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Search Results: 1 - 10 of 489 matches for " Misha DP Luyer "
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Nutritional stimulation of the autonomic nervous system
Misha DP Luyer,Quirine Habes,Richard van Hak,Wim Buurman
World Journal of Gastroenterology , 2011, DOI: 10.3748/wjg.v17.i34.3859
Abstract: Disturbance of the inflammatory response in the gut is important in several clinical diseases ranging from inflammatory bowel disease to postoperative ileus. Several feedback mechanisms exist that control the inflammatory cascade and avoid collateral damage. In the gastrointestinal tract, it is of particular importance to control the immune response to maintain the balance that allows dietary uptake and utilization of nutrients on one hand, while preventing invasion of bacteria and toxins on the other hand. The process of digestion and absorption of nutrients requires a relative hyporesponsiveness of the immune cells in the gut to luminal contents which is not yet fully understood. Recently, the autonomic nervous system has been identified as an important pathway to control local and systemic inflammation and gut barrier integrity. Activation of the pathway is possible via electrical or via pharmacological interventions, but is also achieved in a physiological manner by ingestion of dietary lipids. Administration of dietary lipids has been shown to be very effective in reducing the inflammatory cascade and maintaining intestinal barrier integrity in several experimental studies. This beneficial effect of nutrition on the inflammatory response and intestinal barrier integrity opens new therapeutic opportunities for treatment of certain gastrointestinal disorders. Furthermore, this neural feedback mechanism provides more insight in the relative hyporesponsiveness of the immune cells in the gut. Here, we will discuss the regulatory function of the autonomic nervous system on the inflammatory response and gut barrier function and the potential benefit in a clinical setting.
Peritoneal carcinomatosis of colorectal origin: Incidence, prognosis and treatment options
Yvonne LB Klaver,Valery EPP Lemmens,Simon W Nienhuijs,Misha DP Luyer
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i39.5489
Abstract: Peritoneal carcinomatosis (PC) is one manifestation of metastatic colorectal cancer (CRC). Tumor growth on intestinal surfaces and associated fluid accumulation eventually result in bowel obstruction and incapacitating levels of ascites, which profoundly affect the quality of life for affected patients. PC appears resistant to traditional 5-fluorouracil-based chemotherapy, and surgery was formerly reserved for palliative purposes only. In the absence of effective treatment, the historical prognosis for these patients was extremely poor, with an invariably fatal outcome. These poor outcomes likely explain why PC secondary to CRC has received little attention from oncologic researchers. Thus, data are lacking regarding incidence, clinical disease course, and accurate treatment evaluation for patients with PC. Recently, population-based studies have revealed that PC occurs relatively frequently among patients with CRC. Risk factors for developing PC have been identified: right-sided tumor, advanced T-stage, advanced N-stage, poor differentiation grade, and younger age at diagnosis. During the past decade, both chemotherapeutical and surgical treatments have achieved promising results in these patients. A chance for long-term survival or even cure may now be offered to selected patients by combining radical surgical resection with intraperitoneal instillation of heated chemotherapy. This combined procedure has become known as hyperthermic intraperitoneal chemotherapy. This editorial outlines recent advancements in the medical and surgical treatment of PC and reviews the most recent information on incidence and prognosis of this disease. Given recent progress, treatment should now be considered in every patient presenting with PC.
Non-invasive markers of gut wall integrity in health and disease
Joep PM Derikx, Misha DP Luyer, Erik Heineman, Wim A Buurman
World Journal of Gastroenterology , 2010,
Abstract: The intestinal mucosa is responsible for the absorption of nutrients from the lumen and for the separation of the potentially toxic luminal content (external environment) from the host (internal environment). Disruption of this delicate balance at the mucosal interface is the basis for numerous (intestinal) diseases. Experimental animal studies have shown that gut wall integrity loss is involved in the development of various inflammatory syndromes, including post-operative or post-traumatic systemic inflammatory response syndrome, sepsis, and multiple organ failure. Assessment of gut wall integrity in clinical practice is still a challenge, as it is difficult to evaluate the condition of the gut non-invasively with currently available diagnostic tools. Moreover, non-invasive, rapid diagnostic means to assess intestinal condition are needed to evaluate the effects of treatment of intestinal disorders. This review provides a survey of non-invasive tests and newly identified markers that can be used to assess gut wall integrity.
Colorectal anastomotic leakage: Aspects of prevention, detection and treatment
Freek Daams,Misha Luyer,Johan F Lange
World Journal of Gastroenterology , 2013, DOI: 10.3748/wjg.v19.i15.2293
Abstract: All colorectal surgeons are faced from time to time with anastomotic leakage after colorectal surgery. This complication has been studied extensively without a significant reduction of incidence over the last 30 years. New techniques of prevention, by innovative anastomotic techniques should improve results in the future, but standardization and “teachability” should be guaranteed. Risk scoring enables intra-operative decision-making whether to restore continuity or deviate. Early detection can lead to reduction in delay of diagnosis as long as a standard system is used. For treatment options, no firm evidence is available, but future studies could focus on repair and saving of the anastomosis on the one hand or anastomotical breakdown and definitive colostomy on the other hand.
Controlling postoperative ileus by vagal activation
Tim Lubbers, Wim Buurman, Misha Luyer
World Journal of Gastroenterology , 2010,
Abstract: Postoperative ileus is a frequently occurring surgical complication, leading to increased morbidity and hospital stay. Abdominal surgical interventions are known to result in a protracted cessation of bowel movement. Activation of inhibitory neural pathways by nociceptive stimuli leads to an inhibition of propulsive activity, which resolves shortly after closure of the abdomen. The subsequent formation of an inflammatory infiltrate in the muscular layers of the intestine results in a more prolonged phase of ileus. Over the last decade, clinical strategies focusing on reduction of surgical stress and promoting postoperative recovery have improved the course of postoperative ileus. Additionally, recent experimental evidence implicated antiinflammatory interventions, such as vagal stimulation, as potential targets to treat postoperative ileus and reduce the period of intestinal hypomotility. Activation of nicotinic receptors on inflammatory cells by vagal input attenuates inflammation and promotes gastrointestinal motility in experimental models of ileus. A novel physiological intervention to activate this neuroimmune pathway is enteral administration of lipid-rich nutrition. Perioperative administration of lipid-rich nutrition reduced manipulation-induced local inflammation of the intestine and accelerated recovery of bowel movement. The application of safe and easy to use antiinflammatory interventions, together with the current multimodal approach, could reduce postoperative ileus to an absolute minimum and shorten hospital stay.
Stimulation of the autonomic nervous system in colorectal surgery: a study protocol for a randomized controlled trial
Tim M.P. Berghmans, Karel W.E. Hulsewé, Wim A. Buurman, Misha D.P. Luyer
Trials , 2012, DOI: 10.1186/1745-6215-13-93
Abstract: This prospective, placebo-controlled randomized trial will include 120 patients undergoing colorectal surgery which are randomized for gum chewing preoperatively and in the direct postoperative phase or a placebo. Postoperative ileus will be assessed both clinically by time to first flatus and time to first defecation and by determination of gastric motility using ultrasound to measure dimensions of the antrum. Furthermore the inflammatory response is quantified by analyzing pro-inflammatory mediators. Finally, markers of gut barrier integrity will be measured as well as occurrence of postoperative complications.We hypothesize that chewing gum preoperatively and in the direct postoperative phase in patients undergoing colorectal surgery dampens local and systematic inflammation, via activation of the autonomic nervous system. Down-regulation of the inflammatory cascade via stimulation of the vagus nerve will ameleriote POI and enhance postoperative recovery.NTR2867
Dominant curly coat in horses
DP Sponenberg
Genetics Selection Evolution , 1990, DOI: 10.1186/1297-9686-22-2-257
DNA repair and breast cancer: therapeutic opportunities
DP Silver
Breast Cancer Research , 2011, DOI: 10.1186/bcr3008
Abstract: Laboratory-based studies of BRCA1 and BRCA2 demonstrated that loss of function of either gene resulted in significantly increased susceptibility to certain forms of chemotherapy, including interstrand DNA cross-linking agents such as the platinum drugs and mitomycin C. More recently, loss of BRCA1 or BRCA2 function has also been shown to increase sensitivity to PARP inhibition, a finding made possible as a result of increased understanding of the DNA repair implications of BRCA1 or BRCA2 loss. To a large extent, these laboratory-based observations have now been verified in clinical trials enrolling patients with hereditary breast cancer. The implications of the discovery of BRCA1 and BRCA2 for treatment options in sporadic breast cancer are more complex. Based on a series of striking phenotypic similarities between the majority of sporadic triple-negative breast cancers and most cancers that arise in BRCA1 heterozygotes, the hypothesis arose that perhaps many of these sporadic cancers might also share a similar lesion in DNA repair (BRCAness) with the BRCA1-related tumors. This notion has now been put to the test in ongoing clinical trials that treat sporadic triple-negative breast cancer patients with platinum agents, PARP inhibitors, or combinations. The current evidence for and against this hypothesis will be discussed.
Book Review: Experiencing Wüstenberg’s Habilitationsgeschrift (2003)
DP Veldsman
HTS Theological Studies/Teologiese Studies , 2011,
Abstract: Book Title: Die politische Dimension der Vers hnung Author: Ralf K. Wüstenberg ISBN: 3-579-05418 Publisher: Chr. Kaiser ( ffentliche Theologie 18), Gütersloh, 2004, p. 720
Wat op dees (van) aarde beteken die einde van tradisionele metafisiese taal oor God? In gesprek met die Nuwe-Testamentikus Andries Gideon van Aarde oor sy verstaan van ‘n postsekulêre spiritualiteit
DP Veldsman
HTS Theological Studies/Teologiese Studies , 2011,
Abstract: What does the end of traditional metaphysical language about God mean? In conversation with New Testament scholar Andries Gideon van Aarde on his understanding of a postsecular spirituality South African New Testament scholar Van Aarde’s explorative search for a new direction in theological reflection is explicated in this article with reference to his discussion of Peter Berger and Charles Taylor’s contemporary contributions, which Van Aarde takes as vantage point to articulate the meaning of his ‘courage to be a religious person today’. The articulation of his ‘courage’ to pursue a post-theistic understanding of a contemporary Christian religiosity (read: spirituality) that is non-fundamentalistic, non-populist and post-secular is discussed. At the same time, the basic tenets of his explorations are indicated, being constituted – negatively – by a de-centering of the power of institutional religion and, positively, by the enchantment of a Biblical hermeneutics that does not emphasise a proposition-like and moral code-like reading strategy. Finally, his ‘new direction’, which finds expression in the articulation of a ‘spirituality of living faith’, is scrutinised. It exposes the shortcomings in his (individualistic) exposition within the new correlation of modernisation and pluralism, causing it subsequently to bypass the necessary contemporary outcome in social embodiment.
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