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Bomben R, Roisman A, D'Agaro T, Castellano G, Baumann T, Delgado J, López-Guillermo A, Zucchetto A, Dal-Bo M, Bravin V, Slavutsky I, Vlasova A, Guigó R, Martin-Subero JI, Chapaprieta V, Beekman R, Martin-García D, Beà S, Salaverria I, Aymerich M, Campo E, Gattei V, Hernández L. Expression of the transcribed ultraconserved region 70 and the related long non-coding RNA AC092652.2-202 has prognostic value in Chronic Lymphocytic Leukaemia. Br J Haematol 2018; 184:1045-1050. [DOI: 10.1111/bjh.15237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Burns A, Alsolami R, Becq J, Stamatopoulos B, Timbs A, Bruce D, Robbe P, Vavoulis D, Clifford R, Cabes M, Dreau H, Taylor J, Knight SJL, Mansson R, Bentley D, Beekman R, Martín-Subero JI, Campo E, Houlston RS, Ridout KE, Schuh A. Whole-genome sequencing of chronic lymphocytic leukaemia reveals distinct differences in the mutational landscape between IgHV mut and IgHV unmut subgroups. Leukemia 2017; 32:573. [PMID: 29160863 PMCID: PMC5808063 DOI: 10.1038/leu.2017.311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Conjaerts SHP, Bruijnes JE, Beerhorst K, Beekman R. [Nitrous oxide-induced polyneuropathy]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2017; 161:D2044. [PMID: 29192578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Nitrous oxide, laughing gas, is used as a party drug to achieve a euphoric effect. It has been gaining popularity in recent years and is considered a relatively innocent substance. Nitrous oxide is known to cause subacute degeneration of the spinal cord by inactivation of active vitamin B12. Vitamin B12 plays an essential role in the synthesis of myelin. Hence, vitamin B12 deficiency can lead to degeneration of the dorsal and lateral columns of the spinal cord. Polyneuropathy is a less known complication. We present a 17-year-old woman and a 19-year-old man with subacute axonal polyneuropathy caused by laughing gas abuse. Abstinence of laughing gas and treatment with intramuscular and oral vitamin B12 suppletion respectively have led to improvement of their symptoms. Our cases demonstrate a less-known but treatable complication of laughing gas.
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Visser LH, Beekman R, Tijssen CC, Uitdehaag BMJ, Lee ML, Movig KLL, Lenderink AW. A randomized, double-blind, placebo-controlled pilot study of IV immune globulins in combination with IV methylprednisolone in the treatment of relapses in patients with MS. Mult Scler 2016; 10:89-91. [PMID: 14760960 DOI: 10.1191/1352458504ms978sr] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Some patients with multiple sclerosis (MS) do not show a clear improvement of acute relapses after treatment with intravenous methylprednisolone (IVMP). We compared the efficacy of the combination of intravenous immunoglobulins (IVIg) and IVMP with the standard treatment of IVMP alone in promoting recovery from moderate to severe acute relapses in MS. Methods: Patients with clinically definite MS having a relapse with at least a one point increase in Kurtzke’s expanded disability status scale (EDSS) in comparison to the preattack EDSS were randomized to IVMP-IVIg or IVMP-placebo treatment. The primary outcome criterion was the EDSS grade at four weeks. A preplanned interim analysis was performed after inclusion of 19 consecutive MS patients to evaluate the sample size necessary for a larger trial. Findings: Both groups had improved one point on the EDSS four weeks after start of treatment (P =0.81) and one of the stopping rules of the interim analysis was fulfilled. There were also no differences in secondary outcomes: EDSS at eight and 12 weeks, time to improve]-1 EDSS points, difference in Scripps score and ambulation index. Five patients in the IVMP-IVIg group and two in the IVMP group had a new relapse in the six month follow-up. Interpretation: O ur study could not show superiority of IVMP-IVIg in the treatment of moderate to severe acute relapses in MS.
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Goedee HS, Brekelmans GJF, van Asseldonk JTH, Beekman R, Mess WH, Visser LH. High resolution sonography in the evaluation of the peripheral nervous system in polyneuropathy - a review of the literature. Eur J Neurol 2013; 20:1342-51. [DOI: 10.1111/ene.12182] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/25/2013] [Indexed: 12/20/2022]
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Skokowa J, Steinemann D, Zeidler C, Makaryan V, Beekman R, Klimiankou M, Ünalan M, Kandabarau S, Schnittger S, Kohlmann A, Valkhof MG, Hoogenboezem R, Göhring G, Schlegelberger B, Stanulla M, Vandenberghe P, Donadieu J, Touw IP, Dale DC, Welte K. The Association of Mutations in RUNX1 and CSF3R with the Development of Leukemia in Severe Congenital Neutropenia: A unique pathway in leukemogenesis. KLINISCHE PADIATRIE 2013. [DOI: 10.1055/s-0033-1343625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Palande KK, Beekman R, van der Meeren LE, Beverloo HB, Valk PJM, Touw IP. The antioxidant protein peroxiredoxin 4 is epigenetically down regulated in acute promyelocytic leukemia. PLoS One 2011; 6:e16340. [PMID: 21283726 PMCID: PMC3024432 DOI: 10.1371/journal.pone.0016340] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 12/13/2010] [Indexed: 11/20/2022] Open
Abstract
The antioxidant peroxiredoxin (PRDX) protein family comprises 6 members, which are implicated in a variety of cellular responses, including growth factor signal transduction. PRDX4 resides in the endoplasmic reticulum (ER), where it locally controls oxidative stress by reducing H2O2 levels. We recently provided evidence for a regulatory function of PRDX4 in signal transduction from a myeloid growth factor receptor, the granulocyte colony-stimulating factor receptor (G-CSFR). Upon activation, the ligand-induced G-CSFR undergoes endocytosis and routes via the early endosomes where it physically interacts with ER-resident PRDX4. PRDX4 negatively regulates G-CSFR mediated signaling. Here, we investigated whether PRDX4 is affected in acute myeloid leukemia (AML); genomic alterations and expression levels of PRDX4 were investigated. We show that genomic abnormalities involving PRDX4 are rare in AML. However, we find a strong reduction in PRDX4 expression levels in acute promyelocytic leukemia (APL) compared to normal promyelocytes and different molecular subtypes of AML. Subsequently, the possible role of DNA methylation and histone modifications in silencing of PRDX4 in APLs was investigated. We show that the reduced expression is not due to methylation of the CpG island in the promoter region of PRDX4 but correlates with increased trimethylation of histone 3 lysine residue 27 (H3K27me3) and lysine residue 4 (H3K4me3) at the transcriptional start site (TSS) of PRDX4, indicative of a bivalent histone code involved in transcriptional silencing. These findings suggest that the control of G-CSF responses by the antioxidant protein PRDX4 may be perturbed in APL.
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Taskesen E, Beekman R, de Ridder J, Wouters BJ, Peeters JK, Touw IP, Reinders MJT, Delwel R. HAT: hypergeometric analysis of tiling-arrays with application to promoter-GeneChip data. BMC Bioinformatics 2010; 11:275. [PMID: 20492700 PMCID: PMC2892465 DOI: 10.1186/1471-2105-11-275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 05/21/2010] [Indexed: 12/02/2022] Open
Abstract
Background Tiling-arrays are applicable to multiple types of biological research questions. Due to its advantages (high sensitivity, resolution, unbiased), the technology is often employed in genome-wide investigations. A major challenge in the analysis of tiling-array data is to define regions-of-interest, i.e., contiguous probes with increased signal intensity (as a result of hybridization of labeled DNA) in a region. Currently, no standard criteria are available to define these regions-of-interest as there is no single probe intensity cut-off level, different regions-of-interest can contain various numbers of probes, and can vary in genomic width. Furthermore, the chromosomal distance between neighboring probes can vary across the genome among different arrays. Results We have developed Hypergeometric Analysis of Tiling-arrays (HAT), and first evaluated its performance for tiling-array datasets from a Chromatin Immunoprecipitation study on chip (ChIP-on-chip) for the identification of genome-wide DNA binding profiles of transcription factor Cebpa (used for method comparison). Using this assay, we can refine the detection of regions-of-interest by illustrating that regions detected by HAT are more highly enriched for expected motifs in comparison with an alternative detection method (MAT). Subsequently, data from a retroviral insertional mutagenesis screen were used to examine the performance of HAT among different applications of tiling-array datasets. In both studies, detected regions-of-interest have been validated with (q)PCR. Conclusions We demonstrate that HAT has increased specificity for analysis of tiling-array data in comparison with the alternative method, and that it accurately detects regions-of-interest in two different applications of tiling-arrays. HAT has several advantages over previous methods: i) as there is no single cut-off level for probe-intensity, HAT can detect regions-of-interest at various thresholds, ii) it can detect regions-of-interest of any size, iii) it is independent of probe-resolution across the genome, and across tiling-array platforms and iv) it employs a single user defined parameter: the significance level. Regions-of-interest are detected by computing the hypergeometric-probability, while controlling the Family Wise Error. Furthermore, the method does not require experimental replicates, common regions-of-interest are indicated, a sequence-of-interest can be examined for every detected region-of-interest, and flanking genes can be reported.
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Beekman R, Schreuder AHCML, Rozeman CAM, Koehler PJ, Uitdehaag BMJ. The diagnostic value of provocative clinical tests in ulnar neuropathy at the elbow is marginal. J Neurol Neurosurg Psychiatry 2009; 80:1369-74. [PMID: 19553231 DOI: 10.1136/jnnp.2009.180844] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Provocative clinical tests are often performed in the diagnosis of ulnar neuropathy at the elbow (UNE) although the evidence for the usefulness of these tests is limited. The aim of this study was to determine the diagnostic value of provocative clinical tests in the diagnosis of UNE in a relevant spectrum of patients and controls. METHODS A prospective cohort study was performed in consecutive patients clinically suspected of having UNE. All patients underwent a neurological examination and four commonly used provocative clinical tests (Tinel's test, flexion compression test, palpating for local ulnar nerve tenderness and nerve thickening). Subsequently, in all patients a reference standard test comprising electrophysiological studies and neurosonography was independently assessed. RESULTS 192 eligible patients completed the study protocol. UNE was diagnosed in 137 and an alternative diagnosis was made in 55 patients. The sensitivity, specificity, and positive and negative predictive values were as follows: Tinel's test 62%, 53%, 77% and 30%; flexion compression test 61%, 40%, 72% and 29%; palpating for nerve thickening 28%, 87%, 84% and 33%; and palpating for nerve tenderness 32%, 80%, 80% and 32%. Logistic regression and receiver operating characteristic curves showed that the added value of one or more provocative tests over routine clinical examination is minimal. CONCLUSION The diagnostic value of provocative clinical tests in UNE is poor.
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Spensberger D, Vermeulen M, Le Guezennec X, Beekman R, van Hoven A, Bindels E, Stunnenberg H, Delwel R. Myeloid transforming protein Evi1 interacts with methyl-CpG binding domain protein 3 and inhibits in vitro histone deacetylation by Mbd3/Mi-2/NuRD. Biochemistry 2008; 47:6418-26. [PMID: 18500823 DOI: 10.1021/bi800267f] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The ecotropic viral integration site 1 ( Evi1) gene encodes a putative transcription regulator, which is aberrantly expressed in acute myeloid leukemias (AML) with chromosomal abnormalities involving the 3q26 locus. Repression and activation of transcriptional control have been reported, but it is currently unclear how Evi1 may evoke these opposing effects. Using a yeast two-hybrid screen, we identified a novel binding partner of Evi1, i.e., methyl binding domain 3b (Mbd3b) protein, a member of the Mi-2/NuRD histone deacetylase complex. Applying in vitro and in vivo assays, we found that Evi1 interacts with Mbd3b but not with other MBD family members Mbd1, -2, and -4 or MeCP2. We show that interaction of Evi1 with Mbd3 requires 40 amino acids that are adjacent and downstream of the methyl binding domain (MBD). We further demonstrate that the first three zinc fingers of Evi1 are needed for Mbd3 interaction. Evi1 acts as a transcriptional repressor when recruited to an active promoter, yet when present in the Mi-2/NuRD complex through Mbd3 interaction, it inhibits the histone deacetylation function of this multiprotein structure. Our data may in part explain how Evi1 could act as a repressor as well as an activator of transcription.
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Klomp CMC, van den Broek MWC, Buijs J, Beekman R. [Reversible posterior leucoencephalopathy due to hypercalcaemia]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2006; 150:505-8. [PMID: 16553051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
A 60-year-old woman presented with changes in behaviour, cognition, cortical blindness and headache. These symptoms were caused by a reversible posterior leucoencephalopathy syndrome due to hypercalcaemia caused by a multiple myeloma, type IgD wavelength. She was treated with isotonic saline and pamidronate; the serum calcium levels normalised and the radiological brain abnormalities disappeared as did the clinical neurological abnormalities. Hypercalcaemia probably affects cerebral perfusion and has direct neurotoxic effects which can lead to cerebral oedema. This case history illustrates a rare cause of a syndrome that can be easily treated and is completely reversible.
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Beekman R, van den Berg LH, Franssen H, Visser LH, van Asseldonk JTH, Wokke JHJ. Ultrasonography shows extensive nerve enlargements in multifocal motor neuropathy. Neurology 2006; 65:305-7. [PMID: 16043806 DOI: 10.1212/01.wnl.0000169179.67764.30] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Using ultrasonography we found multiple sites with nerve enlargement along the course of the brachial plexus, median, ulnar, and radial nerves in the majority of 21 patients with multifocal motor neuropathy. Sonography and electrophysiologic studies showed more abnormalities than expected on purely clinical grounds. Moreover, sonography revealed nerve enlargement without clinical or electrophysiologic abnormalities.
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Beekman R, Schoemaker MC, Van Der Plas JPL, Van Den Berg LH, Franssen H, Wokke JHJ, Uitdehaag BMJ, Visser LH. Diagnostic value of high-resolution sonography in ulnar neuropathy at the elbow. Neurology 2004; 62:767-73. [PMID: 15007128 DOI: 10.1212/01.wnl.0000113733.62689.0d] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To determine the diagnostic value of high-resolution sonography in ulnar neuropathy at the elbow (UNE). METHODS Sonographic ulnar nerve diameter measurement was compared at three levels around the medial epicondyle with a criterion standard including clinical and electrophysiologic characteristics in a cohort of 123 patients presenting with clinical signs of UNE. UNE or probable UNE was diagnosed in 84 patients and a different condition in 39 patient controls. Reference values were obtained in 56 healthy volunteers. RESULTS One hundred thirty-six affected arms were studied in 123 patients (UNE in 82, probable UNE in 9, and a different condition in 45 affected arms). Patients with UNE had a larger ulnar nerve diameter than patient controls (p < 0.0001). The sensitivity of sonography was 80%, specificity 91%, positive likelihood ratio 9, and negative likelihood ratio 0.2. The highest diagnostic yield was found in patients in whom electrodiagnostic studies showed signs of ulnar neuropathy but could not localize the lesion (17/20 cases, 86%) and in patients who had motor conduction velocity slowing across the elbow without conduction block (32/37 cases, 86%). CONCLUSIONS High-resolution sonography is an accurate and easily applied test for the diagnosis of UNE. The authors recommend its use in addition to electrodiagnostic studies because it improves the reliability of the diagnosis of UNE.
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Beekman R, Wokke JHJ, Schoemaker MC, Lee ML, Visser LH. Ulnar neuropathy at the elbow: Follow-up and prognostic factors determining outcome. Neurology 2004; 63:1675-80. [PMID: 15534254 DOI: 10.1212/01.wnl.0000142535.24626.90] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the outcome in patients with ulnar neuropathy at the elbow (UNE) treated surgically or conservatively, and the prognostic value of clinical, sonographic, and electrophysiologic features. METHODS After a median follow-up of 14 months, 69 of 84 patients initially included in a prospective blinded study on the diagnostic value of sonography in UNE were re-evaluated. The patients underwent renewed systematic clinical and sonographic examination. Patients were scored as having a poor (stable or progressive symptoms) or favorable (complete remission of symptoms or improvement) outcome. RESULTS Of the 74 initially affected arms, 12 (16%) had a complete remission, 21 (28%) improved, 25 (34%) remained stable, and 16 (22%) had progression. Surgically treated patients (28 arms) had a more favorable outcome than those treated conservatively (p = 0.03). After surgery, the mean ulnar nerve diameter decreased from 3.2 to 2.9 mm (p = 0.03), while this was not seen after conservative treatment. Multiple logistic regression analysis showed that more outspoken nerve enlargement found during sonography at the time of the diagnosis was associated with a poor outcome (OR: 2.9, p = 0.009). Furthermore, the presence of a motor conduction block (OR: 0.2, p = 0.03) and motor velocity slowing across the elbow (OR: 0.1, p = 0.01) were associated with a favorable outcome. CONCLUSION More pronounced ulnar nerve thickening at the time of the diagnosis is associated with poor outcome at follow-up, especially in conservatively treated cases, while electrodiagnostic signs of demyelination on testing indicate favorable outcome.
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Beekman R, Visser LH. High-resolution sonography of the peripheral nervous system - a review of the literature. Eur J Neurol 2004; 11:305-14. [PMID: 15142223 DOI: 10.1111/j.1468-1331.2004.00773.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
High-resolution sonography is capable of depicting peripheral nerves and the brachial plexus. In this study we review the literature on this subject. Normal peripheral nerves have a characteristic echotexture. Most nerves are readily visualized, although this is not always the case with the nerves of the lower extremity. The main pathological changes that can be demonstrated are nerve enlargement and increased hypoechogenicity. In order to demonstrate nerve enlargement, measurements should be performed and compared with a set of reference values. Several neuropathies have been studied by means of ultrasonography. However, many studies concern case reports and show methodological shortcomings. The best studied peripheral neuropathy is the carpal tunnel syndrome in which ultrasonography seems to have an additional value when combined with nerve conduction studies. Nerve enlargement has also been demonstrated in radial neuropathy at the humerus and in ulnar neuropathy at the elbow. The role of sonography in various hereditary and inflammatory neuropathies is uncertain although diffuse nerve thickening could be demonstrated. Further systematic studies are needed to determine the role of sonography in the diagnostic process of the various neuropathies. It would be important to study the subcategories of patients in whom electrodiagnostic studies are normal or show equivocal findings.
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Abstract
OBJECTIVE To describe three cases of migraine (two with aura) after an intracranial endovascular procedure. Method.-Retrospective. RESULTS One patient had an attack of migraine with prolonged aura after embolization of a dural arteriovenous fistula. Another patient had an attack of migraine with aura (and hemiparesis) after a diagnostic angiogram. The third patient already suffered from migraine with aura and had a migraine attack after embolization of an occipital arteriovenous malformation. A quadrantanopia persisted in this patient. Outcome of the other two patients was good. CONCLUSION Intracranial endovascular procedures can induce migraine with aura. We could not identify the underlying pathophysiological mechanism, but mechanical, chemical, immunological, or hemodynamic factors could be involved.
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Heinrichs M, Beekman R, Limburg M. Simulation to estimate the capacity of a stroke unit. Stud Health Technol Inform 2001; 77:47-50. [PMID: 11187595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Preceding the implementation of a Stroke Unit (SU), data have been collected and used for building a simulation model of patient flow. This model was subsequently used to estimate the optimal capacity of the SU to be implemented. Because stroke patients require acute hospital care, this implies a highly variable number of immediate admissions. This variability complicates optimizing the capacity. In order to support decisions with regard to staffing (i.e. capacity) of the SU, different scenarios are simulated and compared to provide insight in the trade-off between regular understaffing and a low bed occupancy rate. In 1996 the Department of Neurology of the Academic Medical Center in the Netherlands implemented its SU to improve the quality of care for stroke patients. Data collected in the years 1997 and 1998 that the SU has been operational were evaluated and confirm the predictions made from simulating different scenarios. We conclude that simulation models provide a powerful tool for supporting decision making with regard to resource planning at the departmental level in our hospital.
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Beekman R, Kuks JB, Oosterhuis HJ. Myasthenia gravis: diagnosis and follow-up of 100 consecutive patients. J Neurol 1997; 244:112-8. [PMID: 9120493 DOI: 10.1007/s004150050059] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
One hundred consecutive patients with myasthenia gravis (MG) referred between 1985 and 1989 were analysed for epidemiological characteristics, evolution of early signs, delay in diagnosis, yield of diagnostic tests and effects of treatment. The female to male ratio was 1.6:1.0. Sixteen patients had a thymoma. Ocular MG occurred in 14. Associated autoimmune diseases were found in 15 patients. In 34% of the women and 10% of the men the diagnosis was delayed for more than 2 years. In the first 3 months progression was more rapid in men than in women. Anti-acetylcholine receptor antibodies were found in 94% of the patients with generalized MG and in 29% of the ocular patients. The neostigmine or the edrophonium test was positive in 84% of the generalized and in 60% of the ocular patients. Electromyography was diagnostic in 71% of the generalized and in 42% of the ocular patients tested. Thymectomy was performed in 56 patients (12 with thymomas). Fifty-one per cent were treated with one or more immunosuppressive drugs, at any time. After a mean follow-up of 9.6 years after onset remissions had occurred in 43%, considerable improvement in 25%, moderate improvement in 20% and 12% remained unchanged. There were no deaths due to MG. Thirty-six per cent remained dependent on immunosuppressive drugs. Medication-free remission was most frequent (35%) in the early-onset (< 50 years) group. Side-effects of pyridostigmine were noted in 34% of 99 patients, of prednisone in 65% of 49 patients, and of azathioprine in 54% of 28 patients, but these necessitated stopping the drug in only 1%, 10% and 14% respectively.
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Beekman R, Kuks J, Oosterhuis H. Myasthenia gravis, diagnosis and follow up. Neuromuscul Disord 1994. [DOI: 10.1016/0960-8966(94)90117-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Beekman R, Oosterhuis HJ. [Use of alternative treatments by patients with myasthenia gravis]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 1994; 138:294-6. [PMID: 8121511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To analyse the use of alternative treatments by patients before and after myasthenia gravis was diagnosed, and the influence on the diagnostic delay. DESIGN Retrospective study. SETTING University Hospital Groningen, Netherlands. METHOD A questionnaire was sent to 90 consecutive patients with myasthenia gravis to inquire about their use of alternative treatments. RESULTS Of the 72 respondents 18 had used alternative treatments. Of these 11 had even done so before diagnosis. The most important reason for the use was the lack of understanding and trust that these patients said they experienced from their regular doctors. Almost all patients discontinued alternative treatment when it became clear that it had no effect. Compared with those not using alternatives, the diagnosis was delayed in the group of patients using alternative treatments, but not significantly. CONCLUSION More attention for patients with chronic and undefined complaints may shorten the delay in diagnosing and treating myasthenia gravis adequately.
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Christos S, Katch VL, Beekman R, Eakin D, Lindauer A, Crowley D, Katch FI. HEMODYNAMIC RESPONSES TO UPRIGHT CYCLING OF ADOLESCENT CARDIAC TRANSPLANT PATIENTS. Med Sci Sports Exerc 1992. [DOI: 10.1249/00005768-199205001-00520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Beekman R, Ehling T, Kuks J, Oosterhuis H. Epidemiological data of 100 recent myasthenic patients. J Autoimmun 1991. [DOI: 10.1016/0896-8411(91)90102-i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Unger FM, Cavanaugh DJ, Johnson GF, Tuuri DT, Beekman R. Radiologic and real time echocardiographic evaluation of the cyanotic newborn. Radiographics 1986; 6:603-60. [PMID: 3685508 DOI: 10.1148/radiographics.6.4.3685508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Prior to echocardiography, the recognition of serious heart disease in the cyanotic newborn or young infant could be extremely difficult. The profound hemodynamic changes taking place in the heart and lungs after birth influence the clinical manifestations of many cardiac disorders, and sometimes suggest the existence of a cardiac disorder when none is present. Real time echocardiography has revolutionalized the diagnosis of the cyanotic infant. If the reason for the infant's cyanosis or respiratory distress is not apparent from the history, physical examination, laboratory values, and chest radiograph; real time echocardiography should be performed to exclude or diagnose cyanotic congenital heart disease and persistent fetal circulation. This will prevent misdiagnosis in cyanotic infants and assure rapid and appropriate treatment.
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Kveselis DA, Rocchini AP, Beekman R, Snider AR, Crowley D, Dick M, Rosenthal A. Balloon angioplasty for congenital and rheumatic mitral stenosis. Am J Cardiol 1986; 57:348-50. [PMID: 2936234 DOI: 10.1016/0002-9149(86)90922-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Marks C, Katch V, Rocchini A, Beekman R, Rosenthal A. Validity and reliability of cardiac output by CO2 rebreathing. Sports Med 1985; 2:432-46. [PMID: 3934731 DOI: 10.2165/00007256-198502060-00004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This article reviews the available literature on the validity and reliability of the non-invasive techniques, commonly known as CO2 rebreathing, for estimating cardiac output. The differing indirect methodologies are described and illustrated. A table, constructed from the available literature, comparing criterion versus estimated cardiac outputs is presented. The varying combinations of methods employed, differing measurement conditions, i.e. rest and exercise, and divergent populations are illustrated and discussed. The correlation between criterion and estimated cardiac output for these studies ranged from r = 0.09 to 0.96, with a % standard deviation of the differences of 1.5 to 176.8%. The Collier and end-tidal methods, in conjunction with either the Comroe or McHardy CO2 dissociation curve appears to be the most established, valid and reliable combination of methods for estimating resting cardiac output. These methods appear to be comparable to the combination of the Defares, end-tidal and Comroe curve methods for estimating cardiac output during exercise. Because of the potential for large errors, caution is urged when interpreting cardiac output results based on indirect estimation for individual assessment, or for subjects with certain types of pulmonary or heart diseases.
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