Fetal Tachyarrhythmia - Part I: Diagnosis

Fetal tachycardia, first recognized in 1930 by Hyman et al1, is a condition occurring in approximately 0.4-0.6% of all pregnancies2. A subset of these cases with more sustained periods of tachycardia is clinically relevant. The necessity of therapeutic intervention in this condition is still a matter of discussion focused on the natural history of the disease. The spectrum of opinions varies from non-intervention3,4,5 based on a number of cases in which the tachycardia subsided spontaneously6, to aggressive pharmacotherapeutic intervention7,8 based on reports of deterioration of the fetal condition ultimately ending in significant neurological morbidity9,10,11, or fetal demise12,13,14. Prenatal treatment through indirect, maternally administered drug therapy seems to be the preference of most centers15,16,17,18,19,20,21. This matter will be discussed further in Fetal Tachyarrhythmia, Part II, Treatment

Fetal Tachyarrhythmia - Part II: Treatment

The decision to initiate pharmacological intervention in case of fetal tachycardia depends on several factors and must be weighed against possible maternal and/or fetal adverse effects inherent to the use of antiarrhythmics. First, the seriousness of the fetal condition must be recognized. Many studies have shown that in case of fetal tachycardia, there is a significant predisposition to congestive heart failure and subsequent development of fetal hydrops and even sudden cardiac death1,2,3 Secondly, predictors of congestive heart failure have been suggested in several studies, such as the percentage of time that the tachycardia is present, the gestational age at which the tachycardia occurs4, the ventricular rate5 and the site of origin of the tachycardia6. However, the sensitivity of these predictors is low and they are therefore clinically not very useful. In addition, hemodynamic compromise may occur in less than 24 - 48 hours as has been shown in the fetal lamb7 and in tachycardic fetuses8,9. On the other hand, spontaneous resolution of the tachycardia has also been described10. Thirdly, transplacental management of fetuses with tricuspid regurgitation11, congestive heart failure or fetal hydrops is difficult12,13, probably as a result of limited transplacental transfer of the antiarrhythmic drug14,15. In case of fetal hydrops, conversion rates are decreased and time to conversion is increased13. Treatment of sustained fetal tachycardia is therefore to be preferred above expectant management, although some centers oppose this regimen and suggest that in cases with (intermittent) fetal SVT not complicated by congestive heart failure or fetal hydrops, conservative management and close surveillance might be a reasonable alternative16,17,18

Immunohistochemical and molecular studies on the pathogenesis of pheochromocytomas and paragangliomas

Abstract In the last decades major progress has been made in discovering genes implicated in the syndromic occurrence of pheochromocytomas (PCC) and paragangliomas (PGL). It’s now well established that about 35% of all PCC/PGL are due to germline mutations in one of the genes: RET, VHL, NF1, SDHA, SDHB, SDHC, SDHD, SDHAF2, TMEM127, MAX, PHD2, HIF2A, KIF1B, and FH. In addition, somatic mutations in RET, VHL, NF1, and HIF2A can also be detected in a subset of sporadic PCC/PGL. However, the pathogenesis of sporadic PCC and PGL is currently poorly understood. This issue has been investigated in the first part of this thesis (Chapters 2 and 3) by a candidate gene approach. SDHB and SDHA immunohistochemistry (IHC) is a valuable tool to identify PCC/PGL patients with mutations in one of the succinate dehydrogenase (SDH) genes. In the second part of this thesis we validated the reproducibility of this assessment method. Moreover, we determined if SDHA IHC could be a valuable tool to guide genetic testing in another tumor type from the SDH-associated tumor spectrum: gastrointestinal stromal tumors. In addition, we searched for new tools to validate SDH mutations. A major problem in PCC management remains the lack of predictive markers for malignancy and the lack of curative treatment options for progressive disease. In the last part of this thesis we focused on activation of intracellular pathways that could be targets for therapy and on validation of a prognostic tool for the distinction between benign and malignant PCC

Феномен мастурбации: негативное или позитивное явление?

Рассмотрены разные взгляды на роль мастурбации в становлении сексуальности человека. Представлены результаты собственных исследований автора, проведенных с целью установить значение этого феномена для формирования сексуального поведения и сексуального здоровья.Various opinions about the role of masturbation in human sexuality development are discussed. The findings of the original research performed to evaluate the significance of this phenomenon in formation of sexual behavior and sexual health are reported

Bleeding related to disturbed fibrinolysis

The components and reactions of the fibrinolysis system are well understood. The pathway has fewer reactants and interactions than coagulation, but the generation of a complete quantitative model is complicated by the need to work at the solid‐liquid interface of fibrin. Diagnostic tools to detect disease states due to malfunctions in the fibrinolysis pathway are also not so well developed as is the case with coagulation. However, there are clearly a number of inherited or acquired pathologies where hyperfibrinolysis is a serious, potentially life‐threatening problem and a number of antifibrinolytc drugs are available to treat hyperfibrinolysis. These topics will be covered in the following review

Receiving and providing informal care:Does context matter?

Boer, A.H. de [Promotor]Woittiez, I.B. [Copromotor

Периоды апробации метода прогноза интегральной метанообильности шахты

Розроблені аналітичній та натурній методи урахування метанового потенціалу вугільних шахт, апробація яких в умовах діючих об’єктів вдовж 5 термінів (1967 – 2009 рр.) показала високу надійність метода прогнозу інтегральної метанообільності шахт ІМА (~9 тис. порівнянь). На базі цього методу пропонується розробить державний нормативний документ для урахування метанового потенціалу вугільних шахт та реалізувати науково-технічні проекти авторів, які включені в програму науково-технічного розвитку Донецької області до 2020 р.Analytic and nature methods of calculation of methane potential of the collieries which check in the conditions of operating objects during 5 periods (1967 – 2009 years) has shown high reliability concerning of the method integrated methane of abundance of object IMA (~9 000 results) are developed. On the basis of this method it is offered to develop the state standard document for calculation of methane potential of collieries and to realize author’s projects to be conclusion to the science-technical program of development of Donetsk region to 2020 year