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Cosmetic outcome and patient satisfaction following percutaneous thermal ablation of early-stage breast cancer; results of an open label randomized phase 2 trial
No full textPurpose: The aim of the present study is to assess patient reported cosmetic outcome and satisfaction following percutaneous thermal ablation and subsequent breast-conserving surgery. Methods: Cosmetic outcome and patient satisfaction were assessed in postmenopausal women diagnosed with unilateral invasive cT1N0M0 breast cancer who participated in a randomized phase 2 treat-and-resect trial comparing the efficacy of radiofrequency ablation (RFA), microwave ablation (MWA) and cryoablation (CA). Cosmetic outcome was measured subjectively with the BCTOS-13 and the Beast-Q questionnaires (0–100 score), and objectively with BCCT.core software at baseline, after thermal ablation and after surgery. Patient satisfaction was defined as satisfaction with the technique (4 point scale), recommendation of the technique to others (yes/no), and the preference for surgery of thermal ablation after completion of both treatments. Results: Forty-one patients were included in the study. The overall median cosmetic outcome was good after thermal ablation, and intermediate after surgery (1.6 vs 1.8; P = 0.07). Most domains of the BREAST-Q were scored higher after thermal ablation, 95 % of patients were very satisfied or satisfied with the technique, and 91 % would prefer thermal ablation over surgery. Differences between the different techniques were limited On the BCCT.core, 94 % of cases were rated as good or excellent after thermal ablation, compared to 80 % after surgery. Conclusion: The present study demonstrates that patient reported and objectivated cosmetic outcomes are good both after thermal ablation and breast-conserving surgery. Patient satisfaction was outstanding following thermal ablation, with a preference for thermal ablation observed in a group of patients who underwent both treatment options.</p
HvJ-arrest Tauritus: Een nieuw hoofdstuk in de discussies rond de samenhang tussen douanewaarde en verrekenprijzen!?
No full textHoewel de Tauritus-uitspraak van het Hof van Justitie van de Europese Unie betrekking heeft op prijsaanpassingen na invoer tussen twee niet-verbonden partijen, betoogt Martijn Schippers in dit artikel dat het betekenis heeft voor de lopende discussies over de interactie tussen het bepalen van douanewaarden en verrekenprijzen. Hij betrekt daarvoor nationale rechtszaken en recent gepubliceerde instrumenten van de Technical Committee on Customs Valuation van de Wereldhandelsorganisatie in zijn betoog.<br/
Vascular Endothelial Growth Factor Tyrosine Kinase Inhibitors or Blocking Antibodies? Unraveling Vascular Endothelial Growth Factor Inhibition Strategies
No full textThe adventure of transdisciplinarity
Get PDFThe Adventure of Transdisciplinarity offers a critical appreciation of the promises, practices, and conceptualizations of transdisciplinarity in higher education. Using a range of methods, it explores how transdisciplinarity is theorized in the literature, how it takes shape in practice, and speculates on what it should or might become. Drawing on STS approaches, this study does not treat transdisciplinarity as a fixed method or framework, but as a situated process – one that must be continually forged and sustained in messy entanglement with institutional routines such as audits, grading processes, and the concerns of examination boards. Mundane practices often dismissed as peripheral or bureaucratic distractions emerge here as central to how transdisciplinarity is actually enacted.This dissertation ultimately proposes to understand transdisciplinarity as ‘the academic acknowledgment that we will not get out of this mess alone.’ Rather than echoing the familiar calls for ‘more autonomy’ or ‘greater independence’ in knowledge production, it reimagines transdisciplinarity as a pursuit of better dependence: a commitment to cultivating generative and response-able relations. In doing so, it reframes transdisciplinarity as an art of relation-making in pursuit of futures worth living.<br/
Beroep niet-ontvankelijk wegens misbruik procesrecht, belanghebbende moet proceskosten heffingsambtenaar vergoeden
No full textThe effectiveness of supplemental and replacement blended cognitive behavioral therapy for internalizing disorders:a meta-analysis
No full textBlended cognitive behavioral therapy (bCBT) combines the use of traditional in-clinic, face-to-face therapy sessions with online therapy platforms. The blended aspect can either be supplementary to face-to-face sessions, or a partial replacement of face-to-face sessions. While bCBT has been available for two decades, there is no statistically synthesized overview of its effectiveness in treating internalizing disorders, including anxiety and depression. In this study, we examined effectiveness in two meta-analyses: 1) comparing bCBT to treatment as usual; 2) comparing bCBT change scores from pre- to post-treatment. We tested the influence of moderators on effectiveness: blended method, online therapist contact, and diagnosis. In line with expectations, results from meta-analysis one (k = 19 studies, N = 2749) showed that supplementary bCBT leads to a significantly superior treatment effect over treatment as usual (Cohen’s d = 0.41, 95% CI [0.24, 0.59]) while replacement bCBT is on par with treatment as usual (d = -0.01, 95% CI [−0.18, 0.17]). Meta-analysis two included 32 studies (N = 1895) and showed significant improvement with bCBT (Morris’s D = 1.12, 95% CI [0.92, 1.33]), irrespective of blended method or therapist contact. Findings suggest that bCBT is a worthwhile form of treatment for both anxiety and depression.</p
First Trimester Maternal Folate and Vitamin B12 Concentrations and Their Associations With First-Trimester Placental Growth:The Rotterdam Periconception Cohort
No full text(Abstracted from Hum Reprod 2025 ;40(8):1485-1494) Embryonic development relies heavily on 1-carbon metabolism, which is influenced heavily by folate and vitamin B12. Both placental and embryonic and fetal development are affected, and previous research has shown supplementation with folic acid during early pregnancy reduces the prevalence of neural tube defects; some research has also shown that deficiencies in folate and vitamin B12 may be associated with adverse pregnancy outcomes such as preeclampsia and low birth weight.</p
Personalized management of patients with bleeding disorders
No full textIn this thesis, we aim to personalize management of hemophilia A by investigating the use of PK-guided dosing using Bayesian forecasting together with combination treatment of desmopressin and FVIII concentrate. Furthermore, we review the use of desmopressin in pregnancy and investigate patient perspectives on the use of desmopressin. In addition we performed in vitro studies with factor IX-FIAV, a possible novel treatment modality for hemophilia A patients with FVIII inhibiting antibodies. The use of aforementioned combination treatment of desmopressin and FVIII concentrate is reported as a possible solution to overcome drawbacks related to treatment with desmopressin or FVIII concentrate alone
Individualized dosing and administration strategies for anticancer therapies
No full textDe behandeling van kanker ontwikkelt zich snel, maar grote variatie tussen patiënten in respons, bijwerkingen en medicijnblootstelling blijft een uitdaging. Dit proefschrift richt zich op het optimaliseren van toedienings- en doseerstrategieën om therapieën beter af te stemmen op de individuele patiënt. In het eerste deel wordt de potentie onderzocht van intraperitoneale (IP) chemotherapie voor patiënten met maag- en darmkanker met buikvliesuitzaaiingen. Een belangrijk aandachtspunt is hoe geneesmiddelen de buikholte bereiken bij patiënten met buikvliesuitzaaiingen, waarbij natuurlijke barrières vaak effectieve blootstelling verhinderen. Studies naar katheter-gebaseerde IP-toediening (CBIP) en PIPAC laten zien dat hogere lokale medicijnconcentraties haalbaar zijn en mogelijk leiden tot verbeterde overleving. Klinische studies naar IP irinotecan tonen een goed verdraagbaar doseringsprofiel en bemoedigende eerste effectiviteitsresultaten. Daarnaast wordt duidelijk dat systemische chemotherapie slechts beperkt de buikholte bereikt, wat de rationale versterkt voor lokale toediening. Verder worden variaties in diagnose- en behandelpraktijken in kaart gebracht, wat heeft geleid tot een gestandaardiseerd nationaal protocol voor stageringslaparoscopie bij maagkanker.Het tweede deel onderzoekt hoe individuele verschillen in blootstelling aan orale doelgerichte therapieën kunnen worden verkleind. Therapeutic Drug Monitoring (TDM) blijkt voor verschillende middelen een effectieve manier om patiënten binnen de therapeutische marge te houden, al is de toepasbaarheid geneesmiddelafhankelijk. Daarnaast worden interacties met andere medicatie geëvalueerd en wordt farmacokinetisch ‘boosten’ onderzocht als strategie om de dosering van doelgerichte middelen zoals olaparib te verlagen zonder werkzaamheid te verliezen. Gezamenlijk tonen deze studies aan dat optimalisatie van zowel toediening als dosering essentieel is voor het verder personaliseren van kankerbehandeling.<br/
Medicalization of Death and Dying in Post-War Hungary and the Netherlands. Taboo and Transparency in Legal Thinking
No full textMedicalization of death and dying after World War II represented a significant shift in both Eastern and Western Europe, with implications for medical law and ethics. Death and dying became subjects of medical decisions and interventions. Increasingly, death occurred in hospitals and was preceded by various medicalprocedures aimed at prolonging life, sometimes artificially. Along with the process of medicalization, families and communities became less involved in the last phase of their loved ones’ lives. In this paper, we explore the repercussions of this process in two post-war societies that took very different paths in addressing doctors’ involvement in end-of-life decisions: Hungary and the Netherlands. The Netherlands is widely known for granting access to physician-assisted dying, including euthanasia and assisted suicide, following decades of legal cases, empirical reports, and legislative changes. In Hungary, although the issue has surfaced repeatedly in public discussions, it still constitutes a medical and legal taboo. Patient autonomy in Hungary developed much later and the legal progress has stagnated since 1997. Patients can refuse certain types of treatment, but only through a bureaucratic procedure. To understand the sharp contrast between the current laws in the two countries, we trace and compare legal developments and ethical thinking in both jurisdictions. We examine changes in the approach to the patient-doctor relationship, the role of information disclosure, patient autonomy, transparency, and the obstacles to these. Our analysis shows that striking the right balance between doctors’ professional responsibilities and patients’ rights remains a challenge in both countries.Keywords: medicalization; end-of-life decisions; Hungary; the Netherlands;law; ethic