in samenwerking met de Centrale OpleidingsCommissie Abstracts Wetenschapsdag

in samenwerking met de Centrale OpleidingsCommissie

Abstracts Wetenschapsdag

2014

“Kleine” studies Naam (posternummer)

Pagina

Jurriaan Brekelmans, Oogheelkunde (1)

2

Mari Elshout, Oogheelkunde (2)

3

Cécile Kicken, Anaesthesie (3)

4

Lucas Ricker, Oogheelkunde (4)

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Elleke Dresen, Radiologie (5)

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Miriam van Heeswijk, Radiologie (6)

7

Soraya Jonker, Oogheelkunde (7)

8

Esther Martens, Klinische neurofysiologie, (8, 9)

9, 10

Milou Martens, Chirurgie (10)

11

Elwin Mommers, Chirurgie (11)

12

Givan Paulus, Chirurgie (12)

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Hellen Römkens, Oogheelkunde (13)

14

Karin Sanders, Longziekten (14)

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Koen Vermorgen, Oogheelkunde (15)

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Eleana Zhang, Neurologie (16)

17

1

Naam Functie Specialisme School Titel Co-auteurs Affiliaties Abstract

Jurriaan Brekelmans WESP-student Oogheelkunde Nee Precut Single Pass Ultradunne Preparatie van Endotheliale Lamellen met een Innovatieve Microkeratoom M.M. Dickman1, P. Steijger-Vermaat2, Y. Schuchard2, F.W.F. van Marion2, T. T.J.M. Berendschot1, F.J.H.M. van den Biggelaar1, R.M.M.A. Nuijts1 1. Afdeling oogheelkunde, MUMC, Maastricht 2. Euro Cornea Bank, Beverwijk Doel: De reproduceerbaarheid en endotheelcel overleving vaststellen van endotheliale lamellen ultradun gesneden (<100μm) met de Gebauer SLc microkeratoom. Methode: 22 gepaarde orgaanmedium gepreserveerde donorhoornvliezen (n=44) ongeschikt voor transplantatie zijn gesneden met de Gebauer SLc microkeratoom met een beoogde lameldikte <100μm. Hierna zijn ze gedurende 3 dagen in orgaanmedium bewaard. De dikte is gemeten via een voorsegment OCT (Casia SS-1000;Tomey) en de endotheelcel overleving via trypaan blauw kleuring. Resultaten: De gemiddelde lameldikte bedroeg 65±13μm, significant kleiner dan 100μm (p<0.001). Er is geen significant verschil gevonden in endotheelcelafname tussen gesneden en niet-gesneden corneas op alle meetmomenten. Lineair-mixed-model-analyse liet alleen tijd van overlijden tot koud preservatie en totale opslagtijd als significante voorspellers van endotheelcelafname zien.

Poster

Conclusie: De Gebauer SLc microkeratoom is een betrouwbare en veilige techniek voor het oogsten van ultradunneendotheliale lamellen. Liggende poster, nr 1

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Mari Elshout Arts-assistent in opleiding Oogheelkunde Nee Kosteneffectiviteit van aflibercept voor de behandeling van leeftijdsgebonden maculadegeneratie M.I. van der Reis1, C.A.B. Webers1, J.S.A.G. Schouten1 1. Afdeling Oogheelkunde, MUMC, Maastricht Doel: De kosteneffectiviteit bestuderen van aflibercept vergelijken met bevacizumab, ranibizumab en geen behandeling, en de invloed van modelparameters. Methode: Een 2-ogen model werd ontwikkeld. Effectiviteitsdata werd ontleend aan klinische trials. Kosten waren gebaseerd op patient interviews en standaard kostprijzen. Tijdshorizon: 2 en 5 jaar. Resultaten: Kosten en QALYs geassocieerd met aflibercept gedurende 5 jaren: €35,390; 2.171 QALYs. Bevacizumab, ABC study, CATT study (PRN en 1x/maand): respectievelijk €15,127; €18,469 en €27,210, met 2.172; 2.186 en 2.171 QALYs. Ranibizumab PRN en 1x/ maand: respectievelijk €38,842 en €69,533, met 2.175 en 2.169 QALYs. ‘Geen behandeling’: €9,032 en 1.968 QALYs. Resultaten waren sterk afhankelijk van of één of beide ogen werden geincludeerd, van de lengte van de tijdshorizon, en of kosten van blindheid werden geincludeerd.

Poster

Conclusie: Aflibercept is kosteneffectief vergeleken met ranibizumab. Het is echter niet kosteneffectief vergeleken met bevacizumab. Toepassing van correcte model parameters is mede bepalend voor de uitkomsten. Liggende poster, nr 2

3

Naam Functie Specialisme School Titel Co-auteurs Affiliaties

Abstract

Cécile Kicken WESP-student Anaesthesie Nee Pressured and warmed transfusion of platelet concentrates does not impair platelet function M.D. Lancé1, R. Oerle2, H.M.S. Theunissen1, Y.M.C. Henskens3 1. Afdeling Anesthesiologie en Pijnbestrijding, MUMC, Maastricht 2. Laboratory for Clinical Thrombosis and Hemostasis, CARIM, Maastricht University, Maastricht 3. Centraal Diagnostisch Laboratorium, Cluster Speciële Hemostase en Transfusie, MUMC, Maastricht Rationale: In patients suffering from massive bleeding, platelet concentrate (PC) transfusion is an important part of hemostatic resuscitation. For these patients it is of utmost importance that PCs are delivered from the laboratory to the bloodstream in the fastest way possible. Ideally the PC would also be warmed to 37 °C prior to transfusion because hypothermia compromises hemostasis. A pneumatic tube transport system (PTS) connecting the laboratory with the OR, combined with pressured and warmed transfusion offers such a fast delivery route. However transfusion guidelines do not recommend it. This in vitro study investigated whether this fast delivery route reduces platelet function. Methods: In vitro platelet function was tested in 10 PCs, of which 5 were irradiated with 25 Gy. PCs underwent a single PTS transport and were subsequently divided into smaller bags, which were pressured to 300 mmHg or pressured to 300 mmHg and warmed in a Ranger™ blood warmer. These conditions were tested on day 2 and 7 after donation. Platelet function was measured with light transmission aggregometry (LTA) in terms of 10 μM ADP, 1 mM Na-arachidonic acid (Na-AA), 4 μg/ml collagen and 30 μM TRAP and multiple electrode aggregometry (MEA) in terms of 6.5 μM ADPtest, 1 mM ASPItest, 3.2 μg/ml COLtest and 32 μM TRAPtest. Data were analyzed with nonparametric testing, p < 0.05 was considered statistically significant.

Poster

Results & conclusion: Single PTS transport reduces the ADP response markedly in fresh PCs. However 7-day storage has an even more pronounced effect on ADP and collagen response. It remains to be established whether this effect of PTS on ADP response is relevant in vivo. Other platelet responses were overall well preserved. Subsequent application of pressure or pressure and warming does not relevantly reduce platelet function in fresh and stored PCs. For patients who greatly benefit from rapid PC delivery from the laboratory to the bloodstream, transport by PTS and pressured plus warmed transfusion may be a feasible option. Liggende poster, nr 3

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Lukas Ricker Arts-assistent in opleiding Oogheelkunde MHeNS The immunocytological composition of subretinal fluid in patients with retinal detachment E.C. La Heij1, A. Kijlstra2 1. Afdeling Oogheelkunde, Medisch Centrum Jan van Goyen, Amsterdam 2. Afdeling Oogheelkunde, MUMC, Maastricht Purpose: A multitude of cytokines have been shown to be upregulated at the time of retinal detachment surgery in patients who develop future proliferative vitreoretinopathy (PVR). Analysis of cytologic specimens at this early stage may thus also provide insight into the cellular composition of the pre-clinical stages of PVR. Since cytologic samples are difficult to handle and cells are often identified using unreliable morphological criteria, data are scarce and often inconclusive. We therefore performed an immunocytological study on cells in subretinal fluid to expand the knowledge on the cellular basis of PVR. Methods: Subretinal fluid samples of 33 consecutive cases with primary rhegmatogenous retinal detachment were collected during scleral buckling surgery. Samples were immediately centrifuged for 5 minutes at 700 rpm. Pellets from all samples were divided onto four slides per sample by cytospin, air-dried, and stored at -80 degrees Celsius. A scale of cellular density was established for each specimen: low cellularity for <100 cells per slide, intermediate cellularity for 100-200 cells per slide, and high cellularity for > 200 cells per slide. Slides were immunostained for cytokeratin 8/18 and CD68 (double staining), CD3 and CD20 (double staining), pankeratin, and alpha-smooth muscle actin (SMA). Results: In the majority of samples only few cells were identified (low cellularity, 13/33 samples, 39%). Intermediate and high cellularity were seen in 12/33 (36%) and 8/33 samples (24%), respectively. Pankeratin positive cells were identified in 33/33 (100%) samples investigated, cytokeratin 8/18 positive cells in 19/33 samples (58%), and CD68 positive cells in 31/33 samples (94%). CD3+ cells were seen in one sample (3%), whereas CD20 staining was negative in all samples investigated. Staining for alpha-SMA was positive in 26 samples (79%). Of samples that stained negative for alpha-SMA, 6/7 (86%) had low cellularity. In two samples, few cells double-stained for both cytokeratin 8/18 and CD68.

Poster

Conclusions: These results underline the paradigm that retinal pigment epithelial cells and infiltrating macrophages play a pivotal role in the sequelae resulting in PVR membrane formation after retinal detachment. The discrepancy between the number of samples with pankeratin and cytokeratin 8/18 positive cells may be explained by early dedifferentiation of pigment epithelial cells. In line with this, alpha-SMA positivity in the majority of samples may be an early sign of epithelial-mesenchymal transition. Lymphocytes are unlikely to play a role after retinal detachment. Liggende poster, nr 4

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Abstract

Elleke Dresen Arts-assistent in opleiding Radiologie Nee Kinetic parameters of DCE MRI selecting good responders after chemoradiation for rectal cancer R.C. Dresen1, M.H. Martens2, S. Subhani2, L.A. Heijnen2, D.M.J. Lambregts1, M. Maas1, R.G. Riedl3, J. Slenter1, G.L. Beets2, E. Kluza1, R.G.H. Beets-Tan1 1. Afdeling radiologie, MUMC, Maastricht 2. Afdeling chirurgie, MUMC, Maastricht 3. Afdeling pathologie, MUMC, Maastricht Purpose: Response assessment after chemoradiation (CRT) in rectal cancer remains difficult. The aim of this study was to investigate if kinetic analysis of dynamic contrast enhanced (DCE) MRI, using the blood-pool contrast agent gadofosveset, can identify good responders after CRT. Materials and Methods: Twenty-five patients with locally advanced rectal cancer received DCEMRI both before and 8 weeks after CRT. The kinetic parameters i.e., the initial slope, initial peak, final slope, and area under the first 60, 90, and 120s of the enhancement curve (AUC60, AUC90, AUC120) were determined from relative signal enhancement-time curves. Receiver operating characteristics (ROC) curves were used to assess the diagnostic performance. Good responders (n=11) were defined as patients with a tumor regression grade (TRG) of 1 or 2 at histopathologic assessment after resection. Poor responders were defined as patients with a TRG of 3 to 5 (n=14). Results: Post-CRT the initial peak, AUC90, and AUC120 were significantly lower in the good responders compared with the poor responders (1.20 vs 1.53, 102 vs 128, 145 vs 181 and p=0.017, 0.028, 0.023 respectively). All parameters except the final slope changed significantly more postCRT in the good responders compared with the poor responders. Before neo-adjuvant CRT, the final slope was significantly lower for the good responders (-1.61x10-3) compared with the poor responders (5.18x10-3, p=0.004). ROC-curves ranged from 0.73 to 0.83. Discussion: Differences in kinetic parameters could be used to distinguish good responders from poor responders, which is still difficult with other imaging modalities.

Poster

Conclusion: Kinetic parameters of dynamic contrast enhanced MRI are a promising tool for predicting response after chemoradiation in patients with rectal cancer, influencing further treatment. Staande poster, nr 5

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Abstract

Miriam van Heeswijk WESP-student Radiologie Nee Prospective validation of MR-volumetry for response after neoadjuvant therapy in rectal cancer. M.H. Martens1,2, D.M.J. Lambregts1, R.F.A. Vliegen3, V. Vandecaveye4, M.N. Sosef5, G.L. Beets2, R.G.H. Beets-Tan1 1. Afdeling Radiologie, MUMC, Maastricht 2. Afdeling Chirurgie, MUMC, Maastricht 3. Afdeling Radiologie, Atrium MC, Heerlen 4. Afdeling Radiologie, UZ Leuven, Leuven, België 5. Afdeling Chirurgie, Atrium MC, Heerlen Introduction: Standard treatment for locally advanced rectal cancer is a long course of chemoradiotherapy (CRT) followed by total mesorectal excision (TME). The assessment of tumor response after CRT with standard MRI is difficult due to post-radiation fibrosis. There are several retrospective studies that suggested that T2W MR volumetry can improve the accuracy the tumor response post-CRT. In these studies cut-off values have been tested on a limited number of patients and the golden standard remains pathology. The aim of this study is to prospectively validate the diagnostic value of previously reported thresholds reported in literature for T2Wbased volumetry in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy. Material and Methods: Twenty-four patients with cT3-4 rectal tumor, with any N-stage, and no metastasis were included. A standard T2W-MRI was performed both pre- and post-CRT. Tumor volume was measured by free-hand regions of interest (ROI) delineating the tumor on each tumor containing slice both before and after CRT. Tumor volume reduction rates (∆volume) were calculated. The cut-off criteria were found by means of literature research. Cut-off criteria tested for outcome were the following: - Pre-CRT Volume of 15 cm3, 16.7 cm3 or 50 cm3; - Post-CRT Volume of 1.6 cm3 and 5 cm3; - Volume reduction cut-off criteria of 70%, 75%, 77%. 84.3% or 88.6%. These criteria were compared between good and poor responders. Good response was defined as: - Tumor downgrading (e.g. cT3 à ypT2) - Tumor Regression Grade (TRG) by Mandard (1-2) or Dworak (3-4); - Histopathologic complete response (pCR) Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: Pre-CRT volume thresholds resulted in sensitivities of 0-40%, specificities of 68-79%, PPV 0-71%, and NPV 39-89%. Post-CRT volume thresholds resulted in sensitivities of 0-60%, specificities of 68-100%, PPV 0-100% and NPV 39-91%. The ∆volume thresholds resulted in sensitivities of 0100%, specificities of 71-100%, PPV of 0-100% and NPV of 41-100%. Highest diagnostic accuracy was obtained with the thresholds of 75 and 77% for identifying a pCR, resulting in a sensitivity of 100%, specificity of 82%, PPV 33% and NPV 100%.

Poster

Conclusion: The highest accuracy was obtained with the ∆volume cut-off value of 75 and 77%, showing promising sensitivity of 100% and sensitivity of 82%. The validation results of the Pre- and Post-CRT volume thresholds were not accurate enough for clinical application. The above mentioned criteria will be tested on a larger, multi-center study population in the near future. Staande poster, nr 6

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Soraya Jonker WESP-student Oogheelkunde Nee Visuele functie na bilaterale implantatie van ReSTOR vs. Finevision multifocale IOLs N.Y. Makhotkina1, N. J.C. Bauer1, T.T.J.M. Berendschot1, F.J.H.M. van den Biggelaar1, C. Pagnoulle2, R.M.M.A. Nuijts1, 1. University Eye Clinic, MUMC, Maastricht 2. PhysIOL, Luik, België Doel: Prospectieve evaluatie van visus en refractie uitkomsten in een gerandomiseerde patiëntengroep met bilaterale IOL implantatie van twee verschillende multifocale IOLs. Methode: 28 cataract patiënten met <1.0D corneaal astigmatisme werden gerandomiseerd voor bilaterale implantatie van ofwel Finevision (micro F) trifocale IOLs ofwel Acrysof ReSTOR® IQ+3.0 IOLs. Resultaten: Zes maanden postoperatief was de gemiddelde manifeste refractieve sferisch equivalent +0.07+0.23 D voor de ReSTOR® en +0.12+0.59 D voor de FineVision groep. De gemiddelde binoculaire ongecorrigeerde verte- (400cm), intermediaire- (70cm) en lees-visus (40cm) was respectievelijk 0.00±0.09, 0.28±0.08 en 0.12±0.08 logMAR met de Restor, en respectievelijk -0.01±0.11, 0.32±0.15 en 0.15±0.13 logMAR met de Finevision. Defocus curves, contrast sensitiviteit en patiënt tevredenheid worden gepresenteerd.

Poster

Conclusie: Goede resultaten werden verkregen na bilaterale implantatie van zowel de Restor als Finevision IOL, zonder significatie verschillen in visueel functioneren. Staande poster, nr 7

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Abstract

Esther Martens Klinisch fysicus in opleiding Klinische neurofysiologie Nee Patiëntselectie en klepgrootte keuze voor transkatheter aortaklep implantatie (TAVI): CT vs. TTE T. Jurençak1, W.R.M. Dassen2, M. Das1, L. van Garsse3, G.V.A. van Ommen2, B.L.J.H. Kietselaer2 1. Afdeling Radiologie, MUMC, Maastricht 2. Afdeling Cardiologie, MUMC, Maastricht 3. Afdeling Cardiothoracale Chirurgie, MUMC, Maastricht Doel: Computer Tomografie (CT) is in opkomst als modaliteit voor het in kaart brengen van aortaklep morfologie bij patiënten met een aortaklepstenose, die in aanmerking komen voor transkatheter aortaklep implantatie (TAVI). Het doel van deze pilot-studie is om de gevolgtrekking uit pre-TAVI CT data vs. transthoracale echocardiografie (TTE) data m.b.t. patiëntselectie (ernstige vs. niet ernstige aortaklepstenose) en klepgrootte keuze (23 vs. 26 mm) te vergelijken. Materialen en methoden: Van 29 patiënten die een TAVI hebben ondergaan zijn zowel CT als TTE pre-TAVI data geanalyseerd. Ter vergelijking van CT en TTE, is stenose ernst puur gebaseerd op aortaklepoppervlak (AVA) grootte: AVA < 1.0 cm2 is geclassificeerd als ernstig vs. AVA > 1.0 cm2 als niet-ernstig. Op CT is AVA bepaald door ROI intekening op een transversale oblique coupe genomen op 20% van het RR-interval. De coupe is geselecteerd in het coronale vlak loodrecht op de aorta wortel op dat niveau waarbij nog net de oorsprong van de klepbladen zichtbaar is. Op TTE is AVA bepaald uit de continuïteitsvergelijking: Vao* Aao = Vlvot* Alvot (1) Met V de snelheid over en A het oppervlak van de aortaklep (index ao) of uitstroomopening van het linkerventrikel (index lvot). Snelheden over aortaklep en LVOT zijn bepaald uit continuous wave respectievelijk pulsed wave Doppler metingen. Alvot is berekend door LVOT diameter intekening op de parasternale lange as opname onder aanname van een cirkelvorming oppervlak. Uit vergelijking (1) volgt dan Aao ofwel AVA. Klepgrootte keuze (23 vs. 26 mm) is gebaseerd op aorta annulus diameter (AAD) metingen. Op zowel CT als TTE is deze bepaald door ROI intekening. Vooralsnog is uitgegaan van de Europese richtlijnen die stellen dat een AAD gemeten op TTE tussen 18-21mm indicatief is voor een 23 mmklep en tussen 22-25mm voor een 26 mm-klep. Dezelfde richtlijnen zijn toegepast voor de kortste as diameter gemeten op CT. Resultaten: Voor 21 van de 29 patiënten (72%) kwamen CT en TTE patiëntclassificatie overeen. Bij 7 van de 8 tegenstrijdige bevindingen, wees TTE op ernstige stenose i.t.t. CT bevindingen. In van deze 6 cases lag CT AVA dicht bij de afkapwaarde (1.0 of 1.1 cm2). TTE en CT klepmaat bevindingen waren voor 12 patiënten (41%) in overeenstemming. In alle 17 tegenstrijdige bevindingen indiceerde TTE de 23mm klep.

Poster

Conclusie: Om uitspraken te kunnen doen over de correctheid van zowel patiëntclassificatie als klepgrootte keuze, is analyse van zowel pre- als post-TAVI data vereist. Op basis van grotendeels overeenkomende CT-TTE bevindingen, kan voorlopig geconcludeerd worden dat TTE leidend zou moeten zijn voor selectie, maar dat CT overwogen kan worden als er twijfel is over de ernst van een aortaklepstenose. Wat betreft klepgrootte keuze, zijn de verschillen tussen TTE en CT erg groot. Aangezien risico’s bij het plaatsen van een te grote klep minder ernstig zijn dan bij een te kleine klep, lijkt CT een veiligere pre-TAVI indicator dan TTE. Staande poster, nr 8

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Esther Martens Klinisch fysicus in opleiding Klinische neurofysiologie Nee Centrifugal pump performance for application in low-flow extracorporeal CO2-removal A.P. Simons 1, Y.G. Ganushchak1, P.W. Weerwind1 1. Department of Cardiothoracic Surgery, MUMC, Maastricht Aim: Extracorporeal life support has been proven a successful technique to provide circulatory and/or pulmonary assistance in acute heart and/or lung failure, thereby using pump flows of 3-6 l/min. More recently, this technique has been adapted to enable extracorporeal CO2 removal using small catheters and decreased pump flows <0.5 l/min in patients suffering from COPD exacerbation. Roller pumps are suitable for such low-flow applications, but the efficacy of modern centrifugal pumps for this purpose has not yet been investigated. The aim of this study was to examine hydrodynamic stability and gaseous micro-emboli (GME) activity to characterise the performance of two centrifugal pump types for application in low-flow extracorporeal CO2 removal. Materials & Methods: The performance of a RotAssist2.8 and a Rotaflow32 centrifugal pump (Maquet Cardiopulmonary AG, Hirrlingen, Germany) was characterised in a mock circulation consisting of a reservoir, the centrifugal pump, an oxygenator, and adjustable tube clamps at the inlet and outlet of the pump. Pressure and gaseous micro-embolic activity was measured at both the pump inlet and outlet using pressure transducers (Baxter International, Inc., Deerfield, IL, USA) and bubble counters (BCC200, Gampt GmbH, Zappendorf, Germany). Flow was measured using ultrasound flow probes (Transonic Systems, Inc., Ithaca, NY, USA). At pump speeds of 1000, 2000, 2500, 3000, 3500, 4000 and 5000 rpm, pressure-flow curves were acquired by stepwise closing the pump inlet tube clamp in one pump speed series and the outlet tube clamp in another. Resulting flow steps amounted to 1 l/min in the >1 l/min flow range, 0.25 l/min in the 1-0.5 l/min flow range, and 0.1 l/min in the <0.5 l/min flow range. Results: Minimum pump inlet and maximum pump outlet pressures were -593 mmHg and 754 mmHg for the RotAssist2.8 and -606 mmHg and 806 mmHg for the Rotaflow32. At flows ranging from 8 to 0 l/min and regardless of which tube clamp, standard deviations of pump pressures and flows for both pumps amounted to <3 mmHg [3.0 - 0.02 mmHg] and <0.03 l/min [0.03 - 0.002 l/min]. GME at the pump outlet were detectable at pump inlet pressures below -156 mmHg (first measured at 2500 rpm and 0.2 l/min) for the RotAssist2.8 and below -224 mmHg (measured at 3000 rpm and 0.9 l/min) for the Rotaflow32.

Poster

Conclusion: Both RotAssist2.8 and Rotaflow32 centrifugal pumps remain hydro-dynamically stable in the low flow area, however, GME formation with decreasing pump inlet pressures should be taken into account to ensure safe low-flow extracorporeal CO2 removal. Staande poster, nr 9

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Abstract

Milou Martens PhD student Chirurgie GROW Dynamic contrast enhanced MRI for response prediction before+after chemoradiation for rectal cancer S. Subhani1, L.A. Heijnen1,2, D.M.J. Lambregts1, J. Buijsen3, M. Maas1, R.G. Riedl4, C.R.L.P.N. Jeukens1, G.L. Beets2, E. Kluza1, R.G.H. Beets-Tan1 1. Afdeling Radiologie, MUMC, Maastricht 2. Afdeling Chirurgie, MUMC, Maastricht 3. Afdeling Radiotherapie, Maastro Clinic, Maastricht 4. Afdeling Pathologie, MUMC, Maastricht Introduction: Standard treatment for locally advanced rectal cancer is a long course of combined radiation and chemotherapy. Response assessment is performed 8 weeks after the last radiation, followed by surgical resection. Up to 20% of the patients obtain a histopathological complete response, i.e. all tumors cells were destroyed by the chemoradiotherapy. The 5-year disease free survival and overall survival of patients with a (near) complete response is high (83-87%). Moreover, these patients may not need a surgical resection, if we are able to select the (near) complete responders prior to surgery. However, response assessment after chemoradiotherapy (CRT) in rectal cancer remains difficult due to post-radiation fibrosis. Using standard MRI, postradiation fibrotic thickening with or without residual tumor have similar imaging features and cannot be reliably distinguished. Currently it is not well understood why some tumors respond very well to CRT, while others show no or very little response. If we were able to predict which tumors are likely going to respond to CRT, this would allow for more individualized treatment options. The aim of this study was to investigate if kinetic analysis of dynamic contrast enhanced(DCE) MRI, using the blood-pool contrast agent gadofosveset, can predict tumor response both before and after chemoradiation in patients with locally advanced rectal cancer. Materials and Methods: Twenty-five patients with locally advanced rectal cancer received DCEMRI both before and 8 weeks after CRT. The kinetic parameters i.e., the initial slope, initial peak, late slope, and area under the first 60, 90, and 120s of the enhancement curve (AUC60, AUC90, AUC120) were determined from relative signal enhancement-time curves. Receiver operating characteristics (ROC) curves were used to assess the diagnostic performance. Good responders (n=11) were defined as patients with a tumor regression grade (TRG) of 1 or 2 at histopathologic assessment after resection. Poor responders were defined as patients with a TRG of 3 to 5 (n=14). Results: Before neo-adjuvant CRT, the late slope was significantly lower for the good responders (1.61x10-3) compared with the poor responders (5.18x10-3, p=0.004). The area under the ROCcurve was 0.83. Post-CRT the initial peak, AUC90, and AUC120 were significantly lower in the good responders compared with the poor responders (1.20vs1.53, 102vs128, 145vs181 and p=0.017, 0.028, 0.023 respectively). ROC-curves ranged between 0.73-0.76. All parameters except the late slope changed significantly more post-CRT in the good responders compared with the poor responders. ROC-curves ranged from 0.77 to 0.81.

Poster

Conclusion: Kinetic parameters of dynamic contrast enhanced MRI are a promising tool for predicting response both before and after chemoradiotherapy in patients with rectal cancer. This would allow for a more personalized treatment, offering options for organ saving treatments. Staande poster, nr 10

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Elwin Mommers Student-assistent Chirurgie Nee Results of Endoscopically assisted Component Separation Technique for large ventral hernias J.A. Wegdam1, S.W. Nienhuijs2, T.S. de Vries Reilingh1 1. Afdeling Chirurgie, Elkerliek ziekenhuis, Helmond 2. Afdeling Chirurgie, Catharina ziekenhuis, Eindhoven Background: Conventional Component Separation Technique (CST) is associated with a high wound complication rate (up to 47%) due to large wound surface and dissection of peri-umbilical perforating arteries to the abdominal skin. Endoscopically assisted Component Separation Technique (ECST) reduces the wound surface and saves these arteries. This study evaluated the results of ECST in terms of feasibility, wound complications and recurrence rate. Methods: Since September 2012 complex ventral hernias were treated in a specialized regional centre for abdominal wall reconstructions. Indications for ECST were medial abdominal wall defects with a maximum transversal diameter of 12cm on pre-operative CT-scan and no previous subcutaneous dissection. Enterostomy was no contra-indication. Follow-up consisted of 3-6 monthly visits to outpatient clinic. Results: Sixteen patients (9 male) with median age of 62 years (range 46-77) underwent ECST. The median defect size was 94.2cm2 (range 22-217). Thirteen patients received an intra-abdominal mesh (Ventralight ST). Three patients did not receive any mesh because of simultaneous extirpation of an infected mesh. The fascia could be closed in the midline in all patients. Eleven patients received bilateral and 4 unilateral ECST. In 1 patient both open (left side) and endoscopic (right side) component separation was performed due to a larger than expected defect (16cm diameter). Median operation time was 105 minutes (range 69-239). Duration of hospital stay was 5 days [range 3-15]. Four patients (24%) had a wound complication within 30 days after surgery (seroma (n=1), abscess (n=3)). Mean follow-up was 6 months (SD 4.4). Two patients had a recurrence hernia cicatricalis after 6 and 7 months. Both were primary closures after extirpation of an infected mesh during ECST.

Poster

Conclusion: This first experience showed closure of defects up to 12cm with endoscopically assisted component separation was feasible with a modest complication rate of 24% and a recurrence rate of 12%. Staande poster, nr 11

12


Givan Paulus PhD student Chirurgie NUTRIM Reduced caloric intake after plication of the stomach through altered ghrelin response M. van Avesaat1, J.M. Conchillo1, A.A. Masclee1, N.D. Bouvy2 1. Afdeling Maag- Darm- Leverziekten, MUMC, Maastricht 2. Afdeling Heelkunde, MUMC, Maastricht Bariatric surgery is the only long-term effective therapy for weight loss in morbidly obese patients. With the rising number of procedures, research and development of minimal invasive procedures also increases. Recently, our center started an endoscopic method to reduce the volume of the stomach by creating plications. The procedure starts with introducing an Articulating Circular Endoscopic (ACE) stapler device. With the device, stomach tissue is acquired by vacuum and stapled to create eight to ten permanent plications. Before and one month after the procedure patients underwent a standardized meal test with blood sampling for gastrointestinal hormones, breath sampling for gastric emptying (13C-octoanoic acid breath test) and visual analogue scale (VAS) for hunger and satiety. Samples were obtained at several time points before and after a standardized breakfast. Ten patients underwent the gastric plication procedure and were tested. Baseline weight was 119.3±3.5 kg, which had decreased to 111.6±3.4 kg (p<0.001) at the day of the standardized maeal test. No changes were found in gastric emptying (GE) compared to baseline (GE half time 141.3±5.9 preoperative vs 138.7±12.3 minutes postoperative, p>0.05). Statistical analysis of Ghrelin concentration in the first hour showed significantly different iAUC after the procedure (6.7±9.1 vs. -33.3±12.0, p<0.05). Furthermore, iAUC of VAS for desire to eat significantly decreased after the procedure (-21.2±7.1 vs. -41.7±7.4, p<0.05). After the procedure we found a significant correlation between ghrelin levels and desire to eat in the first hour of the test day that did not reach statistical significance before the procedure. We did not find any significant changes in the anorexigenic hormones GLP-1 and PYY. One year after plicating the stomach mean weight loss was 19.0±2.4 kg.

Poster

Post-procedural plasma levels of the hunger hormone ghrelin, showed a significant decrease as a response to the meal. This can be related to increased stretch on the plicated fundus. This effect might explain part of the reduced caloric intake as desire to eat changes significantly after the procedure and is positively correlated to plasma levels of Ghrelin. We emphasize that the changed Ghrelin response is part of the explanation to why patients are more likely to reduce their caloric intake and lose weight after plicating the stomach. Staande poster, nr 12

13


Hellen Römkens PhD student Oogheelkunde Nee Reproduceerbaarheid van voorste oogkamerhoek metingen met de SS-OCT H.J.M. Beckers1, M. Frusch2, J.S.A.G. Schouten1, T.T.J.M. Berendschot1, J. de Brabander1, C.A.B. Webers1 1. University Eye Clinic, Maastricht 2. Hogeschool Zuyd, Heerlen Doel: Het onderzoeken van de reproduceerbaarheid van voorste oogkamerhoek metingen met de Swept-source Optical Coherence Tomography (SS-OCT). Methode: Eenendertig gezonde vrijwilligers met basale kennis van oogheelkunde (non-experts), maakten 3 SS-OCT afbeeldingen van hun mede non-experts. Analyse van de beelden vond plaats door experts en non-experts. De variatie tussen experts en non-experts, intra-observer variabiliteit en variatiecoëfficiënt werden geanalyseerd. Resultaten: Er werd een significant verschil gevonden tussen de nasale en temporale hoek in AOD500 (p<0.01), AOD750 (p<0.01) en TISA750 (p<0.01). AOD500 (p=0.025), AOD750 (p=0.012) en TISA500 (p=0.010) waren significant groter bij analyses verricht door non-experts. De variatiecoëfficiënt was alleen significant groter voor AOD500 bij non-experts (11.1% versus 8.7%, p<0.01).

Poster

Conclusie: Deze studie toont een hoge reproduceerbaarheid van SS-OCT voorste oogkamerhoek metingen. Non-experts verkregen grotere AOD en TISA waarden vergeleken met experts. Liggende poster, nr 13

14


Karin Sanders WESP-student Longziekten NUTRIM Internalization and localization of silica in bronchial epithelial cells P.M.P. Peeters1, N.L. Reynaert1 1. Department of Respiratory Medicine, MUMC, Maastricht University Silicon dioxide (SiO2) or silica is one of the most common minerals in the earth’s crust and a major component of sand and rock. Chronic inhalation due to occupational activities, such as agriculture and construction, can cause persistent inflammation, fibrosis and breathing problems, which is known as silicosis. Moreover, it is associated with the development of COPD, heart failure and cancer. Treatment with immuunsuppressive agents is not effective and pneumoconiosis is therefore an important health issue. Exposure of macrophages to SiO2 causes the release of pro-inflammatory cytokines. Production of these cytokines is regulated by the (NOD)-like receptor (NLR) family pyrin domain containing protein 3 (NLRP3). NLRP3 is a multiprotein formed of innate immune receptors, which is also called the inflammasome. NLRP3 is activated in several ways, which eventually results in proteolytic maturation and secretion of inflammatory proteins, such as Il-1β and Il-18. The topic of this research is silica-induced inflammasome activation in bronchial epithelial cells, since epithelial cells are the primary barrier to environmental exposures. It is generally assumed that epithelial lung cells are relatively inactive when exposed to silica. However, results of our group have shown that certain stress-related genes such as Il-1, Il-6, Il-8 and thioredoxininteracting protein (TXNIP) are upregulated in epithelial cells when exposed to SiO2. Furthermore, in vitro it is found that caspase-1, basic Fibroblast Growth Factor (bFGF) and High Mobility Group Box 1 (HMGB1) are increasingly secreted by epithelial cells in response to silica exposure in an NLRP3- and uptake-dependent manner. However, the mechanism of uptake, the localization of the internalized silica particles and the mechanisms by which the inflammasome is activated is unknown. In order to analyze particle uptake, bronchial epithelial cells are exposed to fluorescently labelled SiO2. Furthermore, to determine the intracellular localization cell organelles, such as lysosomes and mitochondria are fluorescently labelled. Analysis will be performed by fluorescence and confocal microscopy.

Poster

We have successfully fluorescently labelled SiO2 particles. Initial studies showed the labelled particles have a similar toxicity towards the non-labelled particles. Furthermore, using confocal optical sectioning, silica particles were shown to be present within the cytoplasm of the epithelial cells. Further, results about the intracellular localization and molecular mechanism are pending. Liggende poster, nr 14

15


Koen Vermorgen Arts-assistent in opleiding Oogheelkunde Nee Visualisatie van filterblazen na trabeculectomie met SS-OCT Casia Tomey C.A.B. Webers1, T.T.J.M. Berendschot1, H.J.M. Beckers1 1. Afdeling Oogheelkunde, MUMC, Maastricht Doel: Het verkrijgen van 3D informatie over interne structuren van de filterblaas na trabeculectomie. Methode: Acht filterblazen werden 1 maand postoperatief onderzocht met de Casia OCT. De kwalitatieve interne structuren (zichtbaarheid van: trabeculectomie-opening, interne ostium, scleraflap, microcysten, hyporeflectief gebied) en kwantitatieve structuren (dikte scleraflap, aantal microcysten, lengte, hoogte en volume van de interne holte, minimale en maximale dikte van de filterblaaswand, totale filterblaashoogte) werden onderzocht en gecorreleerd met de oogdruk. Resultaten: De trabeculectomie-opening, microcysten en een hyporeflectief gebied waren bij alle filterblazen zichtbaar, het interne ostium en de sclerale flap bij 87,5% en een interne holte bij 62,5%. Er werd geen significante correlatie gevonden tussen de oogdruk en de onderzochte structuren.

Poster

Conclusie: Middels de Casia OCT kunnen de interne structuren van een filterblaas goed gevisualiseerd worden. Liggende poster, nr 15

16


Eleana Zhang PhD student Neurologie CARIM Blood-brain barrier permeability is quantitatively increased in lacunar stroke patients S.M. Wong1, H.J. van de Haar1, J.E.A. Staals2, J.F.A. Jansen1, C.R.L.P.N. Jeukens1, P.A.M. Hofman1,W.H. Backes1, R.J. van Oostenbrugge2 1. Department of Radiology, MUMC, Maastricht 2.Department of Neurology, MUMC, Maastricht Background: Lacunar stroke (LS) is a major clinical consequence of cerebral small vessel disease (cSVD). Increased blood-brain barrier (BBB) permeability is thought to play a pivotal role in the pathophysiology of cSVD. Previous studies showed a qualitative increase of BBB permeability in the entire cerebral white matter (WM), and in the normal appearing white matter (NAWM) in LS patients compared to healthy controls. However, quantitative studies are lacking, hence no reliable comparison can be made between studies and no quantitative reference points exist for BBB permeability. We developed a new dynamic contrast enhanced MRI (DCE-MRI) protocol and applied this to quantify BBB permeability in WM and NAWM, in LS patients and healthy controls. Methods: We included 17 first ever LS patients and 8 age and gender matched healthy controls. All received a DCE-MRI using a 3T scanner. Signal intensities were incorporated in the Patlak model to determine the transfer constant Ki, a pharmacokinetic parameter for BBB permeability, in the WM and NAWM. Mean Ki values were compared between the two groups. Here, only Ki values of > 0,002 min-1 were used, as we consider values above this cut off point to be indicative of an abnormal permeability. In addition, risk factors such as hypertension and diabetes were compared. Results: LS patients had a significantly higher mean Ki in WM (3.73∙10-3 vs 3.26∙10-3 min-1; p=0.043) and NAWM (3.74∙10-3 vs 3.26∙10-3 min-1; p=0.043) compared to healthy controls. No differences in risk factors were found between the groups.

Poster

Conclusion: BBB permeability in WM and NAWM was quantitatively higher in LS patients compared to healthy controls, with negligible differences between NAWM and WM within each group. This finding supports previous qualitative studies, reflecting the generalized white matter pathology in cSVD. Moreover, this study provides quantitative BBB permeability data in LS patients, which are essential for future data comparison and analysis. Liggende poster, nr 16

17

“Originele”studies Naam (posternummer)

Pagina

Sema Bektas, Cardiologie (17, 18)

19,20

Maikel Bakens, Chirurgie (19)

21

Dominique Disseldorp, Chirurgie (20, 21)

22, 23

Judith Hilderink, Interne Geneeskunde (22)

24

Inca Hundscheid, Chirurgie (23)

25

Monique de Jong, Keel-, Neus-, en Oorheelkunde (24)

26

Madeleine Kok, Radiologie (25)

27

Noreen van der Linden, Klinische Chemie (26)

28

Alma Mingels, Klinische Chemie (27)

29

Marjolein van der Poel, Interne Geneeskunde (28)

30

Roald Schnerr, Radiologie (29)

31

Ellen Schoorel, Interne Geneeskunde (30)

32

Jantien van der Heyden, Gynaecologie en Obstetrie (31)

33

Desiree Rutten, Cardiologie (32)

34

18


Abstract

Sema Bektas PhD student Cardiologie CARIM Heart Failure with preserved vs reduced ejection fraction: Do they really differ from each other? S. Sanders -van Wijk1, D.J.M. Rutten1, M. Maeder2, W. Estlinbaum3, P. Erne4, H. Rickli2, M.E. Pfisterer5, H.P. Brunner-La Rocca1 1.Department of Cardiology, MUMC, Maastricht 2. Department of Cardiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland 3. Department of Cardiology, Cantonal Hospital Liestal, Liestal, Switzerland 4. Department of Cardiology, Lucerne Cantonal Hospital, Lucerne, Switzerland 5. Department of Cardiology, University Hospital Basel, Basel, Switzerland Background: Several studies showed that patients with heart failure with preserved (HFPEF) versus those with reduced EF (HFREF) are older, more often female and have higher body mass index (BMI). It is unclear to what extent age, gender differences and BMI explain the other differences between HFPEF and HFREF in regard to signs and symptoms, quality of life (QOL) and survival. Methods: 97 HFPEF (EF ≥50%) and 97 HFREF (EF ≤40%) patients from TIME-CHF were included and matched 1:1 for age (79±7 vs 80±7, P=0.65), gender (38% vs 38% male) and BMI >25 (64% vs 64%) respectively. Follow-up period was 548 days. Results: The most common cause of HF in HFREF and HFPEF patients are coronary artery disease (55%) and hypertensive heart disease (HHD) (57%) respectively. The number of comorbidities reflected by the Charlson score was similar in both groups. Severity of complaints reflected by New York Heart Association class, angina, orthopnea, fatigue, exercise intolerance and edema were similarly impaired. Laboratory findings, except haemoglobin and N-terminal brain natriuretic peptide (P<0.01), where similar in both groups. QOL measured by Minnesota living with HF questionnaire and Duke Activity Status Index (DASI) did not differ between the groups at baseline, 12 and 18 months. Hospital free survival in the HFPEF group is significantly lower (P=0.05).

Poster

Conclusion: After matching for age, gender and BMI, prevalence of comorbidities, severity of signs and symptoms and QOL is strikingly similar in HFPEF and HFREF suggesting that age, gender or BMI explain a large part of the differences between HF-groups. Despite these similarities, the hospitalisation free survival is significantly worse in HFPEF. Suggesting that more research is needed to understand the pathophysiology and optimize therapy for HFPEF. Liggende poster, nr 17

19


Abstract

Sema Bektas PhD student Cardiologie CARIM INTERACT-in-HF:improving knowledge to efficaciously raise level of contemporary treatment in HF S. Sanders-van Wijk1, D.J.M. Rutten1, M. Spanjers1, J. Boyne1, C. Hausdorf2, V.M. Brandenburg2, L. de Maesschalck3, C. Knackstedt1, H.P. Brunner-La Rocca1 1. Department of Cardiology, MUMC, Maastricht 2. RWTH University Hospital Aachen, Aachen, Germany 3. Thomas More Mobilab, Research, Geel, Belgium Background: Heart failure (HF) remains to have a poor outcome. Recent advances in HF therapy were identified to improve both morbidity and mortality, but improvement in outcome is much less than expected based on large randomized trials. Various reasons may be responsible, such as complexity of disease and comorbidities, inadequate diagnosis and inappropriate treatment. Little attention was placed on patients seen in primary care and HF care mainly focuses on the individual patient-doctor relationship. However, the increasing complexity prevents individual physicians from covering all aspects of care. Thus, multiple stakeholders are involved in the care, both primary and secondary. Still, the relative role, the interaction between them and the processes included are hardly defined. These aspects may not only be relevant for patient care, but also for the setup of health care systems. Whereas the multidisciplinary team should resemble a seamless system across primary and hospital care, there is a scarcity of research considering how these disease management programs perform, in what form they should be offered, and what care and support patients and caregivers would benefit most. Purpose: The INTERACT study is set up to determine and assess relevant factors of the quality of HF care. The study investigates processes of HF care, relevant players and interactions between them. It collects data from individual patients to assess characteristics and management of contemporary HF patients in different countries (the Netherlands, Belgium and Germany) and to evaluate decision making with respect to diagnostics and treatment. Methods: Cross-sectional mixed-methods are used. Patients (n=30 per centre) and their caregivers are interviewed. The patient is the central starting point. Then, the treating GP, cardiologist and HF nurse are interviewed. In parallel, retrospective data based on records from these patients are reviewed to verify data from interviews and to determine characteristics of them. Retrospective data of additional patients (n=60 per centre) are collected to complete the picture of the current situation.

Poster

Conclusion: These data will be used to define bottlenecks that prevent best clinical practice to be used in daily care at all levels, comparing practice in different countries. Based on these results, intelligent information and communication technology (ICT) will be developed to improve care. Thus, the proposal aims to better understand HF care, which will lead to a better care and finally to improved outcome. Liggende poster, nr 18

20


Abstract

Maikel Bakens WESP-student Chirurgie Nee Sarcopenia patients undergoing surgery for pancreatic carcinoma, influences postoperative outcomes? M.M.E. Coolsen1,2, M.C. de Jong1,2, D. van Dijk1,2, R.M. van Dam1,2, C.H.C. Dejong1,2, S.W.M. Olde Damink1,2,3 1. Department of Surgery, MUMC, Maastricht 2. Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht 3. Department of Surgery, Royal Free Hospital, and University College London, Division of Surgery and Interventional Science, United Kingdom Introduction: The influence of sarcopenia, defined as depletion of muscle mass, on postoperative short-term outcomes following pancreatic surgery and its effects on postoperative infectious complications remains undefined and is therefore the aim of the present study. Methods: All patients scheduled to undergo a pancreaticoduodenectomy (PD) for malignancy between July 2008-August 2012 were included. Sarcopenia was assessed using the pre-operative CT-scan according to established methods; a cutoff value of 52.4 55.4 cm2/m2 in men and 38.5 38.9 cm2/m2 in women was used to define sarcopenia. Patient characteristics and postoperative complications were prospectively collected and subsequently analysed. Results: 154 patients were enrolled. 95 patients underwent a PD, 59 received a double bypass (DB) because of irresectability. 91/154 patients (59.1%) were classified as sarcopenic. 90-day-mortality was higher in sarcopenic patients (n=11 (7.1%) vs n=1 (0.6%); p=0.02). Infectious complications occurred in 59/154 patients (38.1%) and overall complications in 79/154 patients (51.3%). Of the total group, significantly more patients with sarcopenia developed infectious complications (n=41(26.6%) vs n=18 (11.7%);p=0.04); while the occurrence of overall complications was comparable (n=51 (33.1%) vs n=28(18.2%); p=0.15). Significantly more sarcopenic patients developed infectious as well as overall complications after PD (n=31 (32.6%) vs n=11 (31.6%); p=0.009 and n=37 (38.9%) vs n=17 (17.9%); p=0.03, respectively). No differences in complications were observed in the DB group (all p>0.05). On univariate analysis but not on multivariate analysis, sarcopenia was found to increase the risk of infectious complications (OR=2.1 [95%-CI 1.04.1];p=0.04), On multivariate analysis, obesity (OR=2.3 [95%-CI 1.2-4.7];p=0.01) and undergoing a PD (vs DB: (OR=2.2 [95%-CI 1.0-4.6];p=0.04)) were associated with an increased risk of infectious complications.

Poster

Conclusion: 90-day mortality seems higher in sarcopenic patients. However, due to low incidence further analysis was not possible. Whereas sarcopenia might negatively impact short-term outcomes, its real effects remain ill-defined. Conversely, obesity and undergoing a pancreaticoduodenectomy were found to be independent predictors of postoperative morbidity Staande poster, nr 19

21


Dominique Disseldorp Arts-assistent niet-in-opleiding Chirurgie Nee Botplastiek bij correctie-osteotomie voor malunions van de distale radius is niet noodzakelijk P.R.G. Brink1, M. Poeze1, P.F.W. Hannemann1 1. Afdeling Chirurgie, MUMC, Maastricht Introductie: Malunion is één van de meest voorkomende complicaties van distale radius fracturen na zowel conservatieve als operatieve behandeling. Malunions kunnen geassocieerd zijn met pijnklachten, krachtsverlies en functiebeperking. Hiermee vormen ze een behoorlijke belemmering in het dagelijks functioneren. Diverse chirurgische methoden kunnen gebruikt worden bij de behandeling van malunions, maar open wig osteotomie met plaatfixatie en botplastiek wordt als dé standaardprocedure beschouwd. Met deze techniek wordt de radius op lengte gebracht en de stand gecorrigeerd. Het ontstane botdefect wordt opgevuld met autoloog corticospongieus of spongieus bottransplantaat, of een allogene botspaan. Hierbij is de gedachte dat zowel de biologie als de stabiliteit verbeterd. Er zijn ook nadelen aan het gebruik van botspanen zoals morbiditeit op donorplaats, langere operatieduur, hogere kosten en mismatch tussen de botspaan en het defect. Ondanks de nadelen zijn er talloze studies met deze standaardprocedure gepubliceerd, waarbij diverse uitkomstmaten worden geëvalueerd. Het doel van dit onderzoek was om te kijken of correctie-osteotomie zonder opvulling van het defect vergelijkbare resultaten laat zien. Patiënten en methoden: Sinds 1993 zijn er 122 patiënten behandeld met een correctieosteotomie zonder opvulling van het defect. Alle patiënten zijn door dezelfde operateur behandeld. De indicaties voor correctie-osteotomie waren pijn en bewegingsbeperking. Er is gekeken naar het eventueel optreden van nonunion, standsverlies en complicaties met betrekking tot de wekedelen. Resultaten: Slechts 2 van de 122 correcties had een vertraagde botgenezing (6 en 15 maanden in plaats van 4 maanden). Alle correcties zijn in dezelfde stand genezen welke tijdens de operatie was bereikt. In totaal waren er 22 complicaties opgetreden ten gevolge van de gebruikte fixatietechniek: tendinitis (7), CTS (3), peesruptuur (3), CRPS (4), tendovaginitis stenosans (1), snapping tendon (1) en functiebeperking door overmatige callusvorming (1). Tevens had één patiënt pijnklachten op basis van een te lange schroef. Bij een andere patiënt zat de schroef los in de processus styloideus radii. Bij deze complicaties werden geen significante verschillen gevonden tussen dorsale of volaire plaatfixatie. De radiologische uitkomsten waren postoperatief verbeterd in vergelijking met preoperatieve uitkomsten en nagenoeg vergelijkbaar met de onaangedane zijde. Deze onderzoeksresultaten zijn vergelijkbaar met in de literatuur beschreven studies, waarbij de standaardprocedure van correctie-osteotomie met plaatfixatie en botplastiek is gebruikt.

Poster

Conclusie: Deze studie laat zien dat het opvullen van het defect bij correctie-osteotomie van de distale radius niet noodzakelijk is voor botgenezing of het voorkomen van secundaire dislocatie. Hiermee worden de nadelen van een botplastiek voorkomen. Staande poster, nr 20

22


Dominique Disseldorp Arts-assistent niet-in-opleiding Chirurgie Nee Geen verschil in uitkomstmaten tussen volaire en dorsale plaatfixatie bij distale radius fracturen P.R.G. Brink1, M. Poeze1, P.F.W. Hannemann1 1. Afdeling Chirurgie, MUMC, Maastricht Introductie: Diverse chirurgische methoden worden gebruikt voor de behandeling van distale radius fracturen. In de afgelopen twee decennia heeft open repositie met interne fixatie middels volaire of dorsale plaat aan populariteit gewonnen. In de praktijk wordt meestal de voorkeur gegeven aan volaire plaatfixatie vanwege de angst voor complicaties die dorsale platen in het verleden gaven. De nieuwere dorsale fragment specifieke platen met een kleiner profiel zouden mogelijk minder complicaties geven. Momenteel bestaat er in de literatuur geen consensus over welke plaatfixatie de beste behandeling is voor distale radius fracturen. Het doel van deze studie was het vergelijken van complicaties, functionele en radiografische resultaten tussen volaire en dorsale plaatfixatie. Dit onderzoek is de eerste Nederlandse studie die deze vergelijking maakt bij een grote patiëntenpopulatie. Patiënten en methode: In dit retrospectief cohort onderzoek zijn in totaal 147 volwassen patiënten met een gedisloceerde distale radius fractuur of malunion geïncludeerd. Deze patiënten zijn tussen januari 2003 en april 2010 behandeld met plaatosteosynthese. Alle patiënten hadden een postoperatief follow-up van 2 jaar. Zestig patiënten zijn behandeld met volaire plaatfixatie en 87 patiënten met dorsale plaatfixatie. Complicaties werden middels dossieronderzoek vastgesteld. Daarnaast zijn de patiënten benaderd om terug te komen naar het ziekenhuis voor het ondergaan van diverse onderzoeken. Als eerste hebben de patiënten gevalideerde vragenlijsten ingevuld, waaronder de Patient-Rated Wrist Evaluation (PRWE) en Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Deze vragenlijsten gaan vooral over het uitoefenen van de dagelijkse activiteiten en eventuele klachten na de operatie. Vervolgens zijn bij deze patiënten de functie en de kracht van beide polsen getest. Als laatste zijn röntgenfoto’s van beide polsen gemaakt. Resultaten: De demografische en baseline kernmerken waren vergelijkbaar tussen beide groepen. De complicaties waren niet significant verschillend tussen beide groepen. Bij de verschillende functionele en radiologische uitkomstmaten werden eveneens geen significante verschillen gevonden tussen beide groepen behalve de palmaire flexie en radiale deviatie. De palmaire flexie bleek significant beter te zijn bij de patiënten met een gedisloceerde distale radius fractuur die behandeld waren met een volaire plaat. De radiale deviatie was significant beter bij de patiënten met correctie van een malunion die een dorsale plaat hadden gekregen. Deze verschillen waren mogelijk ten gevolge van de anatomische opbouw door de type plaatfixatie en hadden geen invloed op het dagelijks functioneren.

Poster

Conclusie: Deze studie toont aan dat er geen voorkeur gegeven kan worden aan de type plaatfixatie. De keuze van type plaat dient dus gebaseerd te zijn op fractuurtype en de ervaring van de chirurg met de verschillende fixatietechnieken. Staande poster, nr 21

23

Naam Functie Specialisme School Titel Co-auteurs

Judith Hilderink Student-assistent Interne Geneeskunde Nee Ontwikkeling van een smartphone-app voor de interpretatie van laboratoriumuitslagen S. Meex1, R. Koopman2, R. Rennenberg2

Affiliaties

1. Afdeling Klinische chemie, MUMC, Maastricht 2. Afdeling Interne Geneeskunde, MUMC, Maastricht Inleiding: Bij het vervolgen van patiënten in de tijd is het soms lastig om echte veranderingen in laboratoriumuitslagen te onderscheiden van zogeheten ‘natuurlijke schommelingen’. Dit onderscheid wordt door veel artsen gemaakt op basis van klinische ervaring en intuïtie. Er zijn echter voorbeelden te bedenken waar een wetenschappelijk onderbouwde objectivering van deze kansberekening een zinvolle aanvulling kan zijn op het klinisch gevoel. Wij beschrijven de ontwikkeling van een smartphone-app waarmee de waarschijnlijkheid van een stijging of daling van een laboratoriumuitslag ten opzichte van de vorige uitslag objectief kan worden vastgesteld, gegeven de tijd tussen de metingen.

Abstract

Methoden: Een verandering in opeenvolgende uitslagen bij een individu kan pas met grote waarschijnlijkheid als ‘echt’ worden beschouwd indien het verschil tussen de opeenvolgende uitslagen groter is dan de totale intrinsieke variatie. De grootte van dit kritisch verschil is voor elke bepaling verschillend, en wordt bepaald door twee componenten: de biologische binnenpersoonsvariatie (CVi), en de analytische variatie (CVa). De waarschijnlijkheid dat de verandering echt is kan berekend worden met de volgende formule: Z-score= procentuele verandering/ √(2* (CVa²) + (CVi²)) De belangrijkste parameter voor een goede functionaliteit van de app is een betrouwbare schatting van de biologische binnen-persoonsvariatie over de tijd. Aan de hand van de gepubliceerde literatuur over de biologische variatie hebben we statistische modellen opgesteld die het effect van het tijdsinterval tussen twee metingen op de biologisch variatie beschrijven. Voor het modelleren van deze gegevens is een log-lineair verband gebruikt. Deze modellen zijn geïntegreerd in de smartphone-app. Resultaten: Voor het ontwikkelen van de app hebben we uit de wetenschappelijke literatuur data verzameld over de biologische variatie van 42 laboratoriumbepalingen. Bij 50% van de bestudeerde analyten werd een tijdsrelatie gevonden in de biologische variatie, waarvan 12% een verschil aantoont tussen binnendaagse- en tussendaagse biologische variatie en in 38% werd een continue tijdsrelatie gevonden in de biologische variatie. Deze informatie hebben we statistisch gemodelleerd en geïntegreerd in een smartphone-app die voor alle standaard laboratoriumbepalingen de waarschijnlijkheid berekent dat een verandering tussen twee laboratoriumuitslagen ‘echt’ is.

Poster

Conclusie: Deze smartphone-app kan als hulpmiddel dienen bij de interpretatie van opeenvolgende laboratoriumuitslagen en is met name bedoeld voor beginnend arts-assistenten en coassistenten om hun klinische gevoel te helpen ontwikkelen. Staande poster, nr 22

24


Abstract

Inca Hundscheid PhD student Chirurgie NUTRIM Females are better protected from gut injury during ischemia-reperfusion than males: sex matters J. Grootjans3, D.H.S.M. Schellekens1,2, J. P.M. Derikx1,2, R. M. van Dam1,2, W.A. Buurman1,2, K. Lenaerts1,2, C.H.C. Dejong1,2 1. Department of Surgery, MUMC, Maastricht 2. School for Nutrition, Toxicology and Metabolism (NUTRIM), Maastricht 3. Department of Internal Medicine, Slotervaart ziekenhuis, Amsterdam Introduction: Gender differences in the pathophysiological response to ischemia-reperfusion (IR) have particularly been recognized in cardiovascular and cerebral systems. However, it is unknown if sexual dimorphism exists in human intestinal IR, a frequent occurring and highly lethal disease. Recognition of such differences and elucidation of the underlying pathophysiological mechanisms could lead to more evidence-based medicine for females, and the development of novel therapeutic strategies to reduce IR-associated morbidity and mortality. Therefore, we aimed to investigate sex differences in human intestinal mucosal responses to IR. Materials & Methods: Intestinal IR was studied using a human experimental model. In 16 patients (M8:F8) undergoing pancreaticoduodenectomy, an isolated part of jejunum was subjected to 45 minutes of ischemia (45I) followed by 30 (30R) or 120 minutes of reperfusion (120R). Intestinal tissue was collected at all time points to assess morphology (hematoxylin/eosin (HE)), neutrophil influx (myeloperoxidase (MPO)) and Paneth cell apoptosis (Lysozyme/M30 double staining). Endoplasmic reticulum (ER) stress was analyzed using an X-box binding protein-1 (XBP1) splicing assay and XBP1-spliced/XBP1-unspliced (XBP1s/XBP1u) ratios were calculated. QPCR techniques were used to determine inflammatory cytokine expression. Arteriovenous (V-A) concentration differences of intestinal fatty acid binding protein (I-FABP) were measured using an enzyme-linked immunosorbent assay (ELISA) to assess the level of enterocyte damage. Results were analyzed using Mann-Whitney U tests. Data are presented as mean±SEM. A P-value <0.05 is considered statistically significant. Results: HE staining revealed more extensive small intestinal epithelial damage in male subjects compared to females. In line, I-FABP V-A concentrations differences were higher in males compared to females, both at 45I (233.9±73.3 ng/ml vs 55.5±18.3 ng/ml, P<.05) and at 45I30R (79.2±19.4 ng/ml vs 24.4±6.6 ng/ml, P<.05). Furthermore, male small intestine showed higher XBP1s/XBP1u ratios at 45I30R than female small intestine (4.3±0.8 vs 2.2±0.4, P<.05), indicating enhanced ER stress in males. As expected, this was associated with a higher number of apoptotic Paneth cells per crypt in male subjects compared to females at 45I (5.8±1.2 vs 1.7±0.4, P<.05) and 45I30R (18.3±2.9 vs 7.6±1.9, P<.05). Furthermore, males had a more pronounced influx of neutrophils per villus at 45I30R (6.9±1.2 vs 3.6±0.6, P<.05) and a higher relative mRNA expression of inflammatory cytokines TNF-a and IL-10 after 45I120R, compared to females (2.6 fold and 6.4 fold respectively, P<.05).

Poster

Conclusion: The human female small intestine is better protected from IR-induced epithelial damage than the male small intestine, and correspondingly displayed notably less inflammatory responses. Unravelling the molecular mechanisms underlying this effect could lead to new therapeutic strategies for intestinal IR. Staande poster, nr 23

25


Monique de Jong WESP-student Keel-, Neus- en Oorheelkunde Nee DTI of the central auditory pathways in lambs after perinatal asphyxia B. Kremer1, B. Kramer2, R.J. Stokroos1, J. Dudink2, S.M. Schaefer1 1. Afdeling KNO, MUMC, Maastricht 2. Afdeling Kindergeneeskunde, MUMC, Maastricht Introduction: Each year 1-3 per 1000 newborns are diagnosed with congenital sensorineural hearing loss (SNHL). In previous studies, severe perinatal hypoxic-ischemia was identified as one of the main risk factors for auditory impairment, with affected newborns showing impaired brainstem conduction in the post natal period. To enable early detection of brain ischemia – and therefore the possibility for early intervention – diffusion tensor magnetic resonance imaging (DTI) in the neonatal patient has become more important in recent years. DTI can give an insight in white matter pathway integrity through for example fractional anisotropy (FA). The additional value of this imaging modality has become apparent for predicting patient outcome in the acute setting as well as for long-term follow-up. The relation between abnormalities on DTI and functional outcome has also been subject of investigation when it comes to SNHL. Several studies show a high radial diffusivity and consequently low FA in multiple central auditory nuclei in patients with SNHL, which indicates a demyelination of the auditory tract. Also, shorter latencies in electrophysiological auditory tests, such as brainstem auditory evoked potentials (BAEP) and magneto encephalography (MEG), are associated with a higher FA in the inferior colliculus and acoustic radiations, which indicate a positive relation between white matter myelination on conduction velocity. Smith et al. showed impaired brainstem conduction in a lamb model in subjects that underwent severe asphyxia compared to controls. BAEP measurements of the intervention suggest retro cochlear damage. The present study aims to identify the suggested retro cochlear damage in these asphyxiated lambs by means of DTI. Methods: The intervention group consists of 8 lambs with induced neonatal hypoxic-ischemia according to the lamb model as described by Smit et al. The control group consists of 8 healthy shams. DTI were obtained of the 16 lambs. The regions of interest (ROI) were determined manually. ROI’s were the cochlear nuclei, the superior olive nucleus, the trapezoid body, the lateral lemniscus, the inferior colliculus, the medial geniculate body and the auditory cortex (superior temporal Heschl gyrus). The DWI was scored independently by two trained researchers. A qualitative standardized scoring system was used for defining abnormalities in the ROI; 0 = no abnormalities, 1= mild/possible abnormalities, 2= sever/definite abnormalities. Quantitative DTI measurements as the apparent diffusion coefficient in the ROI, fractional anisotropy, axial diffusivity, and radial diffusivity, were obtained for all subjects and compared among groups. All measurements were achieved by two independent observers blinded for intervention with determination of inter-rater reliability (for example intra-class correlation coefficient or Pearson’s correlation coefficient). Results: Pending.

Poster

Conclusion: Pending. Staande poster, nr 24

26


Abstract

Madeleine Kok PhD student Radiologie CARIM Contrast media reduction using low kV settings in CT angiography: a phantom study C. Mihl1,2, A. Seehofnerova1, S. Altintas1,2,3, B.L.J.H. Kietselaer1,2,3, J. Turek1, J.E. Wildberger1,2, M. Das1,2 1. Department of Radiology, MUMC, Maastricht 2. CARIM school for Cardiovascular Diseases, MUMC, Maastricht 3. Department of Cardiology, MUMC, Maastricht Purpose: Using lower kV settings will result in higher attenuation values for protocols with the same iodine delivery rate (IDR) and total iodine load. This bares the potential to reduce contrast media (CM), with potential benefit in terms of patient safety (contrast induced nephropathy: CIN) and cost effectiveness. Thus, the purpose of this study was to investigate how to reduce IDR and total iodine load in lower kV settings in CT angiography (CTA) while keeping attenuation values diagnostically sufficient. Methods and materials: CM with a concentration of 300 mg I/ml (Iopromide) was used and injected in a circulation phantom with physiological parameters (BP 120/80mmHg, HR 60bpm). Sequential serial CT (SOMATOM Definition Flash, Siemens) scans at the level of the aorta ascendens (incl. coronaries) were performed with the following parameters: 128x0.6mm coll., mAs 142, cycletime 0.43s, gantry rot.time 0.28s, delay 10s. Images were reconstructed at 1 mm slice thickness with an increment of 0.7 mm and a soft tissue kernel (B30f). Initially, the same injection protocol (CM volume=40 ml, flow rate=5.3 ml/s, IDR=1.6 g I/s and total iodine load=12 g I) was used for each kV setting (120, 100, 80 and 70 kV). Secondly, based on attenuation values of the first scans IDR and total iodine load were chosen for each kV: 2.0 g I/s and 15 g (120 kV); 1.6 g I/s and 12 g (100 kV); 1.2 g I/s and 9 g (80 kV) and 1.0 g I/s and 7.5 g (70 kV). After that, IDR was decreased for each kV by steps of 0.2 g I/s until diagnostically insufficient attenuation values (<325 HU) were reached. Total iodine load was consecutively reduced to keep injection time constant (7.5 s). Attenuation values were measured and compared in the ascending aorta (AA), descending aorta (DA) and left main coronary artery (LM). Results: Using the identical injection parameters for each kV, attenuation values (HU±SD) were as follows: 326±2.1 (120 kV); 406±3.1 (100 kV); 524±3.0 (80 kV); 651±3.8 (70 kV). Attenuation values >409 HU were found using the chosen IDR and total iodine load for each kV. After reducing IDR with 0.2 g I/s, diagnostically sufficient attenuation values (>341<367 HU) were achieved. Minimal IDR and iodine load for each kV were as follows: 1.8 g I/s and 13.5 g I (120 kV); 1.4 g I/s and 10.5 g I (100 kV); 1.0 g I/s and 7.5 g I (80 kV); 0.8 g I/s and 6.0 g I (70 kV).

Poster

Conclusion: In lower kV settings (100, 80 and 70 kV) injection parameters such as total iodine load, IDR and CM volume could be reduced by 22%, 44% and 56% respectively compared to 120 kV, while keeping diagnostically sufficient attenuation values (>325 HU). This could play an important role in terms of patient safety (CIN) and lowering costs. Staande poster, nr 25

27


Abstract

Noreen van der Linden PhD student Klinische Chemie CARIM Effect of six-month resistance-type exercise training on cardiac troponin T in (pre)frail elderly M. Tieland2,3, L.J.J. Klinkenberg1, L.B. Verdijk3,4, L.C.P.G.M. de Groot2,3, L.J.C. van Loon3,4, M.P. van Dieijen-Visser1, S.J.R. Meex1 1. Department of Clinical Chemistry, Cardiovascular Research Institute Maastricht (CARIM), MUMC, Maastricht 2. Division of Human Nutrition, Wageningen University , Wageningen 3. Top Institute Food and Nutrition, Wageningen University, Wageningen 4. Department of Human Movement Sciences, School for Nutrition, Toxicology and Metabolism (NUTRIM), MUMC, Maastricht Background: Cardiac troponin is the preferred biomarker for diagnosing non ST-segment elevation myocardial infarction. With the introduction of high-sensitivity assays, cardiac troponin levels became also detectable in apparently healthy subjects. This has expanded its role from acute cardiac care to risk stratification and prognostic medicine. A previous, observational study showed that higher physical activity in elderly subjects was associated with both a lower basal cardiac troponin T (cTnT) and a lower probability of a significant increase of cTnT over time. However, a causal relationship has not been demonstrated. The present trial was conducted to investigate the hypothesis that a six-month resistance-type exercise training program can influence the basal serum cardiac troponin T levels in (pre)frail elderly, a group with high vulnerability to adverse cardiovascular outcomes and all-cause mortality. Methods: Sixty-two (pre)frail elderly subjects (≥65 years) participated in a 24-week supervised resistance-type exercise training program, or were followed up during a parallel non-interventional control period. Training was scheduled twice per week and workload was gradually increased during the study. Plasma cTnT was measured using the high-sensitive cTnT assay (Roche Diagnostics) at 0, 12 and 24 weeks of intervention. Results: All cTnT concentrations during the study (range 3.78–105.70ng/L) were above the detection limit (3ng/L), and 40 subjects (65%) had at least one measurement above the 99th percentile (14ng/L). Ten subjects withdrew from the study, leaving 52 subjects for follow-up analyses. Using mixed linear model analyses, no differences between the intervention and the control group on the course of cTnT levels during the six-month period were observed (intentionto-treat analysis p=0.38, per-protocol analysis p=0.16).

Poster

Discussion: Despite the elevated basal levels of cTnT and the fact that subjects had not previously participated in any structured exercise program, we found no evidence for an effect of a 24-week resistance-type exercise training program on the course of cTnT levels. Possible limitations of our study are the type of exercise and the physical state of the subjects, which precluded a higher training frequency. The biweekly schedule was however sufficient to induce substantial improvements of muscle strength and physical performance in this group. Future studies will reveal whether more intensive and more prolonged interventions can beneficially affect the course of basal troponin levels over time. Staande poster, nr 26

28


Abstract

Alma Mingels Klinisch chemicus in opleidng Klinisch chemie CARIM Cardiac troponins in patients with chest discomfort: strong contribution of the heart and kidneys E.P.M Cardinaels1, S. Altintas2, M.O Versteylen2, I.A Joosen2, L.J Jellema3, J.E. Wildberger4, H.J Crijns2, O. Bekers1, M.P van Dieijen-Visser1, B.L. Kietselaer2,4*, A.M.A Mingels1* 1. Central Diagnostic Laboratory, Department of Clinical Chemistry, CARIM, MUMC, Maastricht 2. Department of Cardiology, CARIM, MUMC 3. Department of Clinical Chemistry, Gelre Hospitals, Apeldoorn 4. Department of Radiology, CARIM, MUMC (*) both authors contributed equally Background: Highly sensitive cardiac troponin (hs-cTn) concentrations are strong predictors of acute cardiovascular events in patients with coronary artery disease. Hs-cTn are also known to be elevated in many other conditions such as renal dysfunction. This complicates the interpretation of baseline hs-cTn levels in the individual patient and adds up to the current confusion regarding hscTn. Aim: Hs-cTnT and hs-cTnI concentrations were investigated on their association with cardiac imaging measures, renal function and the incidence of cardiovascular events in patients with chest discomfort. Materials and Methods: A cohort of 1864 patients with stable chest discomfort underwent cardiac computed tomographic angiography and echocardiography. Serum samples were analyzed using hs-cTnT and hs-cTnI assays. Renal function was assessed by the estimated glomerular filtration rate (eGFR), established from serum creatinine and/or cystatin C. Results: Hs-cTn concentrations were significantly associated with cardiac imaging parameters, such as coronary calcium score (hs-cTnT: stβ=0.100; hs-cTnI: stβ=0.122) and left ventricular mass (hscTnT: stβ=0.179; hs-cTnI: stβ=0.267) and were also strongly associated with eGFR (hs-cTnT: stβ=0.289; hs-cTnI: stβ=-0.222)(all p<0.001 and after adjustment for traditional risk factors). Interestingly, renal function exerted no confounding effects on the association of cardiac parameters with hs-cTn concentrations. Moreover, the association between eGFR and hs-cTn remained equally as strong among patients with no (hs-cTnT: stβeGFR:-0.295; hs-cTnI: stβeGFR:0.228), non-obstructive (hs-cTnT: stβeGFR:-0.290; hs-cTnI: stβeGFR:-0.176) and obstructive plaques (hs-cTnT: stβeGFR:-0.293; hs-cTnI: stβeGFR:-0.249) (all p<0.001). Still, hs-cTn concentrations remained significant and comparable predictors for cardiovascular events.

Poster

Conclusion: In patients with chest discomfort, we identified cardiac pathology and renal function as two separate reasons leading to troponin accumulation. Even after consideration of these influences, hs-cTn remained important for the prediction of cardiovascular events. Staande poster, nr 27

29


Abstract

Marjolein van der Poel Arts-assistent in opleiding Interne Geneeskunde GROW Quality of life more impaired in younger than in older DLBCL survivors M.W.M. van der Poel1, S. Oerlemans2,3, H.C. Schouten1, F. Mols2,3, J.F.M. Pruijt4, H. Maas5 and L.V. van de Poll-Franse2,3 1. Department of Internal Medicine, MUMC, Maastricht 2. Comprehensive Cancer Centre South, Eindhoven 3. Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg 4. Department of Internal Medicine, Jeroen Bosch hospital, ‘s Hertogenbosch 5. Department of Geriatric Medicine, TweeSteden hospital, Tilburg Purpose: The objective of this study was to compare Health-Related Quality of Life (HRQOL) between Diffuse Large B-Cell Lymphoma (DLBCL) survivors of different age categories (18-59 years/ 60-75 years/ 76-85 years) and to compare their HRQOL with an age- and sex-matched normative population. Methods: The population-based Eindhoven Cancer Registry was used to select all patients diagnosed with DLBCL from 1999 to 2010. Patients (n=363) were invited to complete the EORTC QLQ-C30 questionnaire and 307 survivors responded (85%). Data from an age-and sex-matched normative population (n=596) were used for comparison. Results: DLBCL survivors aged 18-59 years scored better on physical functioning, quality of life, appetite loss and constipation than survivors of 76-85 years old (all p<.05). Financial problems more often occurred in survivors aged 18-59 years compared to survivors of 76-85 years old (p<.01). Compared to the normative population, DLBCL survivors aged 18-59 years showed worse scores on cognitive and social functioning and on dyspnea and financial problems (p<.01, large and medium size effects). In survivors of the other age categories only differences with trivial or small size effects were found.

Poster

Conclusion: Although younger DLBCL survivors have better HRQOL than older survivors, the differences found between younger survivors and the normative population were the largest. This suggests that having DLBCL has a greater impact on younger than on older survivors and that the worse HRQOL observed in older DLBCL survivors in comparison with younger survivors is caused mostly by age itself and not by the disease. Staande poster, nr 28

30


Abstract

Poster

Roald Schnerr Klinisch fyiscus in opleiding Radiologie Nee Angiography and pulsatility of small intracranial vessels at 7 Tesla J.F. Jansen1,2, P.A. Hofman1,2, J.E. Wildberger1,2,5, K. Uludag3, R.J. van Oostenbrugge2,4,5, W.H. Backes1,2,5 1. Department of Radiology, MUMC, Maastricht 2. Research School for Mental Health & Neurosciences (MHeNS), MUMC, Maastricht 3. Maastricht Brain Imaging Centre (M-BIC), Maastricht 4. Department of Neurology, MUMC, Maastricht 5. Cardiovascular Research Institute Maastricht (CARIM), MUMC, Maastricht Cerebral small vessel disease (SVD) is a term that covers a large range of neuropathological disorders and related clinical symptoms which are considered to be related. Observable features of SVD on MRI are white matter lesions, microbleeds as well as lacunar infarcts. However, the direct pathology of small cerebral blood vessels in terms of occlusions or increased vessel wall stiffness has not yet been visualized. Our goal is to directly image small (perforating) arteries of the brain and to characterize their condition. To reach the required spatial resolution we use high field MRI imaging (7 Tesla Magnetom MRI, Siemens Healthcare, Erlangen, Germany). We apply three-dimensional high spatial resolution (0.2 mm) arteriography and velocity-sensitized (phase-contrast) MR angiography. At 7-Tesla we identify the lenticulostriate arteries (LSAs) in healthy volunteers and determine their pulsatility for the first time. Staande poster, nr 29

31


Abstract

Ellen Schoorel Arts-assistent in opleiding Interne Geneeskunde GROW Probability of vaginal birth after caesarean: do not ask the obstetrician D.R.M. Hünen1, S.M.J. van Kuijk2, B.C.C Augustijn1, A. Kwee3, B.W.J Mol4, J.G. Nijhuis1, L.J.M. Smits2, R.P.M.G Hermens5, H.C.J. Scheepers1 1. GROW-School for Oncology and Developmental Biology, Department of Obstetrics, MUMC, Maastricht 2. Department of Epidemiology, Caphri School for Public Health and Primary Care, MUMC, Maastricht 3. Department of Obstetrics, University Medical Centre Utrecht, Utrecht 4. Department of Obstetrics, Academic Medical Centre, Amsterstam 5. Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen Background: There is an increasing number of women with a prior caesarean section (CS) who deliver by elective repeat CS (ERCS) instead of intended vaginal birth after caesarean (VBAC). The probability of successful VBAC plays a central role within risk estimation for mode of birth. We aimed to determine predictive performance of clinicians for successful VBAC compared to a prediction model and used actual clinical outcomes as a benchmark. Methods: Clinical vignettes were constructed from actual patients with known outcomes of intended VBAC (successful or failed). We randomly drew 450 clinical cases in order to create vignettes. For each vignette, the probability of successful VBAC was estimated both by a clinician and prediction model, and compared to the actual outcome. Discriminative performance was assessed by obtaining the areas under the curve (AUC) of the receiver operator characteristic; predictive performance was assessed by calibration per-risk-quantile and Hosmer-Lemeshow (H-L) statistics. Findings: Four-hundred-and-six vignettes were completed. For clinicians, the AUC was 0.60 (CI 95% 0.54 – 0.67) while the AUC for the prediction model was 0.70 (CI 95% 0.64 – 0.76) (p-value for difference P<0.003). Calibration-per-risk-quantile showed that clinicians generally underestimated the probability of successful intended VBAC below 70.0%. Calibration-per-risk-quantile for the prediction model was good in all probability ranges. The corresponding H-L statistic confirmed lack of fit for clinicians (p = 0.024), no evidence was found for lack of fit for the prediction model (p = 0.42). Interpretation: Compared to the model, clinicians performed poorly with regard to prediction of successful intended VBAC whilst the majority counsels with a self-derived probability. Hence, in comparison to clinical judgement, the use of the VBAC prediction model can be beneficial.

Poster

Funding: The Netherlands Organisation for Health Research and Development Staande poster, nr 30

32

Naam Functie Specialisme School Titel Co-auteurs

Affiliaties

Abstract

Jantien van der Heyden Arts-assistent in opleiding Gynaecologie en Obstetrie GROW Ontwikkeling op 2-jarige leeftijd na vroegtijdig gebroken vliezen: Follow-up van de PPROMEXIL studie C. Willekes1, A.L. van Baar2, A.G. van Wassenaer3, E. Pajkrt3, M.A. Oudijk4, M.M. Porath5, J.J. Duvekot6, K.W.M. Bloemenkamp7, M. Groenewout8, M. Woiski9, J. van ’t Hooft3, B. Nij Bijvank10, C.J. Bax11, J.M. Sikkema12, A.L.M. Mulder1, J.G. Nijhuis1, B.W.J. Mol13, D.P. van der Ham14 1. Maastricht Universitair Medisch Centrum, Maastricht, 2. Universiteit Utrecht, Utrecht. 3. Academisch Medisch Centrum, Amsterdam. 4. Universitair Medisch Centrum Utrecht, Utrecht. 5. Máxima Medisch Centrum, Veldhoven. 6. Erasmus Medisch Centrum, Rotterdam. 7. Leids Universitair Medisch Centrum, Leiden. 8. Universitair Medisch Centrum Groningen, Groningen. 9. Universitair Medisch Centrum St. Radboud, Nijmegen. 10.Isala, Zwolle. 11.VU Medisch Centrum, Amsterdam. 12. Ziekenhuisgroep Twente, Almelo. 13. School of Paediatrics and Reproductive Health, University of Adelaide, Australia. 14. Martini ziekenhuis Groningen. Introductie: De PPROMEXIL studie liet zien dat bij vrouwen met laat preterm gebroken vliezen inleiding van de baring niet leidt tot een betere neonatale uitkomst. In deze studie analyseren we de neurologische- en gedragsontwikkeling van deze kinderen op 2-jarige leeftijd. Materiaal & methoden: De originele PPROMEXIL studie includeerde vrouwen met preterm gebroken vliezen tussen 34 en 37 weken zwangerschapsduur, die 24 uur na het breken van de vliezen niet in partu waren. Deelnemende vrouwen werden gerandomiseerd tussen inleiding van de baring of afwachtend beleid. Vrouwen die niet wilden deelnemen, konden in een observationale studie worden geïncludeerd. Op het moment dat de kinderen twee jaar oud werden, kregen de ouders de ‘ages and stages questionnaire (ASQ)’, de ‘child behavioral checklist (CBCL)’ en een algemene vragenlijst toegestuurd. Resultaten: We benaderden 551 van de 739 geschikte vrouwen voor follow-up (75%). Complete follow-up werd verkregen van 320 kinderen (responspercentage 58%). In de inleidgroep had 14% (n=16) van de kinderen een abnormale score in ≥1 domeinen van de ASQ, versus 26% (n=27) in de groep met afwachtend beleid (relatief risico (RR) 0.55, 95% betrouwbaarheidsinterval (BI) 0.320.96; p-waarde 0.033). Voor de CBCL, werd een abnormale score in ≥1 domeinen gevonden in 13% (n=15) in de inleidgroep en in 15% (n=16) in de groep met afwachtend beleid (RR 0.96, 95% BI 0.45-1.65; p-waarde 0.645).

Poster

Conclusie: Hoewel inleiding van de baring niet leidt tot verbetering van de korte termijn neonatale uitkomst, reduceert het mogelijk de kans op ontwikkelingsmoeilijkheden op de leeftijd van 2 jaar vergeleken met een afwachtend beleid. Liggende poster, nr 31

33


Abstract

Desiree Rutten PhD student Cardiologie CARIM The relationship between depression and heart failure: findings from TIME-CHF S. Bektas1, S. van Wijk1, O. Pfister2, H. Rickli3, S. Kiencke4, M. Gutmann5, M. Peter6, R. Schindler2, H.P. Brunner-La Rocca1,2 1. Department of Cardiology, MUMC, Maastricht 2. Department of Cardiology, University Hospital Basel, Basel, Switzerland 3. Department of Cardiology, Kantonsspital St.Gallen, St.Gallen, Switzerland 4. Department of Cardiology, University Hospital Bruderholz, Bruderholz, Switzerland 5. Department of Cardiology, University Hospital Liestal, Liestal, Switzerland 6. Department of Cardiology, Kantonales Spital Sursee-Wolhusen, Wolhusen, Switzerland Purpose: There is an increased risk of depression in patients (pts) who suffer from heart failure (HF). However, risk factors for depression and effects of HF on depression over time are not well known. Thus, we examined prevalence and risk factors of depression in HF pts and analyzed the impact of HF on depression over time. Methods: A post-hoc analysis of the TIME-CHF data was done. The 15-item Geriatric Depression Scale (GDS-15) was used to identify depression in HF pts. Results: 593 pts (age 77±8y) completed the GDS-15 at baseline, 382 pts at 18 months. At baseline, moderate depression (GDS-15 score 6-9) was found in 21% and severe depression (score≥10) in 8%, respectively. Little factors influenced depression. Thus, fatigue (p=0.001), exercise intolerance (p=0.001) and orthopnea (p<0.03) were the only independent factors, but many other factors such as age, gender, co-morbidities, aetiology of HF, NYHA-class, NT-proBNP and LVEF were not. In patients with depression, mortality was higher (p<0.04) and quality of life (QoL) was lower (Minnesota questionnaire) than in those without (median [IQR] 56 [41-67] vs 34 [22-47], p<0.001). Over time, patients with decline in depression were older, had a higher BMI and Charlson score (all p<0.05) than those with improvement of depression. Severity of HF and its changes had no influence.

Poster

Conclusion: Depression is common in HF pts, affecting both outcome and QoL. HF itself and its changes over time had little influence on depression in this elderly HF cohort. Liggende poster, 32

34

“Veelbelovende” studies Naam (posternummer)

Pagina

Mark Hazebroek, Cardiologie (33)

36

Caroline Jaarsma, Cardiologie (34)

37

Sophie Joosten, Oncologie (35)

38

Tim de Ruijter, Oncologie (36)

39

Siamack Sabrkhany, Fysiologie (37)

40

Gaston Duijsens, Chirurgie (38)

41

Lisa Hillen, Pathologie (39)

42

Marjolein Kleppe, Gynaecologie en Obstetrie (40)

43

Marjan Klinkert, Chirurgie (41)

44

Ruben Vogels, Chirurgie (42)

45

Michiel de Wolf, Anaesthesie (43)

46

Dirk Schellekens, Chirurgie (44)

47

Martijn Smulders, Cardiologie (45)

48

Mathijs Vaessen, Oogheelkunde (46)

49

Nienke Visser, Oogheelkunde (47)

50

Laura Wielders, Oogheelkunde (48)

51

35


Mark Hazebroek PhD student Cardiologie CARIM Predictors of improved LVRR and long-term prognosis in idiopathic dilated cardiomyopathy patients R. Dennert1, J. Franssen1, J. Verdonschot1, S. Heymans1 1. Department of Cardiology, MUMC, Maastricht Purpose: To determine the clinical and endomyocardial biopsy (EMB)-derived predictors of left ventricular reverse remodeling (LVRR) in patients with idiopathic dilated cardiomyopathy (IDCM). Methods: Between January 1st 2004 and April 31st 2013 we enrolled 223 consecutive patients (131 males, mean age 53±12, baseline LVEF 29±10%, symptom duration 8.5 [3.7-25] months) who underwent endomyocardial biopsy (EMB) because of IDCM. IDCM diagnosis is based on the WHOcriteria and is defined by left ventricular (LV) ejection fraction (EF) <50% and LV end-diastolic dimension (LVEDD)>33mm/m2 without coronary artery disease, primary valvular disease or other known diseases causing DCM. EMB was performed to evaluate viral presence and load, cardiac inflammation, and/or fibrosis. LVRR was defined as a LVEF increase of ≥10 absolute units or a LVEF ≥50% together with a decrease of indexed LVEDD of ≥10% or ≤33mm/m2. Primary endpoint was LVRR after 12 months (range 6–18 months). Secondary endpoint was the composite of mortality or heart transplantation (HTx) after a mean follow-up of 3.5±2.0 years. Results: Viral presence was found in 166 (74%), Parvovirus B19 (PVB19) presence in 152 (68%), PVB19>500 c/mcg DNA in 46 (21%), cardiac inflammation in 94 (42%) and LVRR in 95 (43%) patients. Baseline univariate positive predictors of LVRR were previous history or presence of hypertension (P=0.02), higher heart rate (P=0.01), shorter symptom duration (P=0.005), and lower baseline LVEF (P<0.001). Cardiac inflammation, viral presence, PVB19 presence or PVB19>500 c/mcg DNA did not significantly influence LVRR (P=0.59, P=0.93, P=0.87, P=0.40, resp.). Multivariable analysis revealed hypertension (P=0.01), lower baseline LVEF (P<0.001), and shorter symptom duration (P=0.01) as independent predictors of LVRR. Overall long-term survival was relatively good (93%). Presence of LVRR was the only significant predictor of improved long-term prognosis as compared to patients without LVRR (2 (2%) vs 14 (11%); Log-rank P=0.02).

Poster

Conclusion: Both clinical and echocardiographic parameters in patients with IDCM provide a better prediction of LVRR after 12 months as compared to EMB results. Moreover, LVRR was the only significant predictor of improved long-term outcome. Liggende poster, nr 33

36


Abstract

Caroline Jaarsma Arts-assistent niet-in-opleiding Cardiologie CARIM Prognostic value of non-invasive cardiac imaging in suspected or known coronary artery disease M.W. Smulders1,3 (gedeelte 1e auteur), P.J. Nelemans4, S.C.A.M. Bekkers1,3, J. Bucerius3,5,6, T. Leiner7, H.J. Crijns1,3, J.E. Wildberger2,3, S. Schalla1,3 1. Afdeling Cardiologie, MUMC, Maastricht 2. Afdeling Radiologie, MUMC, Maastricht 3. CARIM, Universiteit Maastricht, Maastricht 4. Afdeling Epidemiologie, Universiteit Maastricht, Maastricht 5. Afdeling Nucleaire geneeskunde, MUMC, Maastricht 6. Afdeling Nucleaire geneeskunde, Aken 7. Afdeling Radiologie, UMC, Utrecht Background: Non-invasive cardiac imaging plays a crucial role in the diagnosis and management of patients with suspected or known coronary artery disease (CAD). However, the prognostic value of these non-invasive tests is less well established. Objective: The current study aimed to evaluate the prognostic value of commonly used noninvasive imaging modalities (coronary computed tomographic angiography [CCTA], cardiovascular magnetic resonance [CMR], stress echocardiography [Echo], exercise electrocardiographic testing [EET], positron emission tomography [PET], and single-photon emission tomography [SPECT]) in patients with suspected or known CAD. Data Sources: Studies published between 1990 and 2012 identified by a PubMed search and citation tracking were evaluated. Study Selection: A study was eligible for inclusion if 1) a (derivable) annual event rate (AER) of nonfatal myocardial infarction (MI) and cardiac death for a negative test result or 2) a hazard ratio (HR) was reported. Data Extraction and Synthesis: Pooled estimates of AERs and HRs were calculated for each imaging modality. Main Outcomes and Measures: Non-fatal MI and cardiac death. Results: A total of 143 studies (108.627 patients) were included: 25 CCTA, 17 CMR (11 perfusion, 4 wall-motion, and 2 both), 38 Echo, 4 PET, 35 SPECT, and 24 EET studies. For all 7 modalities, a negative test result was associated with an excellent prognosis with a pooled AER of ≤1.5% for cardiac death and MI (ranging from 0.3% for CCTA to 1.5% for Echo) during a mean follow-up of 2.6 ± 1.8 years. Conversely, a positive test was associated with an increased risk of future cardiac death and MI, with summarized HR estimates ranging from 1.48 (95% confidence interval [CI] 0.94–2.32) for SPECT to 10.93 (95% CI 6.75–17.70) for CMR-perfusion. Since considerable differences exist in the investigated study populations, direct comparisons of the modalities are not appropriate.

Poster

Conclusions: A negative non-invasive cardiac imaging test conveys an excellent prognosis for patients with suspected or known CAD, whereas a positive test indicates a substantially higher risk of cardiac death and MI. The current meta-analysis provides a higher level of evidence that noninvasive cardiac imaging allows appropriate risk-stratification in these patients. Liggende poster, nr 34

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Abstract

Sophie Joosten PhD student Oncologie GROW Epigenetic marker development for a decision support system in renal cancer treatment with sunitinib P.M.M.B. Soetekouw2, M.J. Aarts2, M. van Engeland1,3, V.C.G. Tjan-Heijnen2 1. GROW, Research school for Oncology and Developmental Biology, MUMC, Maastricht 2. Division of Medical Oncology, Department of Internal Medicine, MUMC, Maastricht 3. Department of Pathology, MUMC, Maastricht Rationale: Clear cell renal cell carcinoma (ccRCC) is the most common form of kidney cancer, accounting for 75-80% of all cases. ccRCC is often asymptomatic, and approximately 30% of the patients have metastasized disease at time of diagnosis with a 5-year survival rate of less than 10%. The introduction of targeted agents, such as sunitinib, in the treatment of ccRCC has made a significant impact on the survival of these patients. However, response rates to sunitinib lie around 30%, suggesting intrinsic resistance in a large group of patients. Furthermore, disease progression usually occurs after 6-15 months despite continuous treatment, indicating the development of acquired resistance. There is a need for predictive markers to select patients that will benefit from treatment with sunitinib. At this time, the choice of therapy is based on the Motzer criteria that include clinical factors such as performance status, disease-free interval and several laboratory variables. No molecular markers reflecting the biological behavior of the tumor are available for predictive purposes, resulting in overtreatment of patients without benefit of the treatment. In other tumor types, epigenetic silencing of specific genes has been shown to be able to predict the response to treatment. O6-methylguanine methyl transferase (O6-MGMT) promoter CpG island hypermethylation in glioblastoma predicts response to treatment with temozolomide and Werner gene (WRN) hypermethylation in colorectal cancer has been associated with response to irinotecan. Therefore, we hypothesize that promoter methylation of genes involved in the sunitinib pathways predict the response to sunitinib, providing possible predictive markers that can be implemented to guide treatment decisions for advanced RCC treatment, thereby avoiding overtreatment of these patients. Objective: To explore the methylome of sunitinib-resistant and sunitinib-sensitive ccRCC, and to identify novel biomarkers that can predict response to sunitinib. We will combine molecular analysis and patient parameters to develop a decision support tool to guide sunitinib treatment of ccRCC patients.

Poster

Study design: A translational, retrospective study to identify methylation markers that predict response to sunitinib in patients with metastasized ccRCC. We will analyse tumor samples of 60 patients, of which 30 responders and 30 non-responders to sunitinib. An epigenome-wide methylation specific next generation sequencing approach, based on methyl-binding protein 2 (MBD2)-DNA interactions, will be performed to detect differences in the methylation patterns of sunitinib-sensitive and sunitinib-resistant ccRCC. Genes of interest found by this approach will be validated using methylation specific PCR (MSP). Also, we will integrate the clinical patient data (e.g. the Motzer criteria, disease free survival, and overall survival) and molecular data to obtain a decision support tool to guide sunitinib treatment in ccRCC patients. Liggende poster, nr 35

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Abstract

Tim de Ruijter PhD student Oncologie GROW Personalising a targeted therapy for anti-endocrine breast cancer treatment: The transDATA study J.P. de Hoon1,2, B. de Vries2,3, L. van Neste2,3, P.M.M.B. Soetekouw1,2, M. van Engeland2,3, J. Veeck1,2, V.C. Tjan-Heijnen1,2 1. Division of Medical Oncology, Department of Internal Medicine, MUMC, Maastricht 2. GROW, School for Oncology and Developmental Biology, MUMC, Maastricht 3. Department of Pathology, MUMC, Maastricht Introduction: Systemic breast cancer treatments usually produce outcome benefits only in a fraction of patients while others rapidly relapse. One reason for varying treatment response is the intertumoural heterogeneity of breast tumours as reflected by their numerous molecular differences. In about 70% of breast cancers growth depends on hormonal signalling, which is therapeutically addressed by either blockade of tumoural hormone receptor (HR) or reducing circulating oestradiol levels. Based on genomics HR positive tumours cluster in two clinical phenotypes, luminal A and luminal B breast cancer. Interestingly, early relapses and nonresponsiveness to anti-endocrine treatment is highly enriched in the luminal B subtype, yet the reasons for this remain unknown. DNA methylation profiling studies have shown a distinct DNA methylation pattern in luminal B cancers, suggesting a correlation between DNA methylation and poor outcome with antiendocrine treatment. This study assesses methylation differences between luminal A/B breast cancer in a systematic way, identifying predictive biomarkers for anastrozole and potential novel targets in anastrozole-unresponsive tumours. Methods: A biospecimen and data registry is set-up derived of a phase III multicenter study trialling the duration of anastrozole (3 vs. 6 years) in n=1895 post-menopausal women with HR positive breast cancer (DATA study). Formalin-fixed, paraffin-embedded (FFPE) tissues and clinical data are collected for n=1,000 cases. A tissue microarray (TMA) will be constructed allowing for clinical phenotyping. From this cohort, n=120 specimens will be defined consisting of luminal A/B breast cancers exhibiting un/favourable outcome. After optimisation of DNA processing methods, tumor DNA of these patients will be subjected to Infinium 450K arrays. Identified biomarkers of anastrozole response, potential targets of alternative treatment and discriminators between luminal A/B breast cancer will then be validated by immunohistochemistry as well as methylationspecific PCR in the total cohort (n=1,000). Results: So far, we have centrally collected clinical data for all n=1,895 cases, and FFPE tissues for n=288 cases. For TMA construction a fully automated arrayer (GrandMaster, 3D Histech) has been obtained and installed. The methods of FFPE DNA extraction have been optimised for DNA integrity, yield and purity by using different extraction kits (Qiagen, Promega) and tissue sources (cores, sections). In collaboration with a service partner, the integrity of extracted FFPE DNA has been further improved to a quality necessary for processing on Infinium 450K arrays.

Poster

Discussion: Here we present a study design for translational research in large clinical trials. The described DNA optimisation efforts facilitate the use of FFPE DNA on array-based tissue epigenomics. Having established the infrastructural requirements for a registry set-up will empower further studies of this kind. Liggende poster, nr 36

39


Abstract

Siamack Sabrkhany PhD student Department of Physiology CARIM Is platelet count confounding results in cancer biomarker research? M.J.E. Kuijpers1,2, A.W. Griffioen3, M.G.A. oude Egbrink1,4 1. Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht 2. Department of Biochemistry, Maastricht University, Maastricht 3. Angiogenesis Laboratory, Dept. of Medical Oncology, VU Medical Center, Amsterdam 4. Department of Physiology, Maastricht University, Maastricht Introduction: Angiogenesis regulatory proteins may be the key to the early detection of cancer. Since the discovery of tumor angiogenesis as a rate-limiting step in cancer progression, attempts to identify clinically relevant biomarkers in plasma and/or serum have not been successful. The recent discovery of platelets as transporters of tumor angiogenesis regulatory proteins may provide the solution. Platelets may not only serve as transporters but the total platelet count could also be abnormal in patients with an active malignancy. Hence, we hypothesize that platelet count is a confounder in biomarker research. To quantify the total blood growth factor content, we measured various angiogenic and angiostatic factors in platelets and in platelet free plasma (PFP) of a healthy control group. To determine platelet count dynamics in patients with cancer we recorded platelet count of patients before, during and after chemotherapy or surgery and compared this to platelet count of healthy individuals. Methods: Patients with confirmed lung cancer (stage I-IV; n=65) were included in our study. Exclusion criteria contained the use of a platelet-modifying drug or a blood transfusion in the previous two weeks, the presence of non-healing wounds/ulcers, an active inflammatory disease, or major surgery within 28 days prior to this study. Healthy individuals (n=20) were included as controls. All blood samples were collected from the antecubital vein in 3.2% sodium. A Beckman Coulter Counter was used to quantify platelet count in all subjects. Platelets and PFP were isolated from healthy individuals, after which concentrations of VEGF, PDGF, PF4 and CTAPIII were measured by ELISA. Results: A cancer stage dependent increase in platelet count of patients was observed in comparison to healthy individuals (P<0.001). Also chemotherapy and surgery showed to significantly affect platelet count (p<0.001). Quantification of different pro- and antiangiogenic factors revealed that the growth factors levels in platelets were much higher than those in platelet free plasma by factors of: VEGF (726-fold); PDGF (3930-fold); PF-4 (3144-fold); and CTAPIII (5466fold). Calculation of the circulating concentrations of these growth factors showed that the net platelet growth factor content in whole blood is also higher than in PFP by factors of: VEGF (3fold); PDGF (6-fold); PF-4 (4.5-fold); and CTAPIII (10-fold).

Poster

Conclusion: We confirmed that platelets are an important source of angiogenesis related growth factors in blood and that platelet count is dynamic in patients with cancer during chemotherapy and surgery. These findings indicate that biomarker researchers should look beyond traditional fluid sources of growth factors such as plasma or serum. In order to include the potential variations in platelet count, it is imperative to record platelet count in whole blood, so that measured concentrations per platelet can be used to calculate the circulating levels in whole blood. Liggende poster, nr 37

40


Abstract

Gaston Duijsens WESP-student Chirurgie Nee De kans op uitgebreide lymfekliermetastasering na een negatieve echo axilla bij het mammacarcinoom L.M. van Roozendaal1, M. Moossdorff1,2, R.M. Pijnappel3, S. Siesling4, M.B.I. Lobbes5, M.L. Smidt1 1. Afdeling Chirurgie, MUMC, Maastricht 2. GROW School for Oncology & Developmental Biology 3. Afdeling Radiologie, UMC Utrecht, Utrecht 4. Intergraal Kankercentrum Nederland (IKNL) 5. Afdeling Radiologie, MUMC, Maastricht In Nederland bestaat preoperatieve lymfeklierstadiëring van mammacarcinoompatiënten uit lichamelijk onderzoek en echografie van de axilla. Indien er klinisch geen verdachte lymfeklieren worden gedetecteerd (cN0), volgt een schildwachtklierprocedure. Bij een positieve schildwachtklier werd voorheen bij iedere patiënt een completerende okselklierdissectie (cOKD) verricht. De ACOSOG-Z0011 studie toonde aan dat een cOKD veilig achterwege gelaten kan worden bij cN0 mammacarcinoompatiënten met 1 of 2 schildwachtkliermetastasen, behandeld middels lumpectomie, adjuvante radiotherapie en systemische therapie. Dit resulteerde in twijfel ten aanzien van de waarde van de schildwachtklierprocedure. Dit heeft geleid tot het opzetten van de BOOG 2013-08 studie. In deze studie zullen vrouwen met een cT1-2N0 mammacarcinoom behandeld middels lumpectomie en radiotherapie van de mamma, gerandomiseerd worden voor wel versus geen schildwachtklierprocedure. Het doel van deze studie is om te onderzoeken of een negatieve echografie van de axilla accuraat is in het uitsluiten van uitgebreide lymfekliermetastasering (≥4 lymfeklieren, pN2-3) bij cT1-2N0 mammacarcinoompatiënten behandeld middels lumpectomie, schildwachtklierprocedure en radiotherapie van de mamma in een Nederlands cohort. Vrouwen met cT1-2N0 mammacarcinoom, gediagnosticeerd tussen 2011 en 2012 en behandeld middels lumpectomie, schildwachtklierprocedure en radiotherapie, werden geïncludeerd. De data evenals de centra werden geanonimiseerd aangeleverd door IKNL uit de Nederlandse Kankerregistratie. De negatief voorspellende waarde voor het echografisch uitsluiten van uitgebreide lymfekliermetastasen werd berekend voor ieder centrum afzonderlijk en de voor alle centra tezamen. In totaal werden 10.806 patiënten geïncludeerd uit 85 centra. Na een negatieve echografie van de axilla toonde de schildwachtklier en/of het cOKD in 812 (7,5%) van de patiënten een micrometastase (pN1mi), in 1247 (11,5%) 1-3 macrometastasen (pN1) en in 193 (1,8%) 4 of meer macrometastasen (pN2-3). Dit resulteert in een mediane negatief voorspellende waarde voor een negatieve echografie van de axilla voor het uitsluiten van pN2-3 van 98,6%. De negatief voorspellende waarde tussen de deelnemende centra onderling varieert tussen 86.7%-100%.

Poster

Concluderend, een negatieve echografie van de axilla mist slechts bij 1.8% van de patiënten uitgebreide lymfekliermetastasen (pN2-3) bij patiënten met een cT1-2N0 mammacarcinoom behandeld middels lumpectomie, schildwachtklierprocedure en radiotherapie van de mamma. Deze Nederlandse cohortstudie laat zien dat de echografie een betrouwbaar instrument is voor het aantonen van uitgebreide lymfekliermetastasen, en derhalve accuraat patiënten kan selecteren die voldoen aan de inclusiecriteria van de BOOG 13-08 studie. Staande poster, nr 38

41


Poster

Lisa Hillen Arts-assistent in opleiding Pathologie Nee Antiviral drugs to target malignant melanoma A. Haugg1, A. zur Hausen1, V. Winnepenninckx¹ 1. Department of Pathology, MUMC, Maastricht Skin cancer is the second most common cancer in the Netherlands with malignant melanoma (MM) as the major cause of death. Every year 4.500 to 5.000 patients are diagnosed with MM in the Netherlands (data from IKNL). Of importance, death rates and incidence are increasing in contrast to neighbouring countries. This difference might be owed to the different international treatment regimens. Early detection and complete surgical resection remains the golden therapeutic standard to reduce mortality. In advanced disease, treatment options are limited and rarely curative. Therapy is applied according to stage of disease which is based on histomorphological and clinical criteria. Molecular profiling of MM has recently led to the development of targeted therapies with BRAF inhibitors and combinations with MEK inhibitors. Unfortunately, a multitude of critical issues have arisen with these new therapy options: I) development of tumor resistance to BRAF inhibitors, II) high rate of considerable adverse effects and III) unsolved economic issues reflecting the high costs of these targeted therapies. Finally, adequate treatment options for the remaining 52% MM patients harbouring of non-mutated BRAF are lacking. In the framework of drug repositioning, establishment of new drug combinations and patient stratification we have conducted an in-vitro investigation, assessing the tumour-sensitivity to classically used immunotherapeutic drugs alone and in combination with off-use (antiviral) drugs for the treatment of MM. We selected a panel of BRAF mutated and BRAF wildtype human melanoma cell lines. Anticancer sensitivity of interferon alpha 2b (IFNa2b) - an internationally widely used immunomodulator in advanced stages of melanoma - was assessed in these cell lines. IFNa2b is also used in other therapeutic regimes, e.g. renal cell carcinomas and Hepatitis C and B virus infection. In this setting the triad of IFNa2b together with the antiviral drugs Ribavirin and Proteaseinhibitors such as Saquinavir has shown beneficial therapeutic outcome compared to monotherapy. Here we successfully tested the response of melanoma cell lines to immunotherapy with IFNa2b and repositioning of an antiviral therapeutic triad of IFNa2b, Ribavirin and Saquinavir in an anti-melanoma setting. Our experiments showed heterogeneous sensitivity to these drugs alone and in combinatory experimental designs. The different drug responsiveness yielded into two groups of MM cells revealing a Ribavirin sensitive group and a Ribavirin less-sensitive group, whereby a reciprocal trend was seen regarding responsiveness to IFNa2b in melanoma cells. In line with these findings, cytomorphological observations, in vitro characteristics and with one exception also the BRAF mutational status could also be clustered to the preliminary identified drug-related groups. Concluding we could show responsiveness of antiviral drugs in the investigated human melanoma cell lines. Furthermore stratification based on drug responsiveness, morphology and proliferative activity could be developed in this study. The underlying molecular biology of the drug-related groups remains to be elucidated in future experiments. Cell line modelling might be a potential tool for personalizing treatment strategies in MM patients by identifying BRAF-inhibitor responders and those patients benefiting from combination therapy or alternative chemo- and immunotherapeutic reagents. Staande poster, nr 39

42


Abstract

Marjolein Kleppe Arts-assistent in opleiding Gynaecologie en Obstetrie GROW Should appendectomy be performed in mucinous borderline tumours of the ovary? J. Bruls2, T. van Gorp1,3, L. Massuger2, B.F.M. Slangen1,3, K.K. van de Vijver3,4, A.J. Kruse1,3, R.F.P.M. Kruitwagen1,3 1. Department of Obstetrics and Gynecology, MUMC, Maastricht 2. Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen 3. GROW - School for Oncology and Developmental Biology, Maastricht 4. Department of Pathology, MUMC, Maastricht Objectives: Appendectomy is often recommended in patients with mucinous borderline ovarian tumours (mBOTs) based on studies suggesting that metastatic disease from a primary appendiceal tumour can mimic mBOT. The present study assessed the incidence of mucinous neoplasms in the appendix associated with the presence of mBOT. Methods: A retrospective cohort study was performed in two university hospitals in the Netherlands between 1990 and 2011. All patients with mBOT and/or a mucinous appendiceal tumour were included. Results: Of 127 patients included, 98 had a primary mBOT and 29 had a primary mucinous appendiceal tumour. In patients with an mBOT, the appendix was either removed at prior surgery (4%), resected as part of the staging procedure showing no pathological abnormalities (13%), described as normal and not resected (58%), or not described and not resected (25%). During a median follow-up period of 5 years (range 2−23), two patients developed a recurrence in which the appendix was not involved. In all patients with a primary mucinous tumour of the appendix, the appendix appeared abnormal at the time of surgery. Eight of these patients (28%) were diagnosed with invasive ovarian metastases. A review of the literature including the cases from this study identified 510 mucinous ovarian tumours with borderline features and 214 associated appendectomies, of which 4 (1.9%) contained a primary appendiceal malignancy.

Poster

Conclusions: A thorough inspection of the appendix should be performed in patients with a mucinous ovarian tumour with borderline features. An appendectomy should only be performed when the appendix is macroscopically abnormal. Staande poster, nr 40

43


Abstract

Marjan Klinkert WESP-student Chirurgie Nee Schildwachtkliermetastasering bij patiënten met de preoperatieve diagnose ductaal carcinoma in situ L.M. van Roozendaal1, M. Moossdorff1, J. Wesseling2, B. de Vries3,M.L. Smidt1 1. Afdeling Chirurgie, MUMC, Maastricht 2. Afdeling Pathologie, Antoni van Leeuwenhoek, Amsterdam 3. Afdeling Pathologie, MUMC, Maastricht Het ductaal carcinoma in situ (DCIS) is een pre-maligniteit van de mamma met toegenomen signalering sinds de introductie van de borstkankerscreening. Na de diagnose DCIS op histologisch biopt wordt bij circa 20% van de patiënten alsnog een invasief carcinoom gevonden in het resectiepreparaat. In de richtlijn wordt bij DCIS op biopt een schildwachtklierprocedure geadviseerd in geval van mastectomie, leeftijd <55 jaar, solide component op mammografie, verdenking op invasie en matig of slechte gedifferentieerde DCIS. Bij het invasieve mammacarcinoom bestaat de trend naar vermindering van de (chirurgische) behandeling van de oksel, DCIS is tot dusver aan deze trend ontsnapt. Het doel van deze inventarisatie-studie was te onderzoeken hoeveel patiënten met de preoperatieve diagnose DCIS een schildwachtkliermetastase hadden. Uit de lokale PALGA-database werden alle patiënten met alleen DCIS op biopt (periode 2008-2013) verzameld. Patiënten met tevens een ipsilateraal invasief mammacarcinoom op biopt werden geëxcludeerd. Klinische, radiologische en pathologische data van iedere patiënt werden verzameld. In totaal werden 161 patiënten geïncludeerd, waarvan 108 (67%) een schildwachtklierprocedure ondergingen. De schildwachtklier(en) waren negatief (pN0) bij 95/108 patiënten, 11/108 hadden geïsoleerde tumorcellen (pN0i+) en 2/108 hadden een micrometastase (pN1mi). Er werden geen macrometastasen aangetroffen. In totaal werd bij 133/161 patiënten alleen DCIS in het resectiepreparaat aangetroffen en bij 28/161 (17%) naast DCIS ook een invasief carcinoom. Een schildwachtklierbiopsie was verricht bij 83/133 patiënten met alleen DCIS, resulterend in 75/83 pN0 en 8/83 pN0i+. Van de 28 patiënten met DCIS en een invasieve component hadden 25 patiënten een schildwachtklierbiopsie ondergaan. Pathologie toonde bij 20/25 patiënten pN0, bij 3/25 pN0i+ en bij 2/25 pN1mi. Eén van de twee patiënten met pN1mi had mammografisch een kalkhoudend gebied van 90mm en de diagnose DCIS graad 2 na histologisch biopt. Het mastectomiepreparaat toonde 105mm DCIS graad 3 waarin 90mm invasief ductaal carcinoom (IDC) graad 3. Een completerende okselklierdissectie werd niet verricht. De tweede patiënt met pN1mi had een niet-afwijkend mammogram, een massa op echografie en de diagnose DCIS graad 3 na histologisch biopt. Het lumpectomiepreparaat toonde 39mm DCIS graad 2 waarin 4mm IDC graad 1. De completerende okselklierdissectie (18 lymfeklieren) toonde een tweede micrometastase.

Poster

Concluderend blijkt uit deze inventarisatiestudie dat bij 17% van de patiënten met de preoperatieve diagnose DCIS alsnog een invasieve component werd gevonden in het resectiepreparaat, vergelijkbaar met beschikbare literatuur. Onafhankelijk van deze conversie toont de schildwachtklierprocedure slechts in 1,5% een metastase. De schildwachtklierprocedure lijkt derhalve meer overbehandeling dan goede zorg. Het aantal patiënten zal worden uitgebreid met data uit meerdere Nederlandse centra. Staande poster, nr 41

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Abstract

Ruben Vogels PhD student Chirurgie NUTRIM Biocompatibility and mechanical analysis of a new elastic polyurethane suture A. Lambertz1, P. Schuster3, S. Jockenhoevel3, N.D. Bouvy2, C. Disselhorst-Klug4, U.P. Neumann1, U. Klinge1, C.D. Klink1 1. Department of General, Visceral and Transplantation Surgery, RWTH Aachen, Germany 2. Department of General Surgery, MUMC, Maastricht 3. Institut fuer Textiltechnik at RWTH Aachen University, Germany 4. Applied Medical Engineering, Helmholtz Institute, RWTH Aachen, Germany Background: Current surgical threads are mostly made of non-elastic materials like polypropylene. As a suture material these rigid treads can cause wound comlications due to compression of tissue with subsequent tissue damage. Elastic materials could reduce these complications by adapting the thread length and thus reduce tension. Aim of this study was to evaluate the biocompatibility of an elastic Thermoplastic Polycarbonate Urethane (PCU) thread in a rat model and the biomechanical characteristics of PCU sutures in vivo in a pig model. Methods: PCU and polypropylene threads (2-0 USP size) were implanted subcutaneously in 48 rats for 7 or 21 days; every rat received both suture types. The extent of inflammatory tissue response was assessed and immunohistochemistry was performed for macrophages (CD68), apoptosis, and proliferation (KI67). Subsequently, tension experiments were performed in a pig. Suture tension of knotted polypropylene and PCU sutures was measured during the first 30 minutes after implantation. Results: In a rat model the extent of foreign body reaction between PCU and PP sutures was comparable. Significantly less macrophages were found in the granuloma of PCU sutures after 21 days (p=0,015). The amount of apoptotic cells was significantly less in PCU groups at both timepoints (p<0,05). The tension experiments show a significantly reduced peak tension in the PCU group with a significant reduction in tension loss in the first minute when compared to polypropylene (p<0,05). After 30 minutes both materials have highly comparable residual suture tensions.

Poster

Conclusions: Elastic PCU sutures show excellent biocompatibility and the elastic nature of the material leads to superior tension curves for knotted sutures. The use of this material in surgical practice as suture material or as basis for other scaffolds requiring elasticity should be evaluated. Staande poster, nr 42

45


Michiel de Wolf Arts-assistent in opleiding Anaesthesie Nee Emergency ventilation through an airway exchange catheter using Ventrain: an animal study R. Gottschall1, N. Preussler1, B. Preussler1, D. Enk2 1. Afdeling Anaesthesie, Universitair Ziekenhuis Jena, Jena, Duitsland 2. Afdeling Anaesthesie, MUMC, Maastricht The ‘at-risk’ algorithm of the DAS extubation guidelines includes an airway exchange catheter (AEC)-assisted extubation [1]. Flow resistance of a small-bore AEC demands a high pressure oxygen source, but injecting compressed oxygen through an AEC in an airway emergency bears the risks of barotrauma, haemodynamic deterioration and even death. To minimize these hazards expiratory times have to be prolonged leading to low minute volumes. The Ventrain (Dolphys Medical, Eindhoven, The Netherlands) is a flow-regulated, manually operated ejector ventilator capable of assisting expiration by jet-flow generated suction [2]. This device has been shown to achieve minute volumes of about 7.5 L/min through a 100 cm long, 3 mm inner diameter (ID) AEC in-vitro [3]. The goal of our study was to investigate the efficacy of Ventrain connected to this AEC on reoxygenation and ventilation in an acute hypoxic animal model with a simulated completely obstructed airway. Methods: With approval of the local animal welfare committee six pigs (26.5-29.8 kg) were anaesthetised and pressure-controlled normoventilated (PCV) via a cuffed endotracheal tube with an FiO2 of 0.4. After placement of monitoring lines and baseline recordings the ventilator was disconnected. During apnoea the 100 cm long, 3 mm ID AEC was placed in the distal trachea through a bronchoscopy adapter simulating complete upper airway obstruction. When peripheral saturation reading revealed an oxygen saturation of 70 % (“0”), ventilation with Ventrain was started at an oxygen flow of 15 L/min, a frequency of 30/min, and an inspiration/expiration ratio of 1 : 1 while continuously observing chest movements. Arterial blood samples were collected at baseline, “0”, and during ten minutes after resumption of ventilation. Results: The minute volume necessary for normoventilation during PCV was 5.1 [3.6-6.3] L/min. No signs of barotrauma or haemodynamic deterioration were noted. The data are presented as median [range]. Arterial bloodgass samling revealed oxygen saturations to have dropped to 47.3% [29.6-56.9] during apnoea and pCO2 to have risen to 59.5 [51.7-63.3] mmHg. After commencement of ventilation using Ventrain, oxygen saturations and pCO2 levels returned to baseline within one minute. Discussion: Ventilation with Ventrain through small-bore AEC’s ensures rapid re-oxygenation and sufficient ventilation. As (almost completely) decompressed oxygen is insufflated and expiration can be assisted, Ventrain overcomes the drawbacks of jet ventilation through an AEC when managing airway obstruction after extubation. Conflicts of interest: D. Enk is the inventor of the Ventrain and receives royalty payments from Dolphys Medical.

Poster

References: 1. Popat M et al.. Anaesthesia 2012; 67: 318-40. 2. Hamaekers A, Borg P, Enk D. British Journal of Anaesthesia 2012; 108: 1017-21. 3. Dias EM et al.. European Journal of Anaesthesiology 2012; 29 (Suppl. 50): 239-40. Staande poster, 43

46


Dirk Schellekens PhD student Chirurgie NUTRIM SM22 in plasma and urine reflects transmural ischemic injury of the intestines K. Reisinger1,2, J. Derikx1,2, K. Lenaerts1,2, M. Poeze1,2, W.Buurman2, K. Dejong1,2 1. Department of Surgery, MUMC, Maastricht 2. NUTRIM School for Nutrition, Toxicology and Metabolism, MUMC, Maastricht Acute mesenteric ischemia is an abdominal emergency requiring rapid diagnosis and treatment since the duration of ischemia is the most important determinant of outcome. Current biomarkers only detect ischemic mucosal injury, whereas differentiation between mucosal and transmural ischemic intestinal damage is imperative because only the later needs emergency surgery. A previous study showed that SM22 (22-kDa protein exclusively expressed in visceral smooth muscle tissue) is a potential biomarker for intestinal muscularis externa injury. Our aim is to study SM22 release test characteristics and its usefulness in differentiation between mucosal and transmural damage in patients. SM22 release was investigated in rats subjected to mesenteric ischemia by 0, 2, 4, 6, 8, 12, 24 hours jejunal blood supply ligation. One day after laparotomy blood, urine and tissue was sampled and SM22 concentrations were measured using a newly build ELISA. Organ-specific SM22 release and clearance was studied in blood drawn from portal, hepatic, renal vein and a (radial) artery in rats and in 10 patients undergoing major upper abdominal surgery. SM22 and I-FABP (a sensitive marker to study enterocyte damage) were quantified in plasma of 12 patients with proven intestinal ischemia and 50 healthy volunteers. Tissue sections were stained with haematoxylin/eosin (HE) and SM22. In rats, histological assessment revealed degeneration of the mucosa and necrosis of the muscular layers of the intestinal wall in jejunum exposed to 24h ischemia as compared to control. Staining for SM22 revealed a decrease in staining intensity or even a total absence of SM22 protein in the muscular layers after 24h ischemia. Baseline plasma SM22 levels were ≤0.1 ng/ml in all animals. After ischemia, SM22 plasma levels continued to rise significantly for the 24h period compared to control (p < 0.05). Urinary SM22 concentrations were significantly higher in rats with intestinal ischemia compared to control (p < 0.05). Transorgan measurements showed that SM22 was specifically released from the intestines and removed from circulation by the kidneys, resulting in a plasma half-life of about 16 minutes in rats and 22 minutes in man. SM22 levels were significantly higher in patients with histopathological proven transmural infarction compared to patients with only ischemic mucosal injury and healthy controls (5.9 ng/ml vs 0.6 ng/ml and 0.4 ng/ml (p < 0.001), respectively).

Poster

In conclusion, SM22 is released into the circulation after severe intestinal ischemic injury and is potentially useful as a marker for the detection of transmural injury during intestinal ischemia. Liggende poster, nr 44

47


Abstract

Martijn Smulders PhD student Cardiologie CARIM Utility of CMR for Differentiating Acute From Chronic Myocardial Infarction S.C.A.M. Bekkers1, H.W. Kim2,3, L.M.R.van Assche2,3, M.A. Parker2,3, R.J. Kim2,3,4 1. Department of Cardiology, MUMC, Maastricht 2. Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, NC, USA 3. Division of Cardiology, Duke University Medical Center, NC, USA 4. Department of Radiology, Duke University Medical Center, NC, USA Introduction: Published reports have concluded that T2-weighted CMR (T2W-CMR) is highly accurate in differentiating acute from chronic MI. However, the majority of patients investigated had infarcts <1-week-old or >6-months-old. Clinically, it would be vital to distinguish an infarct a few days versus a few months old, however some studies suggest T2W-CMR edema may persist for months [Heart 2001;85:639-42, AHJ 2007;154:929-36], possibly precluding this differentiation. Purpose: The study primary aim was to assess the prevalence of T2W-CMR edema across a range of infarct ages and to assess its accuracy with and without the inclusion of intermediate-aged infarcts. Secondary aims were to evaluate other CMR markers of acute MI, and to compare image quality of CMR techniques. Methods: 221 CMR studies were performed at various time points post-MI in 117 first STelevation-MI patients enrolled prospectively and consecutively from two CMR centers. Prespecified markers of "acute" MI were hyperintensity on T2W-CMR, microvascular obstruction (MO) on delayed-enhancement-CMR (DE-CMR), and increased end-diastolic wall thickness (Increased-EDWT, >150% of remote measured quantitatively) on cine-CMR. Images were scored blinded to identity and all clinical information. Individual CMR techniques were interpreted separately. Image quality and frequency/severity of artifacts were also evaluated. Results: Mean age was 58±11 years; 84% were men. Prevalence of T2W-CMR hyperintensity steadily decreased for older infarcts starting 1-month post-MI but was still substantial for 1-6 month-old infarcts (Panel A). Even after requiring T2W-hyperintensity to be in the correct infarctrelated-artery territory (to reduce false positives post-hoc) prevalence was 59% (1-3 months), 32% (3-6 months), and 4% (>6-months). Individually, prevalence of MO (57%) and Increased-EDWT (45%) was low for <1-week-old infarcts but substantially increased in combination (77%, p<0.001) while retaining low prevalence for intermediate-aged infarcts (Panel B). Defining acute and chronic MI as <1 and ≥1-month-old, T2W sensitivity and specificity were 88% and 66%. For combined DE/Cine-CMR this was 74% and 97%. When removing patients with 1-6-month-old infarcts, T2WCMR specificity increased to 83% (p<0.01). One-third of T2W-images were graded poor, nearly 5fold higher than cine or DE-CMR (Panel C), as 52% and 92% of T2W-images had some myocardial signal drop-out (2.4±1.8 segments of 17-segments) and/or slow flow (7±3.5 segments).

Poster

Conclusion: Sensitivity of T2W-CMR to detect <1-month-old infarcts is moderately high, but because edema may persist, T2W-CMR is less specific when including intermediate-aged infarcts (1-6 months). Although mildly less sensitive, the presence of MO or increased-EDWT on DE/cineCMR is very specific, and unlike T2W-CMR image quality is rarely poor. Liggende poster, nr 45

48


Abstract

Mathijs Vaessen Arts-assistent in opleiding Oogheelkunde Nee Opsporing van glaucoom: onderzoek en verwijzing door extramurale optometristen H.J.M Beckers1, A. Coops1,2, H.G. Lemij3, N.M. Jansonius4, C.A.B. Webers1 1. Afdeling Oogheelkunde, MUMC, Maastricht 2. Optometristen Vereniging Nederland 3. Afdeling Oogheelkunde, Oogziekenhuis Rotterdam 4. Afdeling Oogheelkunde, Universitair Medisch Centrum Groningen Doel: Het vaststellen van de diagnostische accuratesse en uitvoerbaarheid van de OVN glaucoomrichtlijn voor extramurale optometristen. Methode: Alle opeenvolgende cliënten (≥45 jaar) van participerende optometriepraktijken komen in aanmerking voor glaucoomonderzoek volgens een ‘intent to examine’ principe. Primaire uitkomstmaten zijn het percentage (correct) uitgevoerde onderzoeken en het percentage verwezen cliënten. Verwezen cliënten worden in de tweede lijn geclassificeerd als glaucoompatiënt, glaucoom suspect of anderszins. Voorlopige resultaten: 868 van de eerste 1379 cliënten (63%) werden onderzocht. De richtlijn werd in 742 van de 868 gevallen (85%) correct opgevolgd. Zesenzestig cliënten werden verwezen waarvan 43 (65%) geclassificeerd werden als glaucoompatiënt of glaucoom suspect.

Poster

Conclusie: De richtlijn heeft een positief voorspellende waarde van 65%. Voor een effectievere opsporing van glaucoom zou het percentage onderzochte cliënten hoger moeten liggen. Liggende poster, nr 46

49


Nienke Visser Arts-assistent in opleiding Oogheelkunde MHeNS Toric vs monofocal intraocular lens implantation in patients with cataract and corneal astigmatism H.J.M. Beckers1, N.J.C. Bauer1, S.T.J.M. Gast1, C.A.B. Webers1, R.M.M.A. Nuijts1 1. Afdeling Oogheelkunde, MUMC, Maastricht Purpose: To compare toric and monofocal intraocular lens (IOL) implantation in patients with cataract and corneal astigmatism. Setting: University Eye Clinic Maastricht, the Netherlands. Method: Eighty-six patients with bilateral cataract and at least 1.25 D of corneal astigmatism were randomized for either bilateral toric or bilateral monofocal IOL implantation. Six months postoperatively the uncorrected and best-corrected distance visual acuity (UDVA and BDVA), refraction, misalignment, spectacle use for distance vision and complications were evaluated. Results: Postoperatively, the UDVA in the toric and monofocal group was 0.06 ± 0.14 and 0.21 ± 0.16 LogMAR, respectively (P<0.001). The BDVA was comparable in both groups: 0.00 ± 0.11 LogMAR in the toric group and -0.01 ± 0.09 LogMAR in the monofocal group(P>0.05). Seventy percent of patients with toric IOLs achieved a Snellen UDVA of at least 20/25, compared to 30% of patients with monofocal IOLs (P< 0.001). A refractive cylinder of 1.0 D or less was achieved in 74% of patients in the toric group and 30% of patients in the monofocal group (P<0.001). Seventy-eight percent of patients with toric IOLs reported being spectacle independent for distance vision, compared to 22% of patients with monofocal IOLs (P<0.001). Mean misalignment of toric IOLs was 3.6 ± 3.2 degrees and IOL repositioning was required in 1 patient.

Poster

Conclusion: Toric IOLs result in a better UDVA, a lower refractive astigmatism and a higher spectacle independence for distance vision compared to monofocal IOLs. Liggende poster, nr 47

50


Abstract

Laura Wielders PhD student Oogheelkunde Nee The ESCRS PREMED study: PREvention of Macular EDema after cataract surgery L.H.P. Wielders1, J.S.A.G. Schouten1,2, F.J.H.M. van den Biggelaar1, B. Winkens3, R.M.M.A. Nuijts1,2 1. Universiteitskliniek voor Oogheelkunde, MUMC, Maastricht 2. Regiopraktijk Oogheelkunde, Atrium Medisch Centrum Parkstad, Heerlen 3. Afdeling Methodologie en Statistiek, Universiteit Maastricht, Maastricht Introductie: Jaarlijks worden er in Nederland ongeveer 150.000 cataractoperaties uitgevoerd. Cystoid maculaoedeem (CMO) is een van de meest voorkomende oorzaken van visusvermindering na cataractchirurgie. Gebruik makend van Optical Coherence Tomography (OCT) kan de diagnose CMO na een cataractoperatie worden gesteld bij 4-20% van de gezonde patiënten. 0-5,8% van de patiënten ontwikkelt hierdoor ook daadwerkelijk een verminderde postoperatieve visus. Bij patiënten met diabetes mellitus (DM) ligt deze incidentie veel hoger: tot wel 56% van deze patiënten ontwikkelt klinisch significant CMO na een cataractoperatie. Het ontstaan van CMO beïnvloedt in grote mate het herstel na een cataractoperatie. Daarom zijn er de laatste jaren veel verschillende preventieve behandelingen voorgesteld om het ontstaan van CMO na cataractchirurgie te voorkomen. Helaas is er tot op heden nog geen gerandomiseerde, gecontroleerde studie uitgevoerd, waarin deze preventieve strategieën worden vergeleken. Doel: Het evalueren van verschillende behandelingen ter preventie van CMO na cataractchirurgie bij patiënten met en zonder DM. Methoden: Aan deze Europese multicenterstudie zullen in totaal 1050 patiënten zonder DM en 300 patiënten met DM deelnemen. De studie wordt gecoördineerd door de Universiteitskliniek voor Oogheelkunde Maastricht UMC en wordt gefinancierd door de European Society of Cataract & Refractive Surgeons (ESCRS). Patiënten ondergaan een reguliere cataractextractie met plaatsing van een intraoculaire lens. Patiënten zonder DM worden behandeld met non-steroidal anti-inflammatory drug (NSAID) oogdruppels (bromfenac), corticosteroïd oogdruppels (dexamethason) of een combinatie van beide. Patiënten met DM worden behandeld met beide oogdruppels en worden vervolgens gerandomiseerd over een aantal peroperatieve behandelingsstrategieën, namelijk een subconjunctivale corticosteroïd injectie (triamcinolon acetonide), een intravitreale anti-vascular endothelial growth factor (anti-VEGF) injectie (bevacizumab) of een combinatie van beide. Een controlegroep zal enkel met bromfenac en dexamethason oogdruppels worden behandeld. De primaire uitkomstmaat van deze studie is de verandering in maculadikte zes weken postoperatief, in vergelijking met preoperatief. Verder zal het effect van deze behandelingen op de best gecorrigeerde vertevisus (logMAR) en kwaliteit van leven worden beoordeeld. Resultaten: Tot nu toe werden er 91 patiënten geïncludeerd in de studie. Definitieve resultaten van de PREMED study worden verwacht in 2015.

Poster

Discussie & Conclusie: Aan de hand van de resultaten van deze studie hopen wij wetenschappelijke aanbevelingen te kunnen doen, die zullen leiden tot een kosteneffectieve preventieve behandeling van CMO na cataractchirurgie bij patiënten met en zonder DM. Liggende poster, nr 48

51

Inhoudsopgave Naam (posternummer)

Pagina

Maikel Bakens, Chirurgie (19)

21

Sema Bektas, Cardiologie (17, 18)

19,20

Jurriaan Brekelmans, Oogheelkunde (1)

2

Dominique Disseldorp, Chirurgie (20, 21)

22, 23

Elleke Dresen, Radiologie (5)

6

Gaston Duijsens, Chirurgie (38)

41

Mari Elshout, Oogheelkunde (2)

3

Mark Hazebroek, Cardiologie (33)

36

Miriam van Heeswijk, Radiologie (6)

7

Jantien van der Heyden, Gynaecologie en Obstetrie (31)

33

Judith Hilderink, Interne Geneeskunde (22)

24

Lisa Hillen, Pathologie (39)

42

Inca Hundscheid, Chirurgie (23)

25

Caroline Jaarsma, Cardiologie (34)

37

Monique de Jong, Keel-, Neus-, en Oorheelkunde (24)

26

Soraya Jonker, Oogheelkunde (7)

8

Sophie Joosten, Oncologie (35)

38

Cécile Kicken, Anaesthesie (3)

4

Marjolein Kleppe, Gynaecologie en Obstetrie (40)

43

Marjan Klinkert, Chirurgie (41)

44

Madeleine Kok, Radiologie (25)

27

Noreen van der Linden, Klinische Chemie (26)

28

Esther Martens, Klinische neurofysiologie (8, 9)

9, 10

Milou Martens, Chirurgie (10)

11

Alma Mingels, Klinische Chemie (27)

29

Elwin Mommers, Chirurgie (11)

12

Givan Paulus, Chirurgie (12)

13

Marjolein van der Poel, Interne Geneeskunde (28)

30

Lucas Ricker, Oogheelkunde (4)

5

Hellen Römkens, Oogheelkunde (13)

14

Tim de Ruijter, (36)

39

Desiree Rutten, Cardiologie (32)

34

Siamack Sabrkhany, Fysiologie (37)

40 52

Karin Sanders, Longziekten (14)

15

Dirk Schellekens, Chirurgie (44)

47

Roald Schnerr, Radiologie (29)

31

Ellen Schoorel, Interne Geneeskunde (30)

32

Martijn Smulders, Cardiologie (45)

48

Mathijs Vaessen, Oogheelkunde (46)

49

Koen Vermorgen, Oogheelkunde (15)

16

Nienke Visser, Oogheelkunde (47)

50

Ruben Vogels, Chirurgie (42)

45

Laura Wielders, Oogheelkunde (48)

51

Michiel de Wolf, Anaesthesie (43)

46

Eleana Zhang, Neurologie (16)

17

53

in samenwerking met de Centrale OpleidingsCommissie Abstracts Wetenschapsdag

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