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Contains fulltext : 216167.pdf (publisher's version ) (Open Access)

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Contains fulltext : 195648.pdf (publisher's version ) (Open Access), BACKGROUND: Radiofrequency ablation (RFA) and microwave ablation (MWA) are widely accepted techniques to eliminate small unresectable colorectal liver metastases (CRLM). Although previous studies labelled thermal ablation inferior to surgical resection, the apparent selection bias when comparing patients with unresectable disease to surgical candidates, the superior safety profile, and the competitive overall survival results for the more recent reports mandate the setup of a randomized controlled trial. The objective of the COLLISION trial is to prove non-inferiority of thermal ablation compared to hepatic resection in patients with at least one resectable and ablatable CRLM and no extrahepatic disease. METHODS: In this two-arm, single-blind multi-center phase-III clinical trial, six hundred and eighteen patients with at least one CRLM (

Contains fulltext : 200459.pdf (publisher's version ) (Closed access)

“Dieper dan zes meter zit geen leven”, zegt de visser, die de zuurstofarme zone in het water al tien jaar met een meter per jaar dichter bij de oppervlakte ziet komen. De duiker kent steeds meer ‘velden’ met alleen nog witte schimmels - bacteriematten. De ecoloog kent op de bodem een soort blubberlaag van organisch materiaal en heeft het over een kerkhof onder water. Europa’s grootste zoutwatermeer is snel Europa’s Dode Zee aan het worden. Het kabinet gaat de Grevelingen echter aan de zuurstof leggen.

Contains fulltext : 178198.pdf (publisher's version ) (Closed access), AIMS: Preoperative core needle biopsy (CNB) is commonly used to confirm the diagnosis of breast cancer. For treatment purposes and for determining histological type, especially in case of neoadjuvant therapy, oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) status and E-cadherin assessments are crucial. Considering the increasing demand for same-day diagnosis of breast lesions, an accelerated method of CNB processing was developed, in which the tissue fixation time is radically reduced. METHODS: To determine whether short fixation time frustrates assessment of ER, PR and E-cadherin immunohistochemistry (IHC) and HER2 fluorescence in situ hybridisation (FISH), 69 consecutive patients with 70 invasive breast carcinomas were included through the same-day diagnostics programme of breast lesions of the Radboud university medical center and the hospital Pantein. IHC for ER, PR and E-cadherin and HER2 FISH were compared between CNBs fixed for approximately 60-90 min and traditionally fixed resection specimens. RESULTS: Overall agreement between CNBs and resection specimens was 98.6% for ER (p<0.001; kappa=0.93), 90.0% for PR (p<0.001; kappa=0.75), 100% for E-cadherin (p<0001; kappa=1.00) and 98.6% (p<0.001; kappa=0.94) for HER2 FISH. Positive and negative predictive values were respectively 98.4% and 100% for ER, 95.9% and 76.2% for PR, 100% and 100% for E-cadherin and 90% and 100% for HER2 FISH. CONCLUSIONS: Hormone receptors and E-cadherin IHC and HER2 FISH are highly comparable between briefly fixed CNBs and the corresponding traditionally fixed resection specimens, and can therefore reliably be used in the daily clinical practice of same-day diagnostics of breast cancer.

Contains fulltext : 198391.pdf (publisher's version ) (Closed access)

Ondanks de maatregelen die tot nu toe zijn genomen gaat het met de aal nog steeds bergafwaarts. Volgens Magreet van Vilsteren van de Good Fish Foundation kan een broodje paling niet meer.

Hoe nodig de aanpak van visstroperij is, blijkt wel uit de vele mediaberichten. Meestal zijn de Nederlandse Voedsel- en Warenautoriteit (NVWA) of Sportvisserij Nederland de bron. Waar de georganiseerde hengelsport zich via het uitgebreide boa-apparaat vooral op de sportvisser richt, concentreert de NVWA zich primair op de beroepsvisser.

1 januari 2014, Item does not contain fulltext, PURPOSE: With current diagnostic methods, the majority of patients with symptomatic colorectal anastomotic leakage(CAL) is identified approximately 1 week after operation.The aim of this study is to determine whether real-time polymerase chain reaction (RT-PCR) for detection of Escherichia coli and Enterococcus faecalis on drain fluid can serve as a screening test for CAL in the early postoperative phase. METHODS: All patients included in this multicenter prospective observational study underwent left-sided colorectal resection for both malignant and benign diseases with construction of an anastomosis. In all patients, an intra-abdominal drain was placed during operation. During the first five postoperative days, drain fluid was processed for RT-PCR. The quantitative results of the RT-PCR on days 2 to 5 were compared to the results of day 1 in order to detect concentration changes. RESULTS: In total, 243 patients, with both benign and malignant diseases, were included of whom 19 (7.8 %) developed symptomatic CAL. An increase in E. coli concentration was found insignificantly more patients with CAL on day 4 and 5 [p =0.0004; diagnostic odds ratio (DOR) 7.9]. For E. faecalis, this result was found for days 2, 3, and 4 (p <0.003) with highest DOR on day 3 (31.6). Sensitivity and negative predictive values were 92.9 and 98.7 %, respectively, virtually ruling out CAL in case of negative test results on the third postoperative day. CONCLUSION: Quantitative PCR for E. faecalis performed on drain fluid may be an objective, affordable and fast screening tool for symptomatic colorectal anastomotic leakage.

1 september 2014, Item does not contain fulltext, BACKGROUND: We aim to determine if C-reactive protein (CRP), lipopolysaccharide-binding protein (LBP), and procalcitonin (PCT) in drain fluid can serve as screening tools for colorectal anastomotic leakage (CAL). METHODS: Patients included in this multicenter prospective observational study underwent left hemicolectomy, sigmoid resection, high anterior resection, low anterior resection, or subtotal colectomy. During the first 5 postoperative days, CRP, LBP, and PCT were determined on drain fluid. RESULTS: In total 243 patients were included, of whom 19 (8%) developed CAL. CRP levels were higher in patients with leakage on day 3 and day 5, levels of LBP were higher on days 2, 3, and 4, and PCT levels were higher on day 5. Multivariate analysis showed LBP to be significantly related to CAL. An increase in the average initial value at the first postoperative day with 1 standard deviation increased the risk of leakage by 1.6 times. CONCLUSION: Increased concentrations of LBP in drain fluid are significantly associated to a higher chance of CAL and could contribute in a future prognostic model for CAL.

Om te voorkomen dat vissen in mootjes of ontschubd het gemaal uitkomen zijn er bijvoorbeeld vistrappen. Het Hoogheemraadschap van Delfland koos echter voor visliften. En zoals dat hoort gaan die omhoog én omlaag.

Item does not contain fulltext, CONTEXT: Cancer patients are at increased risk for distress. The Distress Thermometer (DT) and problem list (PL) are short-tools validated and recommended for distress screening in cancer patients. OBJECTIVE: To investigate the level of distress and problems experienced by survivors of differentiated non-medullary thyroid carcinoma (DTC), using the DT and PL and whether this correlates with clinical and demographical variables. PARTICIPANTS, DESIGN AND SETTING: All 205 DTC patients, under follow-up at the outpatient clinic of our university hospital, were asked to fill in the DT and PL, hospital anxiety and depression scale (HADS), illness cognition questionnaire (ICQ) and an ad hoc questionnaire. Receiver Operator Characteristic analysis (ROC) was used to establish the optimal DT cut-off score according to HADS. Correlations of questionnaires scores with data on diagnosis, treatment and follow-up collected from medical records were analyzed. RESULTS: Of the 159 respondents, 145 agreed to participate [118 in remission, median follow-up 7.2 years (range 3 months-41 years)]. Of these, 34.3% rated their distress score >/=5, indicating clinically relevant distress according to ROC analysis. Patients reported physical (86%) over emotional problems (76%) as sources of distress. DT scores correlated with HADS scores and ICQ subscales. No significant correlations were found between DT scores and clinical or demographical characteristics except for employment status. CONCLUSION: Prevalence of distress is high among patients with DTC even after long-term remission and cannot be predicted by clinical and demographical characteristics. DT and PL are useful screening instruments for distress in DTC patients and could easily be incorporated into daily practice.

Met het zand van de tweede Maasvlakte kun je de Amsterdam Arena ruim 223 keer vullen. Het illustreert wat er voor de Zuid-Hollandse kust in zee is veranderd. Om het verlies aan zeebodem te compenseren, is een deel van de Voordelta aangewezen als bodembeschermingsgebied. IMARES onderzoekt of dit werkt voor de bodemfauna.

Item does not contain fulltext, Merkel cell carcinoma is an uncommon, aggressive neuroendocrine tumour of the skin. At presentation regional lymph nodes are involved in approximately one third of the patients. In this report a patient is presented in whom Merkel cell carcinoma presented as a solitary lymph node metastasis with an unknown primary skin lesion. The diagnosis of unknown primary merkel cell carcinoma including the use of immunohistochemical markers and treatment options based on data from the literature are discussed.

Onderwaterstructuren zijn van groot belang voor de meeste vissoorten. Ze kunnen fungeren als paaiplaats, schuilgelegenheid of substraat voor voedselorganismen. In twee haventjes in de Rotterdamse Europoort zijn bij wijze van experiment kunstmatige onderwaterstructuren aangebracht. In dit gezamenlijke proefproject van het mariene kennisinstituut Deltares en het Havenbedrijf Rotterdam zal met onderwatercamera’s worden bestudeerd welke vissen zich in deze kunstmatige habitats gaan ophouden