Academic Ceremonies April 2013

“Postprandial  muscle protein synthesis in the elderly”

Old age involves loss of muscle mass. This dissertation describes a series of nutritional interventions that will be used to effectively raise the muscle structure in the elderly.   Physical exercise before meals is an effective way to achieve this. Also, the quality of the protein in the meals and the quantity play an important role. Quickly digestible proteins are more effective than slowly digestible proteins; particularly the consumption of whey protein (from milk) turned out to be very effective. The quantity of whey protein that has to be consumed in a single meal to raise the maximally raise the muscle structure amounts to 35 grams or more.

Key words:

muscles, old age, proteins, nutrition, milk, meat

“European Union Property Law; From fragments to a system”

The European Union’s internal market has enabled ever more people and companies to buy and sell property across borders. However, Member States’ laws governing property transactions vary, and do not allow parties to choose one country’s property law for their transaction. Adapting to different laws raises transaction costs, and differences between the countries’ property laws may result in a party losing their property rights. European property laws which can be used throughout the Union would therefore be helpful. The central aim of this dissertation has been to propose such European rules of property law.

Key words:

European law, property transactions

“The Ubiquitin Proteolytic System: From the Backyard to the Forefront of Biological Research and Clinical Applications”

“Childhood overweight: The influence of parenting on children’s energy balance-related behavior”

This dissertation studies the influence of education styles and specific parenting practices on the eating and exercise behaviour of children, because this influence appears to be considerable.  Due to a lack of reliable Dutch surveys for parents these were first developed and validated. Subsequently, parents from the KOALA birth study filled out these surveys for their children. Results show that food practices within a family have great influence on the eating behaviour of children.  Children eat healthier when parents are in control of what their child eats. Exercising pressure to eat more and giving food as a reward has a reverse effect. The effect of food rules on the eating behaviour of children further depends on the parenting climate at home and the child’s character (temperament and eating style). In a positive parenting context (characterized by care, structure and behaviour control), food rules have more effect than in a compulsory and overprotective home environment. The findings are important for the improvement of intervention programmes for parents with overweight children.  

Key words:

parenting, eating behaviour, children, overweight

“Ambulatory Rehabilitation in Patients with Spinal Cord Injury: a clinical perspective”

About 45% of patients with a spinal cord injury (SCI) recover ambulatory function within one year after the event. The thesis concentrates on recovery profiles of certain lesion types, the assessment of walking capacity and on robotic training of walking for severely affected patients. The included studies showed that patients with an incomplete SCI show marked recovery. Neural centers below the level of the lesion respond to targeted training which is of importance for the early phase when the symptoms of the SCI are most prominent. The progresses of walking function throughout the rehabilitation can be reliably and validly be assessed using clinical tests. Ambulatory training with robotic devices improves walking speed and endurance. Further studies are required to investigate the importance and feasibility of the training-intensity.

Key words:

spinal cord injury, recovery, walking capacity, robotic training

“Dynamic Cerebral Autoregulation: from methodology towards clinical application”

This dissertation studies the regulation of the blood flow of the brains. In various syndromes, such as after a brain infarct or with a head trauma, locally this regulation does not function sufficiently anymore. The aim of the research was to develop a simple measuring method to quantify the function of this regulation. In this method the blood pressure and the blood flow in the brains is measured non-invasively.  With the use of techniques from the signal analysis, the function of the regulation can be rendered with a few simple parameters. However, the reproducibility of these measurements is still not sufficient for a diagnostic test in the individual patient. The method can, however, be used to compare groups of patients.

Key words:

blood flow, brains, trauma, measurement

“The investigative function of the European Parliament; holding the EU executive to account by conducting investigations”

This dissertation studies the regulation of the blood flow of the brains. In various syndromes, such as after a brain infarct or with a head trauma, locally this regulation does not function sufficiently anymore. The aim of the research was to develop a simple measuring method to quantify the function of this regulation. In this method the blood pressure and the blood flow in the brains is measured non-invasively.  With the use of techniques from the signal analysis, the function of the regulation can be rendered with a few simple parameters. However, the reproducibility of these measurements is still not sufficient for a diagnostic test in the individual patient. The method can, however, be used to compare groups of patients. 

Key words:

European Union, control, parliamentary investigation

“Terug naar af met de GGZ? Pleidooi voor een innovatieve en duurzame psychische hulpverlening”

“Axillary treatment and risk of regional recurrence in breast cancer patients”

The sentinel lymph node procedure was introduced to breast cancer patients with the purpose of less often performing axillary lymph node dissections. In this procedure, the firs lymph nodes that receive lymph from the breast tumour are identified, removed and examined for metastases. Through intensive processing of the sentinel lymph nodes, smaller metastases (micrometastases) are more often identified.  If the sentinel lymph node does not contain metastases, no axillary lymph node surgery is performed. The question is if this is also safe with micrometastases in the sentinel lymph node. Not performing axillary lymph node surgery in this group is being related to an increased risk of metastases within 5 years. Axillary treatment is recommended for patients with sentinel lymph node micrometastases and unfavourable characteristics of the tumour, who don’t receive supportive systemic therapy. 

Key words:

breast cancer, metastases axillary lymph node, sentinel lymph node procedure

“Actus reus and participation in European criminal law”

“Same but different: Functional correlates of different psychopathy dimensions in (antisocial) youth”

“REIT Investment Decisions: Governance, Behavior, and Sustainability”

“Finding ways to promote STI testing among the Afro-Carribean community in the Netherlands”

Research has shown that each year more STI’s are found among the Afro-Caribbean community than among the other ethnic communities in the Netherlands. This may be caused by the travelling behaviour of this community to their country of origin, where they have unprotected sexual contact, and the by the fact that people in this community often have several partners. To prevent spreading early testing is important. Existing interventions to influence sexual behaviour appear not effective for the Afro-Caribbean community in the Netherlands. This study has shown that the social environment (parents, relatives, friends) have a great influence on the personal motivation to be tested for STI.  Interventions should therefore not so much focus on individual factors, but mostly on the influence of the social community. When people speak more openly about sexuality and encourage frequent testing, the negativity about testing would diminish.  

Key words:

STI, Afro-Caribbean community, prevention, intervention

“Can PDE inhibition improve cognition? Translational insights”

Cognitive restrictions belong to the most important symptoms of patients that suffer from neurodegenerative and psychiatric disorders, such as Alzheimer’s disease and schizophrenia. Despite the wide range of possible pharmacological targets the clinical effectiveness of these is generally low. Recently, there has been more and more attention for phosphodiesterases (PDEs) as a target for cognition improvement. This dissertation studies the effects of PDE inhibitors on cognition. The conclusion is that specific PDE inhibitors can indeed improve cognition, but that further translational research is needed to make an in-depth assessment of the full potential of these substances. In this further research extra attention should be given to differences between various kinds of treatment (for example acute versus chronic), the reversing of restrictions versus the improvement of healthy cognition and the behaviour tasks that are used. 

Key words:

cognitive restriction, pharmacological treatment, PDE inhibitors

“On neural integration of faces and sematics”

“Mapping the primate brain with network analysis”

“Sound Science; Recording and Listening in the Biology of Bird Song 1880 – 1980”

Science is generally regarded as a mostly visual practice in which the role of other senses is systematically minimized. Yet, certain scientific problems require specific sensory skills. This dissertation investigated in which way scientists use hearing techniques for their research. This was done on the basis of historical research into field recording practices of ornithologists and behavioural biologists in bio-acoustics, the study of animal sounds. One of the conclusions is that admittedly sound recordings increasingly disqualified human hearing as a faulty and selective instrument, but that a vigilant and experienced ear remained indispensable; for example to identify behaviour in the field or to interpret patterns in the lab. This study is part of a larger research into the meaning of the auditory element (listening) in science, which is historically considered less objective than the visual element (watching).    

Key words:

animal sound, cultural history, biology, listening, senses 

“Exbelt: expelling belt restraints from psychogeriatric nursing homes”

Earlier research at Maastricht University already showed that belt restraining residents of nursing homes is unnecessary and can even be harmful.  And yet, belt restraints are still common practice in many Dutch nursing homes. Therefore, the Maastricht research group developed the ‘EXBELT’ method to reduce and prevent belt restraints. This dissertation studied the effects of the method. The result is a considerable reduction of belt restraints and no new cases in nursing homes where EXBELT was applied. Two years after the introduction the use of belt restraints had even further decreased.  This was not the case in nursing homes where EXBELT was not introduced; there still 14% of the residents are belt restrained. This kind of long-term evaluation is unique worldwide and was never conducted before.   

Key words:

EXBELT, nursing homes, belt restraining

“Prevalence and resistance of the commensal flora in non-hospitalized patients”

Antibiotics resistance (insensitivity of bacteria to antibiotics) is an increasing problem, as is shown in many recent publications. Most studies on this issue are conducted in the hospital, whereas 80% of the antibiotics use takes place outside the hospital. This dissertation investigates the antibiotics resistance of two clinically relevant bacteria, namely Staphylococcus aureus (in nine European countries) and Escherichia coli (in the Netherlands), obtained via non-hospitalized patients. The conclusion is that the antibiotics resistance to these bacteria is currently limited in the extramural setting. The results of this dissertation can be used to optimize antibiotic therapy of non-hospitalized patients to keep antibiotics effective in the future.

Key words:

antibiotics resistance, extramural.

“Clinical and biomarker correlates of genetic risk factors for Alzheimer’s disease”

“Emotional states, crime, and violence; A Schema Therapy approach to the understanding and treatment of forensic patients with personality disorders”

There is little scientific evidence for the effectiveness of the treatment of patients in the forensic psychiatric system (TBS) with dramatic personality disorders.  This dissertation describes the extent to which Scheme Therapy elements and techniques can make a useful contribution to understanding these patients. A second focus of this dissertation was drama therapy, in which showing emotions is the main priority. Central element within the Scheme Therapy are the ‘scheme modi’, i.e. fluctuating emotional situations. The results show that criminal behaviour and its origin can be understood by defining this behaviour as consecutive scheme modi. Moreover, it turns out that Scheme Therapy and drama therapy are effective in consciously provoking scheme modi. If forensic psychiatric patients (TBS patients) and their delinquent behaviour are better understood, risk factors can be better treated. 

Key words:

Forensic psychiatric system (TBS), scheme therapy, emotions, personality disorders, violence

“Going beyond the ‘Grand Mean’; advancing disease management science and evidence”

The research shows that the treatment of diabetes patients in the Netherlands and many other European countries does not sufficiently focus on the patient.  Standardized guidelines, protocols and performance indicators weigh more heavily in the determination of treatment plans than the personal needs, wishes and possibilities of patients.  The research also shows that only a small group of patients, namely the ones with insufficient glycemic control, benefit from the care that is currently offered in family doctor practices. For the control of their diabetes, healthier patients benefit more from self-management than help from a family doctor. Recommendations for a more ‘integrated made to measure care’ are among others better support with self-management and adequate information technology.   
This research was for the greater part financed by the European Commission (DISMEVAL-project).

Key words:

diabetes patients, treatment by family doctor, self-management

“Vasculogenic mimicry in malignant tumors; tumor cells in disguise”

Aggressive tumor cells can obtain the ability to form vascular-like structures that may contribute to blood circulation and/or tumor cell metastasis. This process is referred to as vasculogenic mimicry. Our research was aimed at identifying novel key molecules implicated in this process. By these means, expression of CD44 –an important marker of cancer stem cells – was identified in vasculogenic tumor cells. Also, the importance of perivascular cells in vasculogenic mimicry is described. Although currently applied angiogenesis inhibitors have not proven to be effective against this malignant process, treatment of vasculogenic tumor cells with imatinib (Gleevec®) did hamper their ability to form vascular-like structures. This research increases our knowledge of vasculogenic mimicry and may contribute to the development of clinically more effective treatment strategies against cancer. 

Key words:

angiogenesis, cancer, tumor cell plasticity, vasculogenic mimicry, vasculogenesis

“Recovering memories of childhood sexual abuse; from cognitive mechanisms to classification”

“Afscheid van dezen en genen?”