Wetenschappelijk Jaaroverzicht

Wetenschappelijk Jaaroverzicht

Wetenschappelijk jaaroverzicht 2017 www.catharinaziekenhuis.nl Wetenschappelijk Jaaroverzicht 2017 Onder redactie van: JMAH Jansen (Jolanda) E Looije (Ellen) Een uitgave van het Catharina Ziekenhuis Eindhoven, 2018 © niets van deze uitgave mag worden gekopieerd zonder toestemming van de uitgever. Inhoudsopgave Algemeen Klinisch Laboratorium 5 Anesthesiologie 11 Apotheek 23 Cardiologie 54 Cardiothoracale Chirurgie 69 Chirurgie 58 Dermatologie 97 Diëtetiek 101 Geestelijke verzorging 103 Geriatrie 105 Gynaecologie 107 HaCa 124 Intensive Care 126 Inwendige geneeskunde 129 Kindergeneeskunde 146 Klinische Fysica 150 Kwaliteit 157 Longgeneeskunde 159 Maag, darm, leverziekten 164 Neurologie 171 Nucleaire Geneeskunde 177 Onderwijs & Onderzoek 179 Operatiekamers 182 Orthopedie 184 Pamm 187 Plastische Chirurgie 190 Psychiatrie 192 Psychologie 194 Radiologie 196 Radiotherapie 203 Spoedeisende hulp 210 Urologie 212 Boeken 217 Promoties 219 Wetenschapsavond Catharina Ziekenhuis 2018 224 Tabellen 239 Auteursindex 246 “Medicine is not only a science; it is also an art. It does not consist of compounding pills and plasters; it deals with the very processes of life, which must be understood before they may be guided” Paracelsus (1493-1541) Arts en Theoloog Algemeen Klinisch Laboratorium 5 Absence of the spleen and the occurrence of primary red cell alloimmunization in humans Evers D, van der Bom JG, Tijmensen J, de Haas M, Middelburg RA, de Vooght KMK, van de Kerkhof D, Visser O, Péquériaux NCV, Hudig F, Zwaginga JJ Haematologica. 2017 Aug 102(8):e289-e292 Epub 2017 Apr 14 Geen abstract beschikbaar Impactfactor: 7.702 Analytical evaluation of a new point of care system for measuring cardiac Troponin I Kemper DW, Semjonow V, de Theije F, Keizer D, van Lippen L, Mair J, Wille B, Christ M, Geier F, Hausfater P, Pariente D, Scharnhorst V, Curvers J, Nieuwenhuis J Clin Biochem. 2017 Mar;50(4-5):174-180. Epub 2016 Nov 12 OBJECTIVES: Point-of-care cardiac troponin testing with adequate analytical performances has the potential to improve chest pain patients flow in the emergency department. We present the analytical evaluation of the newly developed Philips Minicare cTnI point-of-care immunoassay. DESIGN & METHODS: Li-heparin whole blood and plasma were used to perform analytical studies. The sample type comparison study was performed at 4 different hospitals. The 99th percentile upper reference limit (URL) study was performed using Li-heparin plasma, Li-heparin whole blood and capillary blood samples from 750 healthy adults, aging from 18 to 86years. RESULTS: Limit of the blank, limit of detection and limit of quantitation at 20% coefficient of variation (CV) were determined to be 8.5ng/L, 18ng/L and 38ng/L respectively without significant differences between whole blood and plasma for LoQ. Cross-reactivity and interferences were minimal and no high- dose hook was observed. Total CV was found to be from 7.3% to 12% for cTnI concentrations between 109.6 and 6135.4ng/L. CV at the 99th percentile URL was 18.6%. The sample type comparison study between capillary blood, Li-heparin whole blood and Li-heparin plasma samples demonstrated correlation coefficients between 0.99 and 1.00 with slopes between 1.03 and 1.08. The method comparison between Minicare cTnI and Beckman Coulter Access, AccuTnI+3 demonstrated a correlation coefficient of 0.973 with a slope of 1.09. The 99th percentile URL of a healthy population was calculated to be 43ng/L with no significant difference between genders or sample types. CONCLUSIONS: The Minicare cTnI assay is a sensitive and precise, clinical usable test for determination of cTnI concentration that can be used in a near-patient setting as an aid in the diagnosis of acute myocardial infarction. Impactfactor: 2.434 Association of Blood Transfusion From Female Donors With and Without a History of Pregnancy With Mortality Among Male and Female Transfusion Recipients Caram-Deelder C*, Kreuger AL, Evers D, de Vooght KM, van de Kerkhof D, Visser O, Péquériaux NC, Hudig F, Zwaginga JJ, van der Bom JG, Middelburg RA JAMA. 2017 Oct 17;318(15):1471-1478 Importance: Transfusion of red blood cells from female donors has been associated with increased mortality in male recipients. Objective: To quantify the association between red blood cell transfusion from female donors with and without a history of pregnancy and mortality of red blood cell recipients. Design, Setting, and Participants: Retrospective cohort study of first-time transfusion recipients at 6 major Dutch hospitals enrolled from May 30, 2005, to September 1, 2015; the final follow-up date was September 1, 2015. The primary analysis was the no-donor-mixture cohort (ie, either all red blood cell transfusions exclusively from male donors, or all exclusively from female donors without a history of pregnancy, or all exclusively from female donors with a history of pregnancy). The association between mortality and exposure to transfusions from ever-pregnant or never-pregnant female donors was analyzed using life tables and time-varying Cox proportional hazards models. Exposures: Red blood cell transfusions from ever-pregnant or never-pregnant female donors, compared with red blood cell transfusions from male donors. Main Outcomes and Measures: All-cause mortality during follow-up. Results: The cohort for the primary analyses consisted of 31?118 patients (median age, 65 [interquartile range, 42-77] years; 52% female) who received 59?320 red blood cell transfusions exclusively from 1 of 3 types of donors (88% male; 6% ever-pregnant female; and 6% never-pregnant female). The number of deaths in this cohort was 3969 (13% mortality). For male recipients of red blood cell transfusions, all- cause mortality rates after a red blood cell transfusion from an ever-pregnant female donor vs male 6 donor were 101 vs 80 deaths per 1000 person-years (time-dependent "per transfusion" hazard ratio [HR] for death, 1.13 [95% CI, 1.01-1.26]). For receipt of transfusion from a never-pregnant female donor vs male donor, mortality rates were 78 vs 80 deaths per 1000 person-years (HR, 0.93 [95% CI, 0.81-1.06]). Among female recipients of red blood cell transfusions, mortality rates for an ever-pregnant female donor vs male donor were 74 vs 62 per 1000 person-years (HR, 0.99 [95% CI, 0.87 to 1.13]); for a never- pregnant female donor vs male donor, mortality rates were 74 vs 62 per 1000 person-years (HR, 1.01 [95% CI, 0.88-1.15]). Conclusions and Relevance: Among patients who received red blood cell transfusions, receipt of a transfusion from an ever-pregnant female donor, compared with a male donor, was associated with increased all-cause mortality among male recipients but not among female recipients. Transfusions from never-pregnant female donors were not associated with increased mortality among male or female recipients. Further research is needed to replicate these findings, determine their clinical significance, and identify the underlying mechanism. Impactfactor: 44.405 CAD mutations and uridine-responsive epileptic encephalopathy Koch J, Mayr JA, Alhaddad B, Rauscher C, Bierau J, Kovacs-Nagy R, Coene KL, Bader I, Holzhacker M, Prokisch H, Venselaar H, Wevers RA, Distelmaier F, Polster T, Leiz S, Betzler C, Strom TM, Sperl W, Meitinger T, Wortmann SB, Haack TB Brain. 2017 Feb 140(2):279-286. Epub 2016 Dec 21 Unexplained global developmental delay and epilepsy in childhood pose a major socioeconomic burden. Progress in defining the molecular bases does not often translate into effective treatment. Notable exceptions include certain inborn errors of metabolism amenable to dietary intervention. CAD encodes a multifunctional enzyme involved in de novo pyrimidine biosynthesis. Alternatively, pyrimidines can be recycled from uridine. Exome sequencing in three families identified biallelic CAD mutations in four children with global developmental delay, epileptic encephalopathy, and anaemia with anisopoikilocytosis. Two died aged 4 and 5 years after a neurodegenerative disease course. Supplementation of the two surviving children with oral uridine led to immediate cessation of seizures in both. A 4-year-old female, previously in a minimally conscious state, began to communicate and walk with assistance after 9 weeks of treatment. A 3-year-old female likewise showed developmental progress. Blood smears normalized and anaemia resolved. We establish CAD as a gene confidently implicated in this neurometabolic disorder, characterized by co-occurrence of global developmental delay, dyserythropoietic anaemia and seizures. While the natural disease course can be lethal in early childhood, our findings support the efficacy of uridine supplementation, rendering CAD deficiency a treatable neurometabolic disorder and therefore a potential condition for future (genetic) newborn screening. Impactfactor: 10.292 Equal clinical performance of a novel point-of-care cardiac troponin I (cTnI) assay with a commonly used high- sensitivity cTnI assay Venge P, van Lippen L, Blaschke S, Christ M, Geier F, Giannitsis E, Hagström E, Hausfater P, Khellaf M, Mair J, Pariente D, Scharnhorst V, Semjonow V Clin Chim Acta. 2017 Mar 25;469:119-125 BACKGROUND: Efficient rule-out of acute myocardial infarction (MI) facilitates early disposition of chest pain patients in emergency departments (ED). Point-of-care (POC) cardiac troponin (cTn) may improve patient throughput. We compared the diagnostic accuracy of a novel cTnI test (Minicare cTnI, Philips), with current POC cTnI (I-Stat, Abbott) and high-sensitivity central laboratory cTnI (hs-cTnI; Architect, Abbott) assays. METHODS: The clinical performance of the assays were compared in samples from 450 patients from a previous clinical evaluation of Minicare cTnI. RESULTS: Minicare cTnI correlated with Architect hs-cTnI (r2=0.85, p<0.0001) and I-Stat cTnI (r2=0.93, p<0.0001). Areas under the receiver operating characteristics curves were 0.87-0.91 at admission (p=ns) and 0.96-0.97 3h after admission (p=ns). The negative predictive values (NPV) at admission were 95% ((92-97%, 95% CI) for Minicare cTnI and increased to 99% (97-100%) at 2-4h, and similar to Architect hs- cTnI (98%, 96-100%), but higher than I-Stat cTnI (95%, 92-97%; p<0.01).

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