[Development and learning outcomes of an e-learning ECT for psychiatry residents]. / Ontwikkeling en leeropbrengsten van een e-learning ECT voor aiossen psychiatrie.

BACKGROUND: Education in electroconvulsive therapy (ECT) has become mandatory in the Dutch psychiatry training. ECT is still relatively rarely used. To increase knowledge about ECT, we have developed a training module about ECT for psychiatrist training. To promote flexible learning, we opted for e-learning, where educational principles have been applied in the design. AIM: In this article we discuss how this e-learning ECT was developed and analyze the learning outcomes for psychiatry residents. METHOD: The e-learning has been developed based on the ADDIE model and consists of an entrance test, various assignments and a final test. The learning outcomes of the first 216 residents have been analyzed quantitatively and qualitatively using test results, self-assessments of their expertise in ECT (before and after) and evaluations. RESULTS: Of the participating residents, 94% found this education relevant to practice. The e-learning was rated with an average of 8.3. Afterwards, one’s own knowledge about ECT was estimated to be significantly higher than before. Afterwards, 72% thought they can indicate ECT more quickly and 99% reported that they can better inform patients and families about ECT. CONCLUSION: The e-learning ECT is appreciated by residents and leads to an experienced improvement in knowledge about ECT.

The impact of the bluetongue serotype 3 outbreak on sheep and goat mortality in the Netherlands in 2023.

In September 2023, bluetongue virus serotype 3 (BTV-3) emerged in the Netherlands, infecting over five thousand livestock farms. In sheep, high morbidity and mortality rates were reported that were unlike previously described bluetongue outbreaks. This study aimed to quantify the impact of BTV-3 in the small ruminant population in the Netherlands in 2023. Sheep and goat movement census data and BTV-3 notification data were available from 2020 until the end of 2023. Data were aggregated to farm and week level and mortality indicators were calculated for lambs (<1 year) and adult animals (≥1 year). Population averaged GEE models with a Negative-binomial distribution and a log-link function correcting for repeated measures per farm in time were used to quantify the association between BTV-3 and mortality. In 2023, 2994 sheep farmers and 89 goat farmers notified clinical signs of BTV-3 to the NVWA. During this BTV-3 outbreak period, an additional 55,000 sheep died compared to the same period in 2020-2022. At flock level a high variety in mortality was observed, with a clear increase in mortality in both flocks that were not notified but that were located in infected areas and in flocks of which the farmer notified clinical signs. During the BTV-3 outbreak period, mortality in infected areas increased 4.2 (95 % CI: 4.0-4.3) times in sheep lambs (<1 year) and 4.6 (95 % CI: 4.4-4.8) times in sheep (≥1 year) compared to BTV-3 free areas. Flocks with a confirmed BTV-3 infection that were notified in September showed a 12.8 (95 % CI: 11.4-14.3) times higher mortality in lambs and a 15.1 (95 % CI: 13.7-16.6) times higher mortality in sheep compared to flocks in BTV-3 areas. In flocks of which the farmer notified clinical signs after September, mortality was 4.6 (95 % CI: 4.2-5.0) and 5.6 (95 % CI: 5.1-6.0) times higher in lambs and sheep compared BTV-3 areas respectively. In goats, around 4000 additional deaths were recorded during the BTV-3 outbreak period. In farms that were notified, mortality of goats (≥1 year) was 1.8 (95 % CI: 1.2-2.8) times higher compared to BTV-3 free areas. Since May 2024, multiple BTV-3 vaccines are available in the Netherlands. In June 2024, the first new infections of BTV-3 were confirmed in Dutch sheep flocks. Hopes are that with the possibility to vaccinate, the spread and impact of BTV-3 in the Netherlands will rapidly decline and that losses as observed in 2023 will no longer be seen.

The value of post-operative chemotherapy after chemoradiotherapy in patients with high-risk locally advanced rectal cancer-results from the RAPIDO trial.

BACKGROUND: Pre-operative chemoradiotherapy (CRT) rather than radiotherapy (RT) has resulted in fewer locoregional recurrences (LRRs), but no decrease in distant metastasis (DM) rate for patients with locally advanced rectal cancer (LARC). In many countries, patients receive post-operative chemotherapy (pCT) to improve oncological outcomes. We investigated the value of pCT after pre-operative CRT in the RAPIDO trial. PATIENTS AND METHODS: Patients were randomised between experimental (short-course RT, chemotherapy and surgery) and standard-of-care treatment (CRT, surgery and pCT depending on hospital policy). In this substudy, we compared curatively resected patients from the standard-of-care group who received pCT (pCT+ group) with those who did not (pCT- group). Subsequently, patients from the pCT+ group who received at least 75% of the prescribed chemotherapy cycles (pCT ≥75% group) were compared with patients who did not receive pCT (pCT-/- group). By propensity score stratification (PSS), we adjusted for the following unbalanced confounders: age, clinical extramural vascular invasion, distance to the anal verge, ypT stage, ypN stage, residual tumour, serious adverse event (SAE) and/or readmission within 6 weeks after surgery and SAE related to pre-operative CRT. Cumulative probability of disease-free survival (DFS), DM, LRR and overall survival (OS) was analysed by Cox regression. RESULTS: In total, 396/452 patients had a curative resection. The number of patients in the pCT+, pCT >75%, pCT- and pCT-/- groups was 184, 112, 154 and 149, respectively. The PSS-adjusted analyses for all endpoints demonstrated hazard ratios between approximately 0.7 and 0.8 (pCT+ versus pCT-), and 0.5 and 0.8 (pCT ≥75% versus pCT-/-). However, all 95% confidence intervals included 1. CONCLUSIONS: These data suggest a benefit of pCT after pre-operative CRT for patients with high-risk LARC, with approximately 20%-25% improvement in DFS and OS and 20%-25% risk reductions in DM and LRR. Compliance with pCT additionally reduces or improves all endpoints by 10%-20%. However, differences are not statistically significant.

Data analysis supports monitoring and surveillance of goat health and welfare in the Netherlands.

Monitoring and surveillance systems have an increasingly important role in contemporary society ensuring high levels of animal health and welfare, securing export positions, and protecting public health by ensuring animal health and product safety. In the Netherlands, a voluntary monitoring and surveillance system is in place since 2003 to provide a broad overview of livestock trends in addition to disease-specific surveillance systems, including insight into the occurrence and prevalence of new and emerging non-notifiable diseases and disorders. Being a major surveillance component of this monitoring and surveillance system for small ruminant health in the Netherlands, an annual data analysis on routine census data is performed to retrospectively monitor trends and developments regarding goat health and welfare. This paper aims to describe the process of the data analysis on goat farms in the Netherlands in 2020 and subsequent results are discussed. The data analysis provides key monitoring indicators such as animal and farm density, mortality, animal movements, and numbers and origin of imported small ruminants. Trends were analysed over a five-year, period and associations between herd characteristics and herd health are evaluated. Results showed that in 2020 the Dutch goat population consisted of 670,842 goats, distributed over 14,730 unique herds and increased by 2.3 % compared to 2019. Between 2016 and 2020, although probably underestimated, recorded mortality rates showed a decline on both small-scale and professional farms, with a strongest decrease on farms with herd sizes over more than 200 animals. Seventy-five percent of all professional farms registered animal introductions, in addition to 63 % of small-scale farms, including 2439 imported goats. Performing risks analyses requires demographic knowledge of the goat industry. During and after several disease outbreaks, such as bluetongue and Schmallenberg virus disease, the data analysis proved to function as a valuable tool, however, appeared just as important for recording outbreak-free data. Since its start in 2006, the concept of the data-analysis has continuously been improved, and will in the future be further developed, especially if more complete data sets become available. Subsequently, data analysis will increasingly support monitoring and surveillance of goat health and welfare.

[Neural networks and clinical efficacy of transcranial brain stimulation in psychiatry]. / Neurale netwerken en klinische effecti­vi­teit van transcraniële hersenstimulatie in de psychiatrie.

BACKGROUND: Non-invasive forms of brain stimulation, including transcranial magnetic stimulation and direct current stimulation, are increasingly being considered by clinicians as a somatic treatment option for psychiatric disorders. AIM: Review article on the history, efficacy transcranial brain stimulation in psychiatric disorders and the role of neural networks for improving clinical efficacy. METHOD: Review of scientific literature. RESULTS: Transcranial magnetic stimulation has been proven effective for the treatment of depression, but treatment efficacy varies widely for other psychiatric disorders. Transcranial direct current stimulation is still at an experimental stage, but results suggest that using weak currents can have positive effects. Neuroscience research provides tools for improving therapeutic outcomes based on neural network approaches. CONCLUSION: Transcranial brain stimulation grafted on network information appears to be a promising approach for enhancing therapeutic outcome in psychiatric disorders.

A low incidence of perineal hernia when using a biological mesh after extralevator abdominoperineal excision with or without pelvic exenteration or distal sacral resection in locally advanced rectal cancer patients.

BACKGROUND: Extralevator abdominoperineal excision (ELAPE), abdominoperineal excision (APE) or pelvic exenteration (PE) with or without sacral resection (SR) for locally advanced rectal cancer leaves a significant defect in the pelvic floor. At first, this defect was closed primarily. To prevent perineal hernias, the use of a biological mesh to restore the pelvic floor has been increasing. The aim of this study, was to evaluate the outcome of the use of a biological mesh after ELAPE, APE or PE with/without SR. METHODS: A retrospective study was conducted on patients who had ELAPE, APE or PE with/without SR with a biological mesh (Permacol™) for pelvic reconstruction in rectal cancer in our center between January 2012 and April 2015. The endpoints were the incidence of perineal herniation and wound healing complications. RESULTS: Data of 35 consecutive patients [22 men, 13 women; mean age 62 years (range 31-77 years)] were reviewed. Median follow-up was 24 months (range 0.4-64 months). Perineal hernia was reported in 3 patients (8.6%), and was asymptomatic in 2 of them. The perineal wound healed within 3 months in 37.1% (n = 13), within 6 months in 51.4% (n = 18) and within 1 year in 62.9% (n = 22). In 17.1% (n = 6), the wound healed after 1 year. It was not possible to confirm perineal wound healing in the remaining 7 patients (20.0%) due to death or loss to follow-up. Wound dehiscence was reported in 18 patients (51.4%), 9 of whom needed vacuum-assisted closure therapy, surgical closure or a flap reconstruction. CONCLUSIONS: Closure of the perineal wound after (EL)APE with a biological mesh is associated with a low incidence of perineal hernia. Wound healing complications in this high-risk group of patients are comparable to those reported in the literature.

Respiratory rate of clinically healthy cats measured in veterinary consultation rooms.

Respiratory rate is commonly recorded during physical examinations. However, reference intervals are only available for resting and sleeping respiratory rates in cats at home. This observational study aimed to establish reference intervals for the respiratory rate in clinically healthy adult cats at primary-care veterinary clinics. Respiratory rates were recorded from 131 cats, in 6 primary-care veterinary clinics, by observation under four circumstances: by the investigator in the consultation room prior to and during a physical examination, by the owner at home when the cat was resting or sleeping, and by the investigator when watching a video-film of the cat recorded by the owner at home. The respiratory rate of the 88 clinically healthy adult (≥12 months) cats in the consultation room ranged 28-176breaths/min (median 64) with a calculated reference interval of 32-135breaths/min. Based on video-recordings, the resting (n=32) and sleeping (n=38) respiratory rates of the same cats were determined: median 27 (range 16-60)breaths/min and median 20 (range 9-28)breaths/min, respectively, which were lower than the respiratory rates recorded in the consultation room (both P<0.0001). We conclude that the reference intervals proposed for cats in textbooks reflect the resting respiratory rate at home. These values are inappropriate for using in the veterinary consultation room, because based on such reference intervals, many cats would erroneously be categorized as having tachypnea. Since the resting and sleeping respiratory rates at home show less variation, owners should be encouraged to film their pets before they visit their veterinarian.

The Mondrian matrix: Culicoides biting midge abundance and seasonal incidence during the 2006-2008 epidemic of bluetongue in the Netherlands.

During the northern Europe epidemic of bluetongue (BT), Onderstepoort-type blacklight traps were used to capture Culicoides Latreille (Diptera: Ceratopogonidae) biting midges weekly between November 2006 and December 2008 on 21 livestock farms in the Netherlands. Proven and potential vectors for the bluetongue virus (BTV) comprised almost 80% of the midges collected: the Obsoletus complex, constituting C. obsoletus (Meigen) and C. scoticus Downes & Kettle (44.2%), C. dewulfi Goetghebuer (16.4%), C. chiopterus (Meigen) (16.3%) and C. pulicaris (Linnaeus) (0.1%). Half of the 24 commonest species of Culicoides captured completed only one (univoltine) or two (bivoltine) generations annually, whereas multivoltine species (including all BTV vectors) cycled through five to six generations (exceeding the one to four generations calculated in earlier decades). Whether this increment signals a change in the phenology of northern Europe Culicoides or simply is an adaptive response that manifests during warmer episodes, thus heightening periodically the incursive potential of midge-borne arboviruses, remains to be clarified. Culicoides duddingstoni Kettle & Lawson, C. grisescens Edwards, C. maritimus Kieffer, C. pallidicornis Kieffer and C. riethi Kieffer are new records for the biting midge fauna of the Netherlands. It is suggested that C. punctatus (Meigen) be added to the European list of vector Culicoides.

The association between vitamin D and cognition: a systematic review.

Vitamin D insufficiency and deficiency are a major health care problem. The association between vitamin D levels and cognitive function is still under debate. We conducted a systematic review to assess the association between levels of vitamin D and cognition. Therefore, the databases of Embase and Pubmed were searched through June 2012 for observational studies relating vitamin D levels to cognition. Our initial search yielded 2182 articles. After applying exclusion criteria, there were 28 studies eligible for inclusion: 25 cross-sectional and 6 prospective studies (3 studies show cross-sectional as well as prospective data). The main finding of the 25 cross-sectional studies was a statistically significant worse outcome on one or more cognitive function tests or a higher frequency of dementia with lower vitamin D levels or intake in 18 out of 25 (72%) studies, whereas 7 (28%) studies failed to show an association. Four out of 6 (66.7%) prospective studies showed a higher risk of cognitive decline after a follow-up period of 4-7 years in participants with lower vitamin D levels at baseline. In conclusion, this review supports the hypothesis that hypovitaminosis D is associated with worse outcome on one or more cognitive function tests or a higher frequency of dementia in cross-sectional as well as prospective studies. Further studies should focus on the role of vitamin D supplementation in the prevention of cognitive decline in participants with low vitamin D levels.

Endophily in Culicoides associated with BTV-infected cattle in the province of Limburg, south-eastern Netherlands, 2006.

Culicoides were captured at a BTV-infected dairy near Gulpen in the province of Limburg (south-east Netherlands) between 14 September and 4 October 2006. Onderstepoort-type blacklight traps were used to sample Culicoides both inside and outside a partially open shed housing 11 cattle. A total of 28 light trap collections were made at the shed and yielded: 9371 Culicoides representing 11 species; >90% comprised five potential vectors of BTV and in order of abundance were Culicoides obsoletus and Culicoides scoticus (of the Obsoletus Complex), Culicoides dewulfi, Culicoides pulicaris and Culicoides chiopterus; Culicoides imicola, the principal Mediterranean (and African) vector of BTV, was absent. 2339 Culicoides representing seven species were captured inside (endophily) the cattle shed; >95% comprised the Obsoletus Complex and C. dewulfi. Conversely, the Pulicaris Complex, represented by five species and including C. pulicaris, showed strong exophily with >97% captured outside the shed. 7032 Culicoides were captured outside the shed, approximately threefold more than inside. This trend was reversed on an overcast day, when eightfold more Culicoides were captured inside; this indicates that when the light intensity outdoors is low Culicoides will attack (i) earlier in the day while cattle are still at pasture, and (ii) might follow cattle into the sheds in the late afternoon leading to elevated numbers of biting midges being trapped inside the shed during the subsequent hours of darkness. Culicoides were captured inside the shed on all 14 sampling nights. On occasion up to 33% were freshly blood fed indicating they had avidly attacked the cattle inside (endophagy); because half the cattle had seroconverted to BTV, and because no cattle were left outdoors at night, the data indicate that (i) the housing of animals in partially open buildings does not interrupt the transmission of BTV, and/or (ii) BTV is being transmitted while cattle are grazing outdoors during the day. The capture of partially engorged midges inside the shed shows they are being disturbed while feeding; this may lead to cattle being attacked repeatedly, and if these attacks include older parous BTV-infected Culicoides, may enhance virus dissemination (particularly in sheds where cattle stand close together). Endo- and exophagy by potential vector Culicoides--coupled to increased adult longevity and multiple feeding events in single (potentially) infected midges--would ensure an R0 of >1, resulting in the continued maintenance and spread of BTV within local vertebrate populations. Four light trap collections made additionally in a mature deciduous forest 70 m from the shed yielded a high proportion (48%) of gravid females amongst which 10% had incompletely digested blackened blood meals in their abdomens; the absence of this age category in Culicoides captured at the sheds indicates that all Culicoides, after engorgement, exit the buildings to undergo oogenesis elsewhere. In Europe, the blacklight trap is used widely for the nocturnal monitoring of Culicoides; a drawback to this approach is that this trap cannot be used to sample midges that are active during the day. Because diurnal biting in vector Culicoides may constitute a significant and underestimated component of BTV transmission a novel capture methodology will be required in future and is discussed briefly.

Accidental importation of the mosquito Aedes albopictus into the Netherlands: a survey of mosquito distribution and the presence of dengue virus.

In the summer of 2005, the Asian tiger mosquito, Aedes albopictus (Skuse) (Diptera: Culicidae) was found for the first time in the Netherlands. It was collected on the premises of several horticultural companies that import the ornamental plant Dracaena sanderiana (Sparagalus: Dracaenaceae [Agavaceae]), known as Lucky bamboo, from southern China, an area endemic for this mosquito species and for arboviruses transmitted by this vector. Here we report the results of a 1-year survey of the distribution and vector status of Ae. albopictus in Lucky bamboo nurseries in the Netherlands (July 2006-June 2007). As it had been established previously that the presence of this species was linked to the import of Lucky bamboo, the survey was conducted only on sites owned by relevant import companies. In total, 569 adult Ae. albopictus were collected with mosquito traps from 15 of the 17 (88%) glasshouses used by Lucky bamboo importers, none of which were found to be infected with dengue virus. On two occasions there was evidence that Ae. albopictus had escaped from the glasshouses, but, overall, there was no evidence that a population had become established in the greenhouses or elsewhere.

Molecular evidence for repetitive parallel evolution of shell structure in Clausiliidae (Gastropoda, pulmonata).

The division of clausiliid genera, using the type of clausilial apparatus (CA) as the decisive criterion, is ambiguous. Two types of CA can be distinguished: the normal (N) type and the Graciliaria (G) type. Morphological resemblance between species with different types of CA led to the hypothesis that the CA type is homoplasious. Therefore sequence variation, phylogenetic relationships, and the evolution of the CA were studied in the genera Albinaria, Isabellaria, and Sericata. Phylogenetic relations were inferred from parsimony and neighbor-joining analyses of the nucleotide sequences of both internal transcribed spacers (ITS1 and ITS2) of the rDNA of 36 species. The variation among the sequences was great: 21.8% of the sequences were ambiguously aligned and excluded from the analysis. A high GC content in the unambiguously aligned portions and a substitutional bias toward a higher GC content are indicators of substitutional constraints in the spacers. We analyzed the data in several ways: using both spacers together and separately, weighting all mutations equally, correcting for transition/transversion bias by weighting, and using transversions only. In all resulting trees, Isabellaria is not a monophyletic group. Its division into two clades is supported by over 40 mutations and one large indel. Clade 1 consists of Isabellaria and Sericata and clade 2 consists of Isabellaria and Albinaria species. The present distribution of the CA type was plotted on the tree and its most parsimonious evolution was reconstructed. The CA type was shown to be highly homoplasious. In clade 1 and clade 2 both types of CA were found; depending on the ancestral state, either the G or the N type evolved several times in parallel. These results contribute decisively to the current debate on the morphological diagnoses of Albinaria, Sericata, and Isabellaria as monophyletic taxa.

Chronaxie calculated from current-duration and voltage-duration data.

To determine the rheobase and the chronaxie of excitable cells from strength-duration curves both constant-current pulses and constant-voltage pulses are applied. Since the complex impedance of the electrode-tissue interface varies with both the pulsewidth and the stimulation voltage, chronaxie values estimated from voltage-duration measurements will differ from the proper values as determined from current-duration measurements. To allow a comparison of chronaxie values obtained by the two stimulation methods, voltage-duration curves were measured in human subjects with a deep brain stimulation electrode implanted, while the current and the load impedance of the stimulation circuit were determined in vitro as a function of both stimulation voltage and pulsewidth. Chronaxie values calculated from voltage-duration data were shown to be 30-40% below those estimated from current-duration data. It was also shown that in the normal range of stimulation amplitudes (up to 7 V) the load impedance increases almost linearly with the pulsewidth. This result led us to present a simple method to convert voltage-duration data into current-duration data, thereby reducing the error in the calculated chronaxie values to approximately 6%. For this purpose voltage-duration data have to be measured for pulses up to 10-20 times the expected chronaxie.

In vivo DNA synthesis is not uniformly increased in arterial smooth muscle of young spontaneously hypertensive rats.

We compared the distribution of DNA synthesis over the arterial tree of young normotensive Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHR) with marginally elevated blood pressure. Six-week-old male SHR and WKY rats were therefore infused with 5-bromo-2'-deoxyuridine (BrdUrd) for 2 days and the nuclear incorporation of the thymidine analogue in the media of various arteries was determined by immunohistochemistry. In WKY rats, 2.5% of the arterial smooth muscle nuclei in elastic, muscular and resistance arteries incorporated BrdUrd. In SHR, DNA synthesis was more marked in large arteries than in resistance arteries. It was in addition significantly larger in the aorta, superior mesenteric, renal and femoral arteries of the SHR than in those of the WKY rats. However, nuclear incorporation of BrdUrd in vivo did not differ between SHR and WKY rats in aortic endothelium, carotid arterial smooth muscle, nor in mesenteric or renal resistance arteries. Between 6 and 20 weeks of age, the number of nuclear profiles per media cross-section did not increase in large arteries of WKY rats and SHR. During this period of time, however, carotid artery and thoracic aorta weight and DNA content increased. SHR large arteries gained more DNA than those of WKY rats. These data indicate that DNA synthesis is uniformly distributed over the arterial system in young WKY rats and that DNA synthesis is elevated in the smooth muscle of large arteries of 6-week-old SHR but not in their resistance arteries.

Endothelium reduces DNA synthesis in isolated arteries.

We evaluated effects of endothelium removal and of endothelium-derived vasoactive agents on DNA synthesis and contractility in the isolated arterial wall. The experiments were performed on renal artery segments that had been 1) isolated from adult rats, 2) suspended in tissue culture for 3 days in the continuous presence of fetal calf serum, and 3) exposed for the last 24 h to 5-bromo-2'-deoxyuridine. Nuclear incorporation of this thymidine analogue was visualized by immunohistochemistry and used as an index of DNA synthesis. Tissue culture did not alter relaxing responses to guanosine 3',5'-cyclic monophosphate (cGMP)-generating agents but promoted relaxing responses to adenosine 3',5'-cyclic monophosphate (cAMP)-generating agents. It stimulated DNA synthesis in the endothelium, media, and adventitia. Mechanical removal of endothelium increased intra-arterial DNA synthesis. This was most prominent in the media. In preparations with endothelium, indomethacin and methylene blue did not enhance DNA synthesis. In segments that had been denuded of endothelium, atrial natriuretic factor, forskolin, iloprost, and prostaglandin E2, but not isobutylmethylxanthine or sodium nitroprusside, significantly reduced intra-arterial DNA synthesis. These data indicate that endothelium removal promotes the mitogenic response of the arterial wall to exogenous growth factors. This cannot be attributed to inhibitory influences of endothelium-derived relaxing factor or prostaglandins released by the endothelium under basal conditions.