMC Academisch Netwerk Gezond & Gelukkig Den Haag (ELAN-GGDH ; in English: Extramural LUMC Academic Network Healthy & Happy The Hague) data platform accomplishes this by combining mental health data with Statistics Netherlands microdata. CONCLUSION: The data platform could add value to external benchmarking and scientific research at group level.

[Male-female ratio in Dutch academic psychiatry]. / Man-vrouwverhouding in de Nederlandse academische psychiatrie.

Background   Psychiatry is at the forefront of the emancipation of women as medical specialists. The share of women in the training of psychiatrists is high. In the labor market of the academia, however, there are indications of structural inequality. At university medical centers in the Netherlands 28% of the professors are female. How are women represented in the higher positions in academia in psychiatry? Aim   To explore how women are represented in the higher positions in psychiatric academia and what interventions can lead to a more equal labor market. Method   Information was obtained through universities and educational institutions on the current proportion of women in various positions in academic psychiatry. By searching the literature, interventions that can lead to a more equal labor market were investigated. Results   In psychiatry departments in the Netherlands 24% of the professors and 33% of the directors of psychiatric residency are female. Women are with 22% also a minority on editorial boards of scientific journals. Conclusion   In the higher academic positions in psychiatry, there is an unequal gender distribution. Culture change in combinations with policy changes can lead to a more equal labor market.

[Cultural diversity in mental health care]. / Culturele diversiteit in de geestelijke gezondheidszorg.

Background  Of the total Dutch population, 25.7% has a migration background. The countries of origin, migration motives and time in the Netherlands are very diverse. Aim  To provide an overview of the cultural diversity within the psychiatry of different groups of people with a migration background, and to address the challenges and mental health care to these groups and the position of transcultural psychiatry in the Netherlands. Method  Based on integration of a narrative literature review (without a systematic search), own experiences and a fictitious case, we discuss the most important groups. This concerns the so-called guest workers as a specific group of first-generation migrants, second-generation migrants with their specific problems, and finally refugees and undocumented migrants with an accumulation of risk-increasing factors. Results  In addition to predisposition and migration factors, insufficient understanding of cultural context contributes to the psychiatric problems of first- and second-generation migrants. Refugees and undocumented migrants also have limited access to care. There is a reimbursement system in the Netherlands for undocumented migrants, through which they can also rely on care. By understanding cultural backgrounds, professionals can further improve their skills and communication in the field of intercultural psychiatry. Conclusion  Cultural diversity of patient groups demands additional attention to diagnosis and therapy.

Asociación entre la invasión perineural en la biopsia de próstata dirigida por RMmp y/o sistemática y los resultados patológicos adversos en la prostatectomía radical asistida por robot / The association between perineural invasion in mpMRI-targeted and/or systematic prostate biopsy and adverse pathological outcomes in robot-assisted radical prostatectomy

Introducción y objetivos: Este estudio tiene como objetivo investigar la relación entre la invasión perineural (IPN) en la biopsia de próstata con aguja dirigida (BD) y/o sistemática (BS) y las características patológicas adversas del cáncer de próstata (CaP) en los especímenes de prostatectomía.Materiales y métodos: Se incluyeron un total de 95 pacientes varones que recibieron una BD transperineal y/o una BS concomitante, tratados posteriormente con prostatectomía radical asistida por robot para CaP entre octubre de 2015 y junio de 2020. Se calculó el rendimiento de la IPN como prueba de clasificación (sensibilidad, especificidad, valores predictivos positivos y negativos) y su correlación con el CaP clínicamente significativo, la positividad del margen quirúrgico, la extensión extraprostática y la invasión de las vesículas seminales en la prostatectomía.Resultados: La edad media de los pacientes era 65 (60-70) años. Se realizó BD y BS concomitante en 78 (82,1%) pacientes, mientras que 16 (16,8%) pacientes recibieron solo BS y uno (1,1%) solo BD. La frecuencia de IPN en la BD y BS fue de 17 (21,5%) y 32 (34,0%), respectivamente. Los valores de especificidad/predictivos negativos de la IPN para positividad del margen quirúrgico, extensión extraprostática e invasión de las vesículas seminales fueron 79,7/88,7%, 92,5/79,0% y 83,3/96,8%, en la BD, y 71,1/87,1%, 80,7/74,2% y 69,5/91,9%, en la BS, respectivamente. También hubo una correlación estadísticamente significativa entre la IPN en la biopsia y la positividad del margen quirúrgico, la extensión extraprostática y la invasión de las vesículas seminales en la prostatectomía, así como en cuanto al grupo de grado ISUP y el estadio pT.Conclusiones: La ausencia de IPN en la biopsia de próstata con aguja puede predecir un CaP localizado con un estadio pT≤2c y márgenes quirúrgicos negativos; por el contrario, su presencia parece ser un indicador de factores desfavorables en la patología final (AU)

Introduction and objectives: This study aims to investigate the relationship between perineural invasion (PNI) in targeted (TBx) and/or systematic (SBx) prostate needle biopsy and adverse pathological features of prostate cancer (PCa) in prostatectomy specimens.Materials and methods: A total of 95 male patients who underwent transperineal TBx and/or concomitant SBx subsequently treated with robot-assisted radical prostatectomy for PCa between October 2015 and June 2020 were included. The performance of PNI as a classification test (sensitivity, specificity, positive and negative predictive values) and its correlation with clinically significant PCa, surgical margin positivity, extraprostatic extension, and seminal vesicle invasion in prostatectomy were computed.Results: The median age of the patients was 65 (60-70) years. TBx and concomitant SBx were performed in 78 (82.1%) patients, while 16 (16.8%) patients underwent SBx alone and one (1.1%) patient underwent TBx alone. The frequency of PNI in TBx and SBx was 17 (21.5%) and 32 (34.0%), respectively. The specificity/negative predictive values of PNI for surgical margin positivity, extraprostatic extension, and seminal vesicle invasion were 79.7/88.7%, 92.5/79.0%, and 83.3/96.8%, in TBx, and 71.1/87.1%, 80.7/74.2%, and 69.5/91.9%, in SBx, respectively. There was also a statistically significant correlation between PNI in biopsy and surgical margin positivity, extraprostatic extension, and seminal vesicle invasion in prostatectomy as well as the ISUP grade group and pT stage.Conclusions: The absence of PNI in prostate needle biopsy may predict localized PCa with a pT stage≤2c and negative surgical margins in contrast to its presence which appears to be an indicator of unfavorable factors in final pathology (AU)

An investigation of the relationship between rheumatological diseases and soluble receptor for advanced glycation end products.

OBJECTIVE: Soluble receptor for advanced glycation end products (sRAGE) is one of the forms of RAGE. It is a trap receptor that has a role in inhibiting pro-inflammatory processes that will occur with the combination of RAGE and its ligands. Our study aims to examine the level of sRAGE in rheumatological inflammatory diseases and its relationship with these diseases. PATIENTS AND METHODS: A total of 60 patients with Behçet's disease (BD), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and 22 healthy control individuals were included in the study. Comorbidity status, sRAGE levels, disease activity scores, demographic and laboratory data of the patients were recorded. Serum sRAGE levels in these diseases and healthy controls were determined by Enzyme-Linked Immunosorbent Assay (ELISA) kit spectrophotometrically. RESULTS: Serum sRAGE levels in the patient groups were significantly higher when compared to the healthy control group (p < 0.001 for all). On the other hand, when the patient groups were compared with each other in terms of sRAGE levels, there was no significant difference (p > 0.05 for all). The serum sRAGE levels were not correlated with C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), and disease activity scores (p > 0.05 for all). CONCLUSIONS: Serum sRAGE levels increased in BD and in other inflammatory rheumatological diseases. However, this increase does not directly correlate with inflammatory markers and disease activity scores. These results suggest that serum sRAGE level may not be used as a biomarker for disease activity in BD and in other rheumatological diseases.

The association between perineural invasion in mpMRI-targeted and/or systematic prostate biopsy and adverse pathological outcomes in robot-assisted radical prostatectomy.

INTRODUCTION AND OBJECTIVES: This study aims to investigate the relationship between perineural invasion (PNI) in targeted (TBx) and/or systematic (SBx) prostate needle biopsy and adverse pathological features of prostate cancer (PCa) in prostatectomy specimens. MATERIALS AND METHODS: A total of 95 male patients who underwent transperineal TBx and/or concomitant SBx subsequently treated with robot-assisted radical prostatectomy for PCa between October 2015 and June 2020 were included. The performance of PNI as a classification test (sensitivity, specificity, positive and negative predictive values) and its correlation with clinically significant PCa, surgical margin positivity, extraprostatic extension, and seminal vesicle invasion in prostatectomy were computed. RESULTS: The median age of the patients was 65 (60-70) years. TBx and concomitant SBx were performed in 78 (82.1%) patients, while 16 (16.8%) patients underwent SBx alone and one (1.1%) patient underwent TBx alone. The frequency of PNI in TBx and SBx was 17 (21.5%) and 32 (34.0%), respectively. The specificity/negative predictive values of PNI for surgical margin positivity, extraprostatic extension, and seminal vesicle invasion were 79.7/88.7%, 92.5/79.0%, and 83.3/96.8%, in TBx, and 71.1/87.1%, 80.7/74.2%, and 69.5/91.9%, in SBx, respectively. There was also a statistically significant correlation between PNI in biopsy and surgical margin positivity, extraprostatic extension, and seminal vesicle invasion in prostatectomy as well as the ISUP grade group and pT stage. CONCLUSIONS: The absence of PNI in prostate needle biopsy may predict localized PCa with a pT stage ≤ 2c and negative surgical margins in contrast to its presence which appears to be an indicator of unfavorable factors in final pathology.

[Adolescents with concurrent ADHD and substance use disorder; international consensus]. / Jongeren met een stoornis in het gebruik van middelen en ADHD: internationale consensus.

BACKGROUND: Substance use disorder (SUD) is common among youths with attention-deficit/hyperactivity disorder (ADHD). Co-morbid ADHD and SUD in youths complicates screening, diagnosis, and treatment of both disorders and is associated with worse treatment prognosis. Limited research in youths with SUD and co-morbid ADHD provides insufficient basis for firm recommendations. To offer clinicians some guidance on this topic, we present the results of an international consensus procedure. AIM: To summarize an international consensus on diagnosis and treatment of young people with comorbid ADHD and SUD. METHOD: In a modified Delphi-study, a multidisciplinary, international group of 55 experts strived to reach consensus on 37 recommendations. RESULTS: Consensus was reached on 36 recommendations. Routine screening of ADHD and/or SUD is important. For the treatment of co-morbid SUD and ADHD in youths, both psychosocial and pharmacological treatment should be considered. Psychosocial treatment should preferably consist of psychoeducation, motivational interviewing (MI), and cognitive behavioral therapy (CBT) focused on SUD or both disorders. Long-acting stimulants are recommended as first choice pharmacotherapy, preferably embedded in psychosocial treatment. Experts did not agree on the precondition that patients need to be abstinent before starting stimulant treatment. CONCLUSION: Clinicians and youths with co-morbid SUD and ADHD can use this international consensus to choose the best possible treatment.

[Ketamine self-medication in a patient with autism spectrum disorder and comorbid treatment-resistant depression]. / Ketamine als zelfmedicatie bij patiënt met autismespectrumstoornis en therapieresistente depressie.

We saw a 60-year-old male veterinarian with a history of autism spectrum disorder, major depressive disorder, and suicidality. He had been treated with more than 15 psychotropic medications, was admitted to inpatient care several times, and attempted suicide once. His current complaints included a decline in social functioning, repetitive behaviour, sensory hypersensitivity, anxiety, low mood, anhedonia, lack of energy, and chronic suicidality. His last medication consisted of risperidone and valproic acid. Despite intensive treatment, he remained impaired by his complaints and could not return to work. After self-medication with ketamine, he reported that his depressive and suicidal complaints disappeared and that his autism-related complaints diminished. This case - together with previous clinical research - suggests that ketamine is likely to be effective against depression and suicidality, that ketamine is potentially effective against autism-related symptoms, and that increasing awareness of the beneficial effects of ketamine can lead to unsupervised, and therefore risky, use of ketamine as a form of self-medication.

The continuing search for an addiction vaccine.

Inspired by advances in immunology, in the 1970s scientists began to study the possibilities of mobilizing the human immune system against intruders other than pathogenic viruses and bacteria. In 1972 the suggestion was first made that it might be possible to provoke immunity to narcotic dependence. Because molecules of narcotics such as heroin and cocaine are too small to stimulate an immune response, researchers sought ways of coupling them to immunogenic proteins. The substances they developed soon became known as addiction vaccines. However, despite fifty years of research, and despite the growing problem of addiction, no vaccine against heroin, cocaine, methamphetamine or nicotine addiction has yet been licensed for clinical use. This paper reviews the history of addiction vaccinology, seeks to explain the unique appeal of a vaccinological approach to addiction, and argues for broad discussion of how such vaccines should ultimately be used.

Ghrelin prevents the development of dermal fibrosis in bleomycin-induced scleroderma.

BACKGROUND: Scleroderma is a chronic inflammatory disease characterized by widespread fibrosis of the skin and the internal organs. Ghrelin is a polypeptide hormone produced by various tissues and inflammatory cells. In experimental studies, ghrelin has been shown to have anti-inflammatory and antioxidant effects, in addition to its metabolic actions. AIM: To evaluate the potential preventive effects of ghrelin on a mouse model of bleomycin (BLM)-induced scleroderma. METHODS: This study involved five groups of BALB/c mice (n = 7 in each group). Mice in the control group received 100 µL/day of phosphate-buffered saline (PBS) subcutaneously, while the other four groups were given 100 µg/day of BLM (dissolved in 100 µL PBS) subcutaneously. Three of the BLM-treated groups received intraperitoneal doses (10 ng/kg/day) of acylated, nonacylated or total ghrelin. Animals were killed at the end of the fourth week, and blood and tissue samples were collected for further analysis. Dermal thickness, serum levels of transforming growth factor-ß1, numbers of inflammatory cells on the dermal layer and numbers of α-smooth muscle actin-positive cells were determined. RESULTS: BLM increased dermal thickness, numbers of inflammatory cells on the dermal layer and activity of the myofibroblastic cells. Application of acylated, nonacylated and total ghrelin decreased the infiltration of inflammatory cells and the activity of the myofibroblastic cells, and reduced dermal fibrosis. CONCLUSIONS: Based on these results, it appears that ghrelin has an antifibrotic action, in addition to the anti-inflammatory and antioxidant effects that have been documented previously. The pathogenic and therapeutic roles of ghrelin in scleroderma should be evaluated by further studies.

Mycophenolate mofetil and daclizumab targeting T lymphocytes in bleomycin-induced experimental scleroderma.

BACKGROUND: T lymphocytes induce the transformation of fibroblasts into myofibroblasts, the main mediators of fibrogenesis. The inosine 5'-monophosphate dehydrogenase inhibitor mycophenolate mofetil (MMF) and the anti-CD25 monoclonal antibody daclizumab (DCZ) have been reported to suppress the proliferation of T lymphocytes. AIM: To evaluate the preventive effects of MMF and DCZ in early stages of bleomycin (BLM)-induced scleroderma. METHODS: This study involved five groups of Balb/c mice (n = 10 per group). Mice in four of the groups were injected subcutaneously (SC) with BLM [100 µg/day in 100 µL phosphate-buffered saline (PBS)] for 4 weeks; the remaining (control) group received only 100 µL PBS. Three of the BLM-treated groups also received either intraperitoneal MMF 50 or 150 mg/kg/day, or SC DCZ 100 µg/week. At the end of the fourth week, all mice were killed, and blood and tissue samples were obtained for further analysis. RESULTS: In the BLM-treated group, increases were seen in inflammatory-cell infiltration, α-smooth muscle actin-positive (α-SMA+) fibroblastic cell count, tissue hydroxyproline content, and dermal thickness. Dermal fibrosis was histopathologically prominent. In BLM-treated mice also given MMF or DCZ, inflammatory-cell infiltration, tissue hydroxyproline content and dermal thickness were decreased. In the MMF groups, decreases were also noted in α-SMA+ fibroblastic cell count. CONCLUSION: In this BLM-induced dermal fibrosis model, MMF and DCZ treatments prevented the development of dermal fibrosis. Further studies are needed to evaluate whether targeting T lymphocytes is effective in resolving pre-existing fibrosis in human scleroderma.

Relationship among leaf (Puccinia recondita Roberge ex Desmaz f. sp. tritici) and yellow (Puccinia striiformis Westendorp. f. sp. tritici) rust resistance and some agro-morphologic traits in wheat hybrids at seedling stage.

This research was carried out to determine if dominant morphological traits can be use instead of the rust resistance tests as marker characters for some agro-morphologic traits both leaf (Puccinia recondita Roberge ex Desmaz. f. sp. tritici.) and yellow rust (Puccinia striiformis Westendorp f. sp. tritici) disease. For this, 13 wheat parent (4 are T. durum Desf. and 9 are T. aestivum L.) were used and three main agro-morphologic traits (Namely, Leaf Colour (LC) (Dark and light green, Dg and Lg, relatively); Auricle Colour (AC) (White and Red, Wh and Re, relatively) and Leaf Waxiness (LW) (Waxy and Non waxy, Wx and Nw, relatively) were investigated at the seedling stage. They were found as dominant and concluded that investigated traits could be used as a morphological marker character for the leaf and yellow rust disease resistance tests under greenhouse conditions without doing complex and risky rust tests. And determined that, these traits may be use effectively without doing the complex rust tests in the limited populations or for the pre-selections. Doing with this, it will be bring a great accuracy, successful, correction and speed to the rust disease studies and provides important and valuable information for the plant breeders and pathologists. In addition, knowing of the resistance type (genetic mechanism etc.) in wheat facilitates it will be make to find out the suit and most appropriate breeding and selection methodology/methodologies.

[Possible teratogenic effects of thiamazole]. / Mogelijke teratogene invloed van thiamazol.

A newborn male presented with choanal atresia and minor dysmorphic facial features. At 4 years of age he showed delayed speech and language development. His mother had been treated with thiamazole for pre-existing hyperthyroidism during the first 3 months of pregnancy. It is possible that the maternal use of thiamazole caused the congenital anomalies. Embryopathy caused by maternal thiamazole use during pregnancy has been described several times before and is mainly characterised by choanal atresia, oesophageal atresia, minor dysmorphic facial features, growth retardation and delayed psychomotor development. Because the use of propylthiouracil during pregnancy has not been associated with similar effects, it is the treatment of choice for hyperthyroidism during pregnancy. For pregnant women or women who wish to become pregnant, thiamazole should be prescribed only ifpropylthiouracil cannot be used.

Left main coronary artery aneurysm.

Left main coronary artery aneurysm is rare finding at coronary angiography. We report a case of a large left main coronary artery aneurysm in a 59-year-old male who had cardiac catheterization for effort angina and inducible myocardial ischemia.

Origin of left main and right coronary arteries from right aortic sinus of Valsalva.

Coronary anomalies may be a part of complex congenital malformations of the heart or be an isolated defect. Anomalous coronary arteries are associated with a higher incidence of congenital heart diseases, but do not appear to be associated with an increased risk for development of coronary atherosclerosis. Coronary anomalies are recognized readily on angiography. Unexpected findings during invasive procedures would suggest a possibly existing coronary anomaly, especially when main branches cannot be opacified by selective contrast medium injection. This case report illustrates the clinical and angiographic findings of a patient undergoing coronary angiography for evaluation of ischemic heart disease with an unexpected presence of anomalous origin of the left coronary artery from the right aortic sinus.

Delayed presentation of calcium channel antagonist overdose.

The calcium channel antagonists are generally safe in therapeutic dosage, but severe side effects with elevated intake are increasingly described. Typical features include confusion, lethargy, hypotension, sinus node depression, and cardiac conduction defects. Even if patients are stable on presentation, this does not preclude the possible late development of adverse events from the long-acting formulations of calcium channel blockers. A case of toxic overdose with 1440 mg of slow-release diltiazem is presented; this patient was stable on presentation, but rapidly became hemodynamically unstable, requiring treatment with intravenous calcium, temporary pacemaker, inotropic support and mechanical ventilation with a successful outcome. A concise review of the therapeutic considerations is provided.

Cardiac papillary fibroelastoma originating from pulmonary vein--a case report.

Cardiac papillary fibroelastoma is a primary cardiac neoplasm that typically affects the cardiac valves, mainly the aortic and mitral valves, and very rarely the endocardium of cardiac chambers. Cardiac papillary fibroelastoma is rarely diagnosed during life, as the majority are incidental findings at autopsy, but with the advent of echocardiography, it is being increasingly recognized. Although the tumor is usually small and histologically benign, it may have a malignant propensity for life-threatening complications, such as a cerebrovascular accident, myocardial ischemia or infarction, or sudden death. The patient reported here presented with an embolic stroke from a thrombus on the surface of a left atrial papillary fibroelastoma. The papillary fibroelastoma was originating from the lower portion of the left inferior pulmonary vein and was protruding into the left atrial cavity. Papillary fibroelastoma originating from the pulmonary veins has not been reported before. The tumor was successfully removed by intraoperative transesophageal echocardiography-guided cardiac surgery. Grossly, the surface of the tumor was smooth and translucent. The gelatinous membrane on the surface tore easily, and soft papillary tumor with multiple fronds was visible. Histology confirmed the mass was a papillary fibroelastoma. Postoperative recovery was uneventful. Follow-up transthoracic echocardiogram revealed no residual or recurrence of tumor. The patient was in excellent health at 2-year follow-up. The case is described and the clinical characteristics of cardiac papillary fibroelastoma are reviewed.

Spinal cord injury caused by gunshot wound during pregnancy.

We report a case of a pregnant woman with acute spinal cord injury (C5) caused by gunshot wound and discuss the respective maternal and fetal considerations. Neither decompressive surgery nor corticosteroid protocols were used. At 37 weeks, the patient delivered a normal female infant after induction of labor and epidural anesthesia, with no medical or obstetrical complications. With conservative management and rehabilitation, this patient had significant recovery of function.

Efficient callus induction and plant regeneration from mature embryo culture of winter wheat (Triticum aestivum L.) genotypes.

Immature and mature embryos of 12 common winter wheat (Triticum aestivum) genotypes were cultured in vitro to develop an efficient method of callus formation and plant regeneration from mature embryo culture, and to compare the responses of both embryo cultures. Fifteen days after anthesis, immature embryos were aseptically dissected from seeds and placed with the scutellum upwards on a solid agar medium containing the inorganic components of Murashige and Skoog (MS) and 2 mg/l 2,4-dichlorophenoxyacetic acid (2,4-D). Mature embryos were moved slightly in the imbibed seeds. The seeds with moved embryos were placed furrow downwards in dishes containing 8 mg/l 2,4-D for callus induction. The developed calli and regenerated plants were maintained on 2,4-D-free MS medium. Plants regenerated from both embryo cultures were vernalized and grown to maturity in soil. Regenerated plantlets all maintained the hexaploid chromosome number. A strong genotypic effect on the culture responses was found for both explant cultures. Callus induction rate, regeneration capacity of callus and number of plants regenerated were independent of each other. Mature embryos had a high frequency of callus induction and regeneration capacity, and therefore, being available throughout the year, can be used as an effective explant source in wheat tissue culture.