Abstractboek 2020

ABSTRACT BOEK 2020

Wetenschappelijke publicaties van az groeninge

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CENTRA 02 ABDOMINALE CHIRURGIE

34 MEDISCHE BEELDVORMING

11 ANESTHESIE

46 NEFROLOGIE

15 APOTHEEK

47 NEUROLOGIE

17 CARDIOLOGIE

56 NEUS-, KEEL- EN OORZIEKTEN

19 ENDOCRINOLOGIE/DIABETOLOGIE

57 NUCLEAIRE GENEESKUNDE

21 GYNAECOLOGIE

62 ONCOLOGIE

23 INWENDIGE ZIEKTEN/ GASTRO-ENTEROLOGIE

67 ORTHOPEDIE 69 PSYCHIATRIE

26 KINDERGENEESKUNDE 71 UROLOGIE 27 KLINISCH LABORATORIUM 33 LONGZIEKTEN

VU Inge Buyse, Pres. Kennedylaan 4 | 8500 Kortrijk Uitgegeven in opdracht van het wetenschappelijk comité van az groeninge Eindredactie Laurence Beels, dienst communicatie

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ABSTRACTBOEK | 2020

Dit abstractboek is ook te raadplegen via azg.site/abstractboek of via deze qr-code:

VOORWOORD

Beste lezer

Dit abstractboek en het wetenschappelijk werk dat erachter steekt, kwam tot stand in een jaar dat zijn voorgaande niet kent.

Bij de eerste lockdown werd een groot deel van de medische, maar ook van de wetenschappelijke activiteiten stil gelegd. Vrij snel werden videocalls met Zoom, Teams, Webex en andere op grote schaal ingevoerd. Dit diende niet alleen om teleconsultaties te houden, maar ook om overleg in multidisciplinaire teams mogelijk te maken.

Samenwerken op afstand in multicentrische teams of tussen ziekenhuizen in een netwerk is gemakkelijker geworden dan ooit. We kunnen ons bijna niet meer voorstellen hoe we voor een kort overleg enkele uren tijd zouden verliezen aan lange afstanden of files.

Het thema ‘Covid-19’ werd ongetwijfeld hét studieonderwerp van de laatste 18 maanden en het laat zich raden dat wetenschappelijke tijdschriften te maken krijgen met een plethora aan studies en case reports in allerlei settings. Ook in ons ziekenhuis werd deelgenomen aan multicentrische studies en werden lokale trials opgestart. In dit en vooral in het volgende abstractboek zullen hier sporen van te vinden zijn.

Het siert alle artsen, wetenschappelijke medewerkers, verpleegkundigen en paramedici die een bijdrage gehad hebben in de publicaties uit dit abstractboek, dat ze in de bijzondere omstandigheden die we gekend hebben, toch nog de energie opgebracht hebben om naast de zorg voor de patiënt wetenschappelijk actief te blijven.

DR. SERGE VANDERSCHUEREN MEDISCH DIRECTEUR 18 JUNI 2021

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CENTRUM

ABDOMINALE CHIRURGIE

ARTIKELS

ABSTRACT 2

ABSTRACT 1

Outcomes after minimally-invasive versus open pancreatoduodenectomy: a pan-European propensity score matched study.

Laparoscopic liver resection for liver tumours in proximity to major vasculature: a single-center comparative study.

D'Hondt M, Vansteenkiste F, Parmentier I, et al.

European Journal of Surgical Oncology, 2020, 46(4 Pt A), 539-547

INTRODUCTION With growing popularity and experience in laparoscopic liver surgery, the options for more difficult procedures increase. Only small case series have been published regarding laparoscopic liver resection (LLR) for tumours in proximity to major vessels (MVs).

OBJECTIVE The aim was to compare outcomes of LLR for tumours located less or more than 15 mm from MVs.

MATERIALS/METHODS This was a retrospective analysis of a prospectively collected database of consecutive LLR (October 2011-August 2017).

Proximity to MVs (PMV) was defined as lesions located within 15 mm to the caval vein, hepatic veins and portal vein (main trunk and first branches). The control group were all lesions located more than 15 mm from MVs.

RESULTS Some 60/235 LLR were performed for lesions in proximity to major vasculature (24%). In the PMV group, median IWATE Difficulty Score was higher (8.5 (IQR: 6.0-9.0) VS 5.0 (IQR: 3.0-6.0), p < 0.001) as was the use of CUSA® (45.0% VS 8.6%, p < 0.001) and Pringle manoeuvre (8.3% VS 1.7%; p = 0.028). Operative time was longer (180min (IQR: 140-210) VS 120min (IQR: 75-150), p < 0.001) and blood loss was higher (190 ml (IQR: 100-325) VS 75 ml (IQR: 50-220), p < 0.001) in the PMV group. There was no difference in perioperative blood transfusion (3.3% VS 1.7%, p = 0.60) or postoperative morbidity (15.0% VS 14.3%, p = 0.89). There was no mortality in both groups. On mean follow-up of 21 months, no significant differences could be found in disease free (p = 0.77) and overall survival (p = 0.12).

CONCLUSION In experienced hands, LLR of lesions in proximity to MVs is safe and feasible with acceptable short and long-term results.

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ABSTRACTBOEK | 2020

Klompmaker S, van Hilst J, D'Hondt M, et al.

Annals of Surgery, 2020, 271(2), 356-363

INTRODUCTION Current evidence on MIPD is based on national registries or single expert centers. International, matched studies comparing outcomes for MIPD and OPD are lacking.

OBJECTIVE To assess short-term outcomes after minimally invasive (laparoscopic, robot-assisted, and hybrid) pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) among European centers.

MATERIALS/METHODS Retrospective propensity score matched study comparing MIPD in 14 centers (7 countries) performing ≥10 MIPDs annually (2012-2017) versus OPD in 53 German/Dutch surgical registry centers performing ≥10 OPDs annually (2014-2017). Primary outcome was 30-day major morbidity (Clavien-Dindo ≥3).

RESULTS Of 4220 patients, 729/730 MIPDs (412 laparoscopic, 184 robot-assisted, and 130 hybrid) were matched to 729 OPDs. Median annual case-volume was 19 MIPDs (interquartile range, IQR 13-22), including the first MIPDs performed in 10/14 centers, and 31 OPDs (IQR 21-38). Major morbidity (28% vs 30%, P = 0.526), mortality (4.0% vs 3.3%, P = 0.576), percutaneous drainage (12% vs 12%, P = 0.809), reoperation (11% vs 13%, P = 0.329), and hospital stay (mean 17 vs 17 days, P > 0.99) were comparable between MIPD and OPD. Grade-B/C postoperative pancreatic fistula (POPF) (23% vs 13%, P < 0.001) occurred more frequently after MIPD. Single-row pancreatojejunostomy was associated with POPF in MIPD (odds ratio, OR 2.95, P < 0.001), but not in OPD. Laparoscopic, robot-assisted, and hybrid MIPD had comparable major morbidity (27% vs 27% vs 35%), POPF (24% vs 19% vs 25%), and mortality (2.9% vs 5.2% vs 5.4%), with a fewer conversions in robot-assisted- versus laparoscopic MIPD (5% vs 26%, P < 0.001).

CONCLUSION In the early experience of 14 European centers performing ≥10 MIPDs annually, no differences were found in major morbidity, mortality, and hospital stay between MIPD and

OPD. The high rates of POPF and conversion, and the lack of superior outcomes (ie, hospital stay, morbidity) could indicate that more experience and higher annual MIPD volumes are needed.

ABSTRACT 3 Hepatopancreatoduodenectomy – a controversial treatment for bile duct and gallbladder cancer from a European perspective.

D'Souza M, Valdimarsson V, D'Hondt M, et al.

The Official Journal of the International Hepato Pancreato Biliary Association, 2020, 22(9), 1339-1348

ABSTRACT 4 International multicenter propensity score matched study on laparoscopic versus open left lateral sectionectomy. van der Poel M, Fichtinger R, D'Hondt M, et al.

The Official Journal of the International Hepato Pancreato Biliary Association, 2020, Oct 7, DOI: 10.1016/j. hpb.2020.09.006

INTRODUCTION Despite a lack of high-level evidence, current guidelines recommend laparoscopic left lateral sectionectomy (LLLS) as the routine approach over open LLS (OLLS). Randomized studies and propensity score matched studies on LLLS vs OLLS for all indications, including malignancy, are lacking.

INTRODUCTION Hepatopancreatoduodenectomy (HPD) is an aggressive operation for treatment of advanced bile duct and gallbladder cancer associated with high perioperative morbidity and mortality, and uncertain oncological benefit in terms of survival. Few reports on HPD from Western centers exist.

The purpose of this study was to evaluate safety and efficacy for HPD in European centers.

MATERIALS/METHODS This international multicenter propensity score matched retrospective cohort study included consecutive patients undergoing LLLS or OLLS in six centers from three European countries (January 2000-December 2016). Propensity scores were calculated based on nine preoperative variables and LLLS and OLLS were matched in a 1:1 ratio. Short-term operative outcomes were compared using paired tests.

MATERIALS/METHODS Members of the European-African HepatoPancreatoBiliary Association were invited to report all consecutive patients operated with HPD for bile duct or gallbladder cancer between January 2003 and January 2018. The patient and tumor characteristics, perioperative and survival outcomes were analyzed.

RESULTS In total, 66 patients from 19 European centers were included in the analysis. 90-day mortality rate was 17% and 13% for bile duct and gallbladder cancer respectively. All factors predictive of perioperative mortality were patient and disease-specific. The three-year overall survival excluding 90-day mortality was 80% for bile duct and 30% for gallbladder cancer (P = 0.013). In multivariable analysis R0-resection had a significant impact on overall survival.

RESULTS A total of 560 patients were included. Out of 200 LLLS, 139 could be matched to 139 OLLS. After matching, baseline characteristics were well balanced. LLLS was associated with shorter operative time (144 (110-200) vs 199 (138283) minutes, P < 0.001), less blood loss (100 (50-300) vs 350 (100-750) mL, P = 0.005) and a 3-day shorter postoperative hospital stay (4 (3-7) vs 7 (5-9) days, P < 0.001).

CONCLUSION This international multicenter propensity score matched study confirms the superiority of LLLS over OLLS based on shorter postoperative hospital stay, operative time, and less blood loss thus validating current guideline advice.

ABSTRACT 5 CONCLUSION HPD, although being associated with substantial perioperative mortality, can offer a survival benefit in patient subgroups with bile duct cancer and gallbladder cancer.

To achieve negative resection margins is paramount for an improved survival outcome.

Laparoscopic versus open right posterior sectionectomy: an international, multicenter, propensity score-matched evaluation. van der Heijde N, Ratti F, D'Hondt M, et al.

Surgical Endoscopy, 2020, 2, DOI: 10.1007/ s00464-020-08109-y

ABDOMINALE CHIRURGIE

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INTRODUCTION

ABSTRACT 6

Although laparoscopic liver resection has become the standard for minor resections, evidence is lacking for more complex resections such as the right posterior sectionectomy (RPS). We aimed to compare surgical outcomes between laparoscopic (LRPS) and open right posterior sectionectomy (ORPS).

Resections for tumors in the posterosuperior segments: a single-center experience of 174 consecutive cases.

Kirmizi S, De Meyere C, Parmentier I, D'Hondt M Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2020, 30(6), 518-521

MATERIALS/METHODS

INTRODUCTION

An international multicenter retrospective study comparing patients undergoing LRPS or ORPS (January 2007-December 2018) was performed. Patients were matched based on propensity scores in a 1:1 ratio. Primary endpoint was major complication rate defined as Accordion ≥ 3 grade. Secondary endpoints included blood loss, length of hospital stay (LOS) and resection status. A sensitivity analysis was done excluding the first 10 LRPS patients of each center to correct for the learning curve. Additionally, possible risk factors were explored for operative time, blood loss and LOS.

Laparoscopic posterosuperior liver resection is a technically difficult and complex surgery. These patients are seen as poor candidates for laparoscopic surgery. This study aimed to show the safe and effective applicability of the posterosuperior segment resections by experienced surgeons in advanced centers.

RESULTS Overall, 399 patients were included from 9 centers from 6 European countries of which 150 LRPS could be matched to 150 ORPS. LRPS was associated with a shorter operative time [235 (195-285) vs. 247 min (195-315) p = 0.004], less blood loss [260 (188-400) vs. 400 mL (280-550) p = 0.009] and a shorter LOS [5 (4-7) vs. 8 days (6-10), p = 0.002].

Major complication rate [n = 8 (5.3%) vs. n = 9 (6.0%) p = 1.00] and R0 resection rate [144 (96.0%) vs. 141 (94.0%), p = 0.607] did not differ between LRPS and ORPS, respectively. The sensitivity analysis showed similar findings in the previous mentioned outcomes. In multivariable regression analysis blood loss was significantly associated with the open approach, higher ASA classification and malignancy as diagnosis. For LOS this was the open approach and a malignancy.

CONCLUSION This international multicenter propensity score-matched study showed an advantage in favor of LRPS in selected patients as compared to ORPS in terms of operative time, blood loss and LOS without differences in major complications and R0 resection rate.

MATERIALS/METHODS Patients who underwent laparoscopic posterosuperior liver resection between October 2011 and October 2019 at the Groeninge Hospital were evaluated retrospectively.

Demographic and perioperative data were obtained from the prospectively maintained database. Resection of at least 3 consecutive Couinaud segments was accepted as a major surgery (trisegmentectomy). Postoperative complications were registered according to the Clavien-Dindo classification.

RESULTS The median age of the 174 patients was 68 years [interquartile range (IQR): 60 to 75]. The semiprone position was used in the majority of operations (82.2%). Nonanatomic resection was performed in more than half of the operations (55.1%). A total of 5 patients underwent major hepatic resection. The median time of surgery was 150 (IQR: 120 to 190) minutes. Median blood loss was determined to be 150 (IQR: 50 to 300) mL. Malignancy was detected in 95% of the cases. The surgical margin was reported to be R0 in 93.3% of the specimens. The median hospitalization time was 4 (IQR: 3 to 6) days. The major complication rate was 1.7%, and only 1 patient died. Overall survival rates for patients who underwent a resection for colorectal liver metastases in the first and fifth years were 97.5% and 62.2%, and disease-free survival rates were 69.8% and 35.5%, respectively.

CONCLUSION Laparoscopic resections in the posterosuperior segments can be performed safely in experienced hands with good short and long term (oncologial) outcomes.

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ABSTRACTBOEK | 2020

ABSTRACT 7

ABSTRACT 8

Pure laparoscopic versus open hemihepatectomy: a critical assessment and realistic expectations - a propensity score-based analysis of right and left hemihepatectomies from nine European tertiary referral centers.

Risk factors of positive resection margin in laparoscopic and open liver surgery for colorectal liver metastases: a new perspective in the perioperative assessment: a European multicenter study.

Cipriani F, Alzoubi M, Fuks D, D'Hondt M, et al.

Journal of Hepato-Biliary-Pancreatic Sciences, 2020, 27(1), 3-15

Cacciaguerra AB, Görgec B, Cipriani F, D'Hondt M, et al.

Annals of Surgery, 2020, Jul 9, DOI: 10.1097/ SLA.0000000000004077

INTRODUCTION

INTRODUCTION

A stronger evidence level is needed to confirm the benefits and limits of laparoscopic hemihepatectomies.

The clinical impact of R1 resection in liver surgery for CRLMs has been continuously appraised, but R1 risk factors have not been clearly defined yet.

MATERIALS/METHODS Laparoscopic and open hemihepatectomies from nine European referral centers were compared after propensity score matching (right and left hemihepatectomies separately, and benign and malignant diseases sub-analyses).

OBJECTIVE To assess the risk factors associated with R1 resection in patients undergoing OLS and LLS for CRLMs.

MATERIALS/METHODS RESULTS Five hundred and forty-five laparoscopic hemihepatectomies were compared with 545 open. Laparoscopy was associated with reduced blood loss (P < 0.001), postoperative stay (P < 0.001) and minor morbidity (P = 0.002), supported by a lower Comprehensive Complication Index (CCI) (P = 0.035). Laparoscopic right hemihepatectomies were associated with lower ascites (P = 0.016), bile leak (P = 0.001) and wound infections (P = 0.009). Laparoscopic left hemihepatectomies exhibited a lower incidence of bile leak and cardiovascular complications (P = 0.024; P = 0.041), lower minor and major morbidity (P = 0.003; P = 0.044) and reduced CCI (P = 0.002). Laparoscopic major hepatectomies (LMH) for benign disease were associated with lower blood loss (P = 0.001) and bile leaks (P = 0.037) and shorter total stay (P < 0.001). LMH for malignancy were associated with lower blood loss (P < 0.001) and minor morbidity (P = 0.027) supported by a lower CCI (P = 0.021) and shorter stay (P < 0.001).

CONCLUSION This multicenter study confirms some associated advantages of laparoscopic left and right hemihepatectomies in malignant and benign conditions highlighting the need for realistic expectations of the minimally invasive approach based on the resected hemiliver and the patients treated.

A cohort study of patients who underwent OLS and LLS for CRLMs in 9 European high-volume referral centers was performed. A multivariate analysis and the receiver operating characteristic curves were used to investigate the risk factors for R1 resection. A model predicting the likelihood of R1 resection was developed.

RESULTS Overall, 3387 consecutive liver resections for CRLMs were included. OLS was performed in 1792 cases whereas LLS in 1595; the R1 resection rate was 14% and 14.2%, respectively. The risk factors for R1 resection were: the type of resection (nonanatomic and anatomic/nonanatomic), the number of nodules and the size of tumor. In the LLS group only, blood loss was a risk factor, whereas the Pringle maneuver had a protective effect. The predictive size of tumor for R1 resection was >45 mm in OLS and >30 mm in LLS > 2 lesions was significative in both groups and blood loss >350 cc in LLS. The model was able to predict R1 resection in OLS (area under curve 0.712; 95% confidence interval 0.665-0.739) and in LLS (area under curve 0.724; 95% confidence interval 0.671-0.745).

CONCLUSION The study describes the risk factors for R1 resection after liver surgery for CRLMs, which may be used to plan better the perioperative strategies to reduce the incidence of R1 resection during OLS and LLS.

ABDOMINALE CHIRURGIE

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ABSTRACT 9

ABSTRACT 10

A multicenter cohort analysis of laparoscopic hepatic caudate lobe resection.

Foreign body granuloma reaction following SIRT mimicking peritoneal metastases: a word of caution.

Cappelle M, Aghayan D, van der Poel M, D'Hondt M, et al.

Langenbeck's Archives of Surgery, 2020, 405(2), 181-189

Willems E, Smet B, Dedeurwaerdere F, D'Hondt M Acta Chirurgica Belgica, 2020, 120(1), 47-49

INTRODUCTION

ABSTRACT

Laparoscopic resection of the hepatic caudate lobe (LRCL) requires a high level of expertise due to its challenging anatomical area. Only case reports, case series, and singlecenter cohort studies have been published. The aim of this study was to assess the safety and feasibility of this laparoscopic procedure.

Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver malignancy with poor survival rates. Surgical resection is the only curative treatment option, yet only a small portion of cases are resectable.

In unresectable situations, suggested therapy consists of a systemic chemotherapy regimen with cisplatinum and gemcitabine. Selective internal radiation therapy (SIRT) has been proposed as an alternative treatment option and may lead to downstaging of unresectable iCCA to surgery.

We present a case of a female patient diagnosed with an unresectable iCCA treated with SIRT in order to obtain downstaging.

Explorative laparoscopy three months later showed multiple peritoneal lesions in the left upper quadrant, mimicking peritoneal metastases. Anatomopathological investigation showed a foreign body granuloma surrounding the SIRT resin particles. These findings have important consequences, as the presence of peritoneal metastases implies a palliative situation. Anatomopathological confirmation of any intra-abdominal lesion mimicking peritoneal metastases should be carried out.

MATERIALS/METHODS A multicenter retrospective cohort study including all patients who underwent LRCL in 4 high-volume hepatobiliary units between January 2000 and May 2018 was performed. Perioperative, postoperative, and survival outcomes were assessed. Postoperative morbidity was stratified according to the Clavien-Dindo classification with severe complications defined by grade III or more.

The Kaplan-Meier method was used for survival analysis.

RESULTS A total of 32 patients were included, including 22 (68.8%) with colorectal liver metastasis (CRLM), one (3.1%) with cholangiocarcinoma, four (12.5%) with other malignancies, and five (15.6%) with symptomatic benign lesions.

Simultaneous colorectal and/or additional liver resection was performed in 20 (62.5%) patients. The median (IQR) operative time was 155 (121-280) minutes, blood loss was 100 (50-275) ml, conversion rate was 9.4% (n = 3), severe complications were observed in 2 patients (6.3%), and median (range) length of hospital stay was 3 [1-39] days.

No 90-day postoperative mortality was noticed. The median (IQR) follow-up for the CRLM group was 14 [10-23] months.

Five-year overall survival rate was 82% in this subgroup.

Small interinstitutional differences were observed without major impact on surgical outcomes.

CONCLUSION LRCL is safe and feasible when performed in high-volume centers. Profound anatomical knowledge, advanced laparoscopic skills, and mastering intraoperative ultrasound are essential. No major interinstitutional differences were ascertained.

ABSTRACT 11 Reply to: is there a place for microwave ablation under Pringle maneuver for perivascular colorectal liver metastases?: Response to "laparoscopic liver resection for liver tumours in proximity to major vasculature: a single-center comparative study".

Willems E, D'Hondt M European Journal of Surgical Oncology, 46(9), 2020, 1768-1769 Er is geen abstract beschikbaar.

ABSTRACT 12 Five-year single center experience of sacral neuromodulation for isolated fecal incontinence or fecal incontinence combined with low anterior resection syndrome.

De Meyere C, Nuytens F, Parmentier I, D'Hondt M

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ABSTRACTBOEK | 2020

Techniques in Coloproctology, 2020, 24(9), 947-958

INTRODUCTION Sacral neuromodulation (SNM) has proven to be a safe and effective treatment for fecal incontinence (FI). For low anterior resection syndrome (LARS), however, SNM efficacy is still poorly documented. The primary aim of this study was to report on efficacy of SNM therapy for patients with isolated FI or LARS. Furthermore, we evaluated the safety of the procedure and the relevance of adequate follow-up.

MATERIALS/METHODS A retrospective analysis was performed upon a prospectively maintained database of all patients who underwent SNM therapy for isolated FI or LARS between January 2014 and January 2019. The Wexner and LARS scores were evaluated at baseline, during test phase, after definitive implantation and annually during follow-up. Treatment success was defined as at least 50% improvement of the Wexner score or a reduction to minor or no LARS.

RESULTS Out of 89 patients with isolated FI or LARS who had a SNM test phase, 62 patients were eligible for implantation of the permanent SNM device. At baseline, 3 weeks, and 1, 2, 3, 4 and 5 years after definitive implantation the median Wexner score of all patients was 18, 2, 4.5, 5, 5, 4 and 4.5, respectively, and 18, 4, 5.5, 5, 4, 3 and 4, respectively, for patients with FI and LARS. Patients with LARS more frequently required changes in program settings.

CONCLUSION SNM therapy is a safe and effective treatment for patients with isolated FI and patients with FI and LARS. Adequate follow-up is essential to ensure long-term effectivity, especially for LARS patients.

In this study, the short- and long-term outcomes and recurrence patterns of one-stage LLR for bilobar CRLM were compared to single laparoscopic resection for CRLM.

MATERIALS/METHODS This single-center study consisted of all patients who underwent a parenchymal sparing LLR for CRLM between October 2011 and December 2018. Demographics, perioperative outcomes, short-term outcomes, oncologic outcomes and recurrence patterns were compared.

Data were retrieved from a prospectively maintained database.

RESULTS Thirty six patients underwent a LLR for bilobar CRLM and ninety patients underwent a single LLR. Demographics were similar among groups. More patients received neoadjuvant chemotherapy in the bilobar group (55.6% vs 34.4%, P = 0.03). There was no difference in conversion rate, R0 resection and transfusion rate. Blood loss and operative time were higher in the bilobar group (250 ml (IQR 150-450) vs 100 ml (IQR 50-250), P < 0.001 and 200 min (IQR 170-230) vs 130 min (IQR 100-165), P < 0.001) and hospital stay was longer (5 days (IQR 4-7) vs 4 days (IQR 3-6), P = 0.015). The bilobar group had more technically major resections (88.9% vs 56.7%, P < 0.001).

Mortality was nil in both groups and major morbidity was similar (2.8% vs 3.3%, P = 1.0). There was no difference in recurrence pattern. Overall survival (OS) was similar (1 yr: 96% in both groups and 5 yr 76% vs 66%, P = 0.49), as was recurrence-free survival (RFS) (1 yr: 64% vs 73%, 3 yr: 38 vs 42%, 5 yr: 38% vs 28%, P = 0.62).

CONCLUSION In experienced hands, LLR for bilobar CRLM can be performed safely with similar oncologic outcomes as patients who underwent a single LLR for CRLM.

ABSTRACT 13 One-stage laparoscopic parenchymal sparing liver resection for bilobar colorectal surgical.

D’Hondt M, Parmentier I, De Meyere C, Pironet Z, Vansteenkiste F, et al.

Endoscopy, 2021, Mar 8, DOI: 10.1007/ s00464-021-08366-5

ABSTRACT 14 Oesophageal-pericardial fistula: a rare complication of radiation-induced oesophagitis.

Denglos P, Nuytens F, Piessen G, et al.

European Journal of Cardio-Thoracic Surgery, 2020, 58(5), 1097-1099

INTRODUCTION Laparoscopic liver resections (LLR) of bilobar colorectal liver metastases (CRLM) are challenging and the safety and longterm outcomes are unclear.

ABDOMINALE CHIRURGIE

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ABSTRACT

INTRODUCTION

Oesophageal-pericardial fistula after radiation therapy for lung cancer is a rare complication associated with a high mortality.

In this casereport, we present the case of 52-year-old women with late radiation-induced oesophagitis after chemoradiotherapy for a pulmonary adenocarcinoma, complicated by an oesophageal-pericardial fistula for which a transthoracic oesophagectomy with pericardial drainagewas performed. The postoperative course was complicated by a fatal hypovolaemic shock due to a perforation of the descending aortanear the initial fistula track. In this case report, we illustrate the importance of thorough inspection of diagnostic images in this context andemphasize the role of endovascular repair in case an associated aortic perforation is suspected.

Laparoscopic liver resection (LLR) as a treatment for colorectal liver metastases (CRLM) has proven to be feasible and safe in selected patients. The role of LLR in two stage hepatectomy (TSH) is poorly documented.

PRESENTATIES ABSTRACT 15

MATERIALS/METHODS A single-center retrospective study was performed in which the role of LLR in the first and second stage of TSH was evaluated.

CONCLUSION The already proven advantages of LLR in the treatment of CRLM favor the role of a laparoscopic approach in TSH for CRLM. In first-stage minor hepatectomy, LLR is progressively becoming the gold standard. Laparoscopic second stage major hepatectomy is feasible in experienced hands, but should be limited to selected cases and should be performed in expert centers.

Laparoscopic liver surgery through day-case surgery: initial single centre experience.

ABSTRACT 19 Baekelandt L, De Meyere C, Parmentier I, D'Hondt M November 2020, Belgian Surgical Week, Antwerpen - België

ABSTRACT 16 Five year single center experience of sacral neuromodulation for low anterior resection syndrome.

The laparoscopic approach for two stage hepatectomy: a single center five year experience.

D'Hondt M, Taillieu E, De Meyere C, Parmentier I March 2020, Americas Hepato-Pancreato-Biliary Association (AHPBA) 2020 Annual Meeting, Miami Beach, Florida - USA

De Meyere C, Pironet Z, Parmentier I, D'Hondt M November 2020, Belgian Surgical Week, Antwerpen - België

ABSTRACT 20

ABSTRACT 17

One stage laparoscopic parenchymal sparing liver resection for bilobar colorectal liver metatases: safety, recurrence patterns and oncologic outcomes.

Combined ablation and resection (care) for colorectal liver metastasis in the era of minimal invasive surgery.

Lutin B, De Meyere C, Parementier I, D'Hondt M, et al.

November 2020, Belgian Surgical Week, Antwerpen - België

D'Hondt M, Parmentier I, De Meyere C, Vansteenkiste F, et al.

March 2020, Americas Hepato-Pancreato-Biliary Association (AHPBA) 2020, Miami Beach, Florida - USA

INTRODUCTION ABSTRACT 18 The role of the laparoscopic approach in two-stage hepatectomy for bilobar colorectal liver metastases: a single-center five year experience.

D'Hondt M, Taillieu E, De Meyere C, Parmentier I November 2020, Belgian Surgical Week, Antwerpen - België

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ABSTRACTBOEK | 2020

Laparoscopic resections (LLR) of bilobar colorectal liver metastases (bCRLM) are challenging and the safety and long term outcomes of these procedures are unclear.In this study the short and long term outcomes and recurrence patterns of one stage LLR for bCRLM were compared to patients who underwent a single laparoscopic resection for CRLM.

MATERIALS/METHODS

MATERIALS/METHODS

This single center study consisted of all patients who underwent a parenchymal sparing LLR for CRLM between October 2011 and December 2018. Data were retrieved from a prospectively maintained electronic database.

In January 2016 a 51 year old male patient presented with massive bilobar colorectal liver metastases. There was one CRLM in the left hemiliver and numerous CRLMs in the right hemiliver. The primary tumor was asymptomatic and the patient received 4 cycles of chemotherapy (Folfox/ Panitumumab). Since the left hemiliver (=FLR) was only 16% of total liver volume (TLV) a right PVE (portal vein embolization) was performed. However, PVE failed and 4 weeks after PVE the FLR-volume was only 18% of TLV. Chemotherapy was continued till 12 cycles. The option of performing an ALPPS procedure was discussed with the patient and the patient agreed. First, a laparoscopic sigmoid resection was performed in October 2016. On December 12 2016 the first step of the ALPPS procedure was performed. During the first stage a metastasectomy in the left hemiliver was performed and the liver parenchyma between the left and right hemiliver was transected. Intraoperative ultrasound reveiled residual portal flow in the right hemiliver after PVE. The right portal vein was isolated an transected using a vascular stapler. Eight days postoperatively the volume of the left hemiliver was 30%. The second stage of ALPPS was performed 1 day later (9 days after the first stage).

RESULTS Thirty six patients underwent a LLR for bCRLM and 90 patients underwent a single LLR. Demographic characteristics were similar among groups. More patients received neoadjuvant chemotherapy in the bilobar group (55.6% vs 34.4%, p=0.03). There was no difference in conversion rate, R0 resection rate, and transfusion rate when comparing the bilobar group with the control group. Blood loss and operative time were higher in the bilobar group (250cc(150450) vs 100cc(50-300), p<0.001 and 200min(170-230) vs 130min(120-190), p<0.001) and hospital stay was longer (5days(4-7) vs 4days(3-6), p<0.001). More patients in the bilobar group underwent a technically major laparoscopic resection (88.9 vs 56.7%, p<0.001). Mortality was nil in both groups and major morbidity was similar (2.8% vs 3.1%).

There was no difference in recurrence pattern (hepatic/ extrahepatic) or interval to chemotherapy. Overall survival was similar when comparing the bilobar group to the control group (1year: 96% in both groups and 5year 76%bilobar vs 66%, p=0.80) and disease free survival was similar (1year: 64% vs 73%, 3year: 38 vs 42%, 5year: 38% vs 28%).

CONCLUSION In experienced hands LLR for bCRLM can be performed safely with similar oncologic outcomes as patients who underwent a single laparoscopic resection for CRLM.

RESULTS Operative time of stage one was 300 minutes an blood loss was 150 ml. Postoperative course was uneventful and hospital stay was 4 days. Operative time of stage two was 90 minutes and blood loss was 150 ml. Postoperatively the patient developed grade A liver failure. The patient was discharged on postoperative day 8. At 20 months postoperatively there was no evidence of disease recurrence.

CONCLUSION ABSTRACT 21 Laparoscopic alpps procedure after failed portal vein embolization.

Laparoscopic ALPPS appears to be feasable in experienced hands. The well-recognized advantages of laparoscopy may play a favorable role in the management of patients with bilobar CRLMs candidate for an ALPPS procedure.

D'Hondt M, Baekelandt L March 2020, Americas Hepato-Pancreato-Biliary Association (AHPBA) 2020, Miami Beach, Florida - USA

ABSTRACT 22

INTRODUCTION

Hybrid minimally invasive esophagectomy for esophageal cancer: five-year survival results of the MIRO trial.

Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) is a relatively new surgical technique for the resection of colorectal liver metastases (CRLMs) with insufficient future liver remnant (FLR). Only 27 cases of laparoscopic ALPPS have been reported in literature. This video aims to demonstrate our first experience with this minimally invasive approach.

Nuytens F October 2020, Virtually the best of the ISDE 2020 (International Society for Diseases of the Esophagus), Online

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ABSTRACT 23 The use of intraoperative ultrasound in minimally invasive hepatic and pancreatic surgery.

D’Hondt M, Aroori S October 2020, Webinar: Clinical Value of Intraoperative Ultrasound in HPB Surgery, Online

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ANESTHESIE ARTIKELS ABSTRACT 1 Incidence of iatrogenic pneumothorax after ultrasound guided supraclavicular nerve block for upper limb surgery: a single centre experience of 3641 blocks.

Vandemoortele O, Helsloot D, Van Belleghem V, Desmet M, et al.

European Journal of Anaesthesiology, 2020, 37, 113

incidence of pneumothorax has been reported in recent years to be decreased by the use of ultrasound. Incidences lower than 0.05% have been reported (1). Our data indicate that real incidence could be even lower.

CONCLUSION Retrospective analysis of 3641 ultrasound guided supraclavicular nerve blocks indicate that this is a safe procedure and confirm previous studies indicating that the overall incidence of pneumothorax is very low (< 0.05 %).

INTRODUCTION An ultrasound guided supraclavicular nerve block is one of several anaesthesia techniques to perform anaesthesia and postoperative analgesia for upper limb surgery. However, the presence of the subclavian artery and pleural cavity in the vicinity of the brachial plexus results in a possible risk for hematoma and pneumothorax. The incidence of iatrogenic pneumothorax after a supraclavicular nerve block without ultrasound is reported to vary between 0.5 and 6 percent.

However, the overall incidence of pneumothorax diminishes with increasing experience and is further reduced with the use of ultrasound to an overall incidence of 0.05%.

OBJECTIVE This audit aims to demonstrate the incidence of iatrogenic pneumothorax after ultrasound guided supraclavicular nerve block in a high volume centre.

MATERIALS/METHODS A retrospective analysis was performed on all supraclavicular nerve blocks for upper limb surgery in our hospital between January 1, 2016 and November 31, 2019. All supraclavicular nerve blocks were performed at the discretion of the attending anaesthesiologist. The overall incidence of clinically significant pneumothorax (suspected by symptoms of dyspnea or chest pain following the performance of the block and confirmed by chest X-ray) was documented.

ABSTRACT 2 Implementation of regional anesthesia guidelines in clinical practice, does it happen in real life?

Desmet M, Missant C, Reynvoet M, Lamote S et al.

European Journal of Anaesthesiology, 2020, 37, 114

INTRODUCTION Clinical practice often lags behind evidence presented in the literature. Current guidelines advocate the use of low volumes of local anesthetics during peripheral nerve blocks (PNB), accept the safety of PNB performance under general anesthesia (GA) and recommend the use of combining ultrasound (US) and nerve stimulation (NS) during PNB.

OBJECTIVE This audit aims to evaluate if clinical practice has changed according to guidelines.

MATERIALS/METHODS An audit was performed on all supraclavicular (SCB) and interscalene blocks (ISB) for upper limb surgery executed in a single centre in 201 6and 2019. All blocks were performed at the discretion of the attending anesthesist. Statistical analysis using Student’s t tests and Chi square tests was performed onthe volume used, the combined use of US and NS and the performance of PNB under sedation or GA.

RESULTS Between 01-01-2016 and 31-11-2019, 3641 supraclavicular nerve blocks were performed for upper limb surgery. All blocks were performed using ultrasound. 2870 blocks were performed by graduated anaesthesiologists with a variable expertise in regional anaesthesia. 771 were performed by residents. No cases of a clinically significant pneumothorax could be identified in our database. Supraclavicular nerve blocks provide excellent analgesia for upper limb surgery and are frequently used for day case surgery. Accidental pleural puncture and pneumothorax could however delay hospital discharge and increase hospital costs. The overall

RESULTS In 2016 and 2019, 828 and 886 SCB were performed.There was a significant reduction of the mean volume used from 35 to 26mL (p<0.05). In 2016 both US and NS was used in 76% of cases where in 2019 this was only 37% (p<0.05). Only a small minority of patients received a PNB under GA (4 in 2016, 5 in 2019), there was a significant reduction in the use of sedatives from 2016 to 2019 (90% in 2016 vs 15% in 2019, p<0.05). In 2016 and 2019, 576 and 645 ISB were performed. There was no difference in the volume used

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(19.4mLvs 18.6mL). The use of NS and US increased from 2016 to 2019 (20% vs 50%,p<0.05). ISBs were performed under general anesthesia in 46 patients in 2016 and 7 in 2019 (p<0.05), there was a significant reduction in the use of sedatives (45%vs 12%, p<0.05). Acceptance of guidelines in clinical practice is diverse. There was an increase in the use of NS combined with US for ISB but not for SCB. The fear of unexpected movement with the needle in close proximity to the pleura was the main reason for anesthesiologists not to use NS in SCB. In contrast to SCB, the volume used for ISB was already low preventing a further reduction. The logistic organization with the presence of a block room explaines the unchanged and low proportion of patients receiving a PNB under GA.

CONCLUSION Our audit demonstrates that in a high volume centre adoptation of clinical guidelines is slow or even non existent.

Further research is necessary to detect the barriers that prevent implementation of clinical guidelines.

RESULTS The analgesic duration of perineural versus intravenous administration as an adjuvant to a long acting local anesthetic peripheral nerve block, was in seven trials with perineural dexamethasone significantly prolonged of which two studies were evaluated as highrisk bias. However, in five trials, no difference between perineural and intravenous dexamethasone was observed.

CONCLUSION No clinically significant difference in the analgesic duration of perineural versus intravenous administration as an adjuvant to a longacting local anesthetic peripheral nerve block could be withheld. The intravenous route is the preferred method of administration as no clinically significant analgetic advantages are seen with the perineural route, and the remaining questions exist of possible neurotoxicity with perineural dexamethasone use.

ABSTRACT 4 ABSTRACT 3

Regional anesthesia of the hip joint: review of regional anesthesia techniques.

Comparison of the analgesic effects of perineural and intravenous dexamethasone on peripheral nerve block: a systematic review.

Coucke C, Desmet M, Vermeylen K, et al.

Acta Anaesthesiologica Belgica, 2020, 71, 7-13

Piepers I, Desmet M, Van de Velde M, et al.

Acta Anaesthesiologica Belgica, 2020, 71, 37-44

INTRODUCTION Perineural dexamethasone has proved to prolong the postoperative analgesia of local anesthetic peripheral nerve blocks. However, a similar increase in postoperative analgesia duration is seen with the use of intravenous dexamethasone.

OBJECTIVE The objective of this systematic review is to compare the duration of analgesia between perineural and intravenous dexamethasone as an adjuvant to a peripheral nerve block with long-acting local anesthetics.

INTRODUCTION As hip fractures are frequent in the frail population, multiple regional anesthesia approaches have been developed over the past years to achieve analgesia of the hip joint.

Achieving optimal analgesia with opioid reduction remains challenging in this group with high morbidity and mortality. Many techniques have changed over the years due to the introduction of ultrasound and an optimisation of radiographic techniques such as MRI. There has been an upcoming interest in the fascia iliaca compartment block (FICB), local infiltration analgesia (LIA) and more recently the pericapsular nerve group block (PENGblock).

OBJECTIVE The aim of this review is to clarify the role of these techniques in hip surgery.

MATERIALS/METHODS A systematic search in Medline and Scopuswas executed up to April 2020 using the following MeSH terms: dexamethasone, nerve block, brachial plexusblock, perineural.

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MATERIALS/METHODS A systematic search was performed in Medline, Embase and the Cochrane database, with the following MeSH terms: conduction anesthesia, nerve block, local Anesthesia.

RESULTS There is increasing evidence that a suprainguinal approach of the FICB is a valuable alternative for hip analgesia, as there is more success in blocking the three targeted nerves (femoral, obturator and lateral femoral cutaneous nerve), compared to the classical infra-inguinal approach. Very recently, the pericapsular nerve group block has seemed a promising option inproviding analgesia of the hip joint, compared to LIA.

Furthermore, although great care has been taken to avoid conflict with the “Safety First Guidelines” issued by the Society for Anesthesia and Resuscitation of Belgium (SARB) and the Belgian Professional Association of Specialists in Anesthesia and Resuscitation (BSAR-APSAR), we emphasize that the “Safety First Guidelines” should be prioritized above the “Guidelines for the safe clinical practice of peripheral nerve blocks in the adult patient.”

CONCLUSION

ABSTRACT 6

Both the FICB as well as the PENG block have been shown to be safe and effective analgesic options in hip fracture.

However, more research is needed to determine the role of both techniques in different hip conditions.

Conscious sedation using dexmedetomidine during surgical paddle lead placement improves outcome in spinal cord stimulation: a case series of 25 consecutive patients.

Vanhauwaert D, Couvreur T, Vandebroek A, et al.

Neuromodulation, 2020, Feb 19, DOI: 10.1111/ner.13124

ABSTRACT 5 Guidelines for the safe clinical practice of peripheral nerve blocks in the adult patient.

Desmet M, Bindelle S, Breebaart M, et al.

Acta Anaesthesiologica Belgica, 2020, 71, 151-161

OBJECTIVE Different anesthesia techniques are used for surgical implantation of paddle lead electrodes for neurostimulation through a laminectomy. We wanted to evaluate the use of dexmedetomidine as sedative for this procedure in a series of patients.

ABSTRACT

MATERIALS/METHODS

In 2013, the first “Clinical guidelines for the practice of peripheral nerve blocks in the adult” were published by the Belgian Association for Regional Anesthesia (BARA) Peripheral Nerve Block working group. Since then a plethora on research has been published providing new insights in the clinical practice of peripheral nerveblocks (PNBs). The aim of this revised version is to provide anesthesiologists an update of the 2013 guidelines according to the most recent evidence in an effort to further enhance quality and safety of clinical practice.

These recommendations were composed by the BARA Peripheral Nerve Blockworking group which included elected BARA boardmembers and non-board BARA all of them with an extensive experience in regional anesthesia (RA). A large-scale review of the literature regarding different topics was performed to support the guidelines by current evidence.

Twenty-five consecutive patients received surgical implantation of a spinal cord stimulation electrode under conscious sedation using dexmedetomidine and local anesthesia. We evaluated the effects of the administered drug, the patient comfort, and the adequacy of the stimulation pattern.

However, in case of limited available data, expert opinion as a result of discussion within the working group, was used as a surrogate for robust data. We would like to remind readers of this manuscript that although these guidelines are intended to optimize patient care, they do not replace sound clinical judgment and cannot ensure the avoidance of adverse outcomes.

RESULTS Twenty-four patients completed the procedure with only dexmedetomidine and local anesthetic. Infusion was started on average 55 minutes (sd 29) prior to incision. The mean dose of lidocaine was 430 mg (sd 95). There were no significant hemodynamic changes. Median time to reach Modified Aldrete's score postoperative was 67 minutes (sd 38). In 46% of the patients, the position of the electrode was changed guided by the feedback of the patient. More than half of the patients remember most details of the procedure. Only four patients mentioned substantial discomfort and only three would definitely not want to undergo this procedure again.

CONCLUSION Implantation of spinal cord stimulation electrodes through a surgical laminectomy using dexmedetomidine is a safe and feasible procedure with adequate comfort for patient and surgeon. This way of working increases the optimal position of the electrode resulting in the most convenient stimulation pattern and avoiding revisions.

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ABSTRACT 7 The use of peripheral nerve blocks for trauma patients: a survey in Belgian emergency departments.

Puype L, Desmet M, Van Belleghem V, et al.

Acta Clinica Belgica, 2020, 75, 1-41

Our survey demonstrated that the vast majority of ED physicians is convinced of the added value of PNBs. Although PNBs are frequently performed after trauma, they are rarely incorporated in pain protocols for trauma patients.

PRESENTATIES

INTRODUCTION Pain is a common symptom in the emergency department (ED). Peripheral nerve blocks (PNBs) can offer specific advantages for the trauma patient.

OBJECTIVE This study aimed to evaluate to what extent PNBs for traumapatients are performed in the Belgian EDs.

Desmet M January 2020, ESRA Winterweek, Langefeld - Oostenrijk

MATERIALS/METHODS

ABSTRACT 9

This cross-sectional survey was conducted from February to July 2019. The medical chiefs of the Eds of 124 acute care hospitals in Belgium were contacted by telephone regarding the use of PNBs after trauma in their ED. The survey assessed the use of a peripheral nerve block (PNB) based on a 26-item questionnaire.These questions had items related to the type of hospital and ED.

Problem based learning discussion: conflict management in the OR.

RESULTS The response rate of the survey was 90%. In 84% of the hospitals, PNBs were performed after trauma. A similar proportion (90%) had a specific pain protocol for trauma patients. In 6% of the ED, PNBs were formally integrated in a multimodal analgesic protocol. Hip fractures were considered the main indication and ultrasound (US) was the preferred technique. However, the majority of the blocks were performed in the operating theatre (68%).

According to our respondents, the main reason why they did not perform blocks in their ED, was a lack of training.

Intralipid was readily available in 50% of the EDs.

CONCLUSION Although the vast majority of the hospitals perform PNBs after trauma, they are rarely incorporated in pain protocols for trauma patients. However, the majority of ED physicians are convinced of the added value of PNBs. Lack of training, time constraint and logistic challenges are the most important reasons why PNBs are not performed in Belgian EDs. Currently, the majority of PNBs are performed in the operating theatre. Providing PNBs early after arrival at the ED increasesthe quality of care and should not be delayed.

Therefore, PNBs are ideally performed in the ED.

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ABSTRACT 8 The 10 most influential papers of 2019.

ABSTRACTBOEK | 2020

Desmet M January 2020, ESRA Winterweek, Langefeld - Oostenrijk

APOTHEEK ARTIKELS

PRESENTATIES

ABSTRACT 1

ABSTRACT 2

Point prevalence survey of antimicrobial use and healthcare-associated infections in Belgian acute care hospitals: results of the global-PPS and ECDC-PPS 2017.

Concordance between guidelines on perioperative management of NOACs and its implementation and preventable causes of the occurence of ischemic stroke.

Vandael E, Latour K, Goossens H, Vanneste L, et al.

Antimicrobial Resistance & Infection Control, 2020, 9(1), DOI: 10.1186/s13756-019-0663-7

Simons S November 2020, European Stroke Organisation - World Stroke Organisation (ESO-WSO), Wenen – Oostenrijk, Online

INTRODUCTION

BACKGROUND

The point prevalence survey of healthcare-associated infections (HAIs) and antimicrobial use organized by the European Centre for Disease Prevention and Control (ECDC-PPS) and the Global Point Prevalence Survey of antimicrobial consumption (Global-PPS) were simultaneously performed in Belgian acute care hospitals in 2017.

Increasing numbers of patients receiving a novel oral anticoagulant (NOAC) are undergoing elective surgery. The extent to which perioperative interruption of NOAC therapy is concordant with best evidence is uncertain.

MATERIALS/METHODS Belgian acute care hospitals were invited to participate in either the ECDC or Global-PPS. Hospital/ward/patient-level data were collected between September-December 2017.

All patients present in the wards at 8 a.m. on the day of the PPS were included. The data of the ECDC and Global-PPS on antimicrobial consumption were pooled. Detailed data on HAIs were analysed for ECDC-PPS.

RESULTS Overall, 110 Belgian acute care hospital sites participated in the ECDC and Global-PPS (countrywide participation rate: 81.4%, 28,007 patients). Overall, a crude prevalence of patients with at least one antimicrobial of 27.1% (95% confidence interval (CI) 26.5-27.6%) was found. The most frequently reported indications were pneumonia (23.2%), urinary tract infections (15.2%) and skin and soft tissue infections (11.9%). The reason for antimicrobial use was recorded for 81.9% of the prescriptions, a stop/review date for 40.8% and compliance with local antibiotic guidelines for 76.6%. In the ECDC-PPS, the crude prevalence of patients with at least one HAI was 7.3% (95%CI 6.8-7.7%).

Most frequently reported HAIs were pneumonia (21.6%) and urinary tract infections (21.3%).

CONCLUSION HAI and antimicrobial use prevalence remained stable in comparison with the previous PPS (7.1% and 27.4% in 2011 and 2015, respectively). Belgian hospitals should be further stimulated to set local targets to improve antibiotic prescribing and reduce HAI.

OBJECTIVE This study investigated whether inappropriate perioperative advice can lead to the occurrence of an ischaemic stroke. Furthermore, we examined the relation between inappropriate dosing, perioperative management and interactions.

MATERIALS/METHODS Data from all ischaemic stroke patients, previously treated with a NOAC, were retrospectively collected from the EVASBE-database (January to October 2019). The following data were retrieved: date of stroke, aetiology, previous stroke, posology and indication for NOAC, renal function, weight, age, concomitant drugs, surgery (indication, date, bleeding risk, preoperative advice), medication management poststroke and discharge therapy. Concordance of perioperative anticoagulation management with regional and EHRA guidelines was rated by a clinical pharmacist according to the explicit risk of thrombosis and bleeding.

RESULTS Of the 57 patients with an ischaemic stroke receiving a NOAC, nine (16%) had been planned to undergo surgery.

The decision to interrupt anticoagulation was concordant with regional guidelines. Compared with EHRA guidelines: three cases stopped without indication (5 days–2 days), and three low and one high bleeding risk patient stopped too early. None of them were bridged.

Firstly, inappropriate dosing (30%) and posology (7%) based on the SmPC criteria was identified. Of the 17 inappropriately dosed patients, underdosing was the main factor (16 vs 1). Secondly, 16 patients (28%) showed one or more interactions with concomitant drugs. Due to the

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pharmacodynamic interactions, a higher risk of thrombosis was seen in two patients. Four patients showed a pharmacokinetic interaction; one was a decreased effect. Thirdly, the greatest risk in the perioperative phase seemed to be post-surgery in comparison with pre-surgery, seen in seven and two patients, respectively. Medication adherence was questionable in five patients (9%).

CONCLUSION The occurrence of ischaemic stroke in the perioperative phase in patients treated with a NOAC was a major problem.

The main issue seemed to be the discordance between our regional and EHRA guidelines regarding perioperative NOAC management. Apart from the perioperative transition phase, other reasons for occurrence were inappropriate dosing, drug interactions and non-compliance.

ABSTRACT 3 Occurrence of ischemic stroke in patients treated with NOAC: a neglected population group.

Vanacker P, Simons S, Verhaeghe A, Geebels A, Meeus G September 2020, ESO-WSO Conference 2020, Wenen Oostenrijk, Online

ABSTRACT 4 Concordance between guidelines on perioperative management of NOACS and ITS implementation: preventable cause of ischemic stroke.

Vanacker P, Simons S, Verhaeghe A, Geebels A, Meeus G September 2020, ESO-WSO Conference 2020, Wenen Oostenrijk, Online

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CARDIOLOGIE ARTIKELS ABSTRACT 1 Secundaire hypertensie.

Dhont S, De Niel C, Van Mieghem C Tijdschrift voor Geneeskunde, 2020, 76, 128-132

INTRODUCTION Het behoud van een normale bloeddruk is essentieel voor een adequate orgaanperfusie. De drie belangrijkste factoren die de bloeddruk bepalen, zijn het sympathische zenuwstelsel, het renine-angiotensine-aldosteronsysteem(RAAS) en het bloedvolume. Hypertensieof verhoogde bloeddruk blijft de best behandelbare risicofactor voor vroegtijdige cardiovasculaire ziekte. De bloeddruk is een normaal verdeelde biologische variabele.

De meest gangbare Europese criteria die worden gehanteerd ter definiëring van arteriëlehypertensie, zijn samengevat. Bij meting in het dokterskabinet moet er bij herhaling een systolische bloeddruk opgemeten worden hoger dan of gelijk aan 140 mmHg en/of een diastolische druk hoger dan of gelijk aan 90 mmHg. Boven deze waarden wegen de voordelen van therapie ontegensprekelijk op tegen de risico’s.

Doorgaans kent hypertensie geen eenduidige etiologie en spreekt men over "primaire", "idiopathische" of "essentiële hypertensie". Bij 5% tot 10% van de patiënten kan men echter een oorzaak aantonen. In die gevallen spreekt men over "secundaire hypertensie". Men moet hieraan in het bijzonder denken bij een jonge patiënt met verhoogde bloeddrukken die resistent blijven tegen een combinatietherapie: per definitie drie voldoende hoog gedoseerde antihypertensiva van verschillende klassen (waaronder zeker een diureticum).

Tijdige doorverwijzing en vroege detectie van een secundaire oorzaak van hypertensie zijn zeer belangrijk aangezien een snelle interventie curatief kan zijn. Op die manier wordt het levenslang innemen van antihypertensiva met de daaraan geassocieerde kosten en bijwerkingen vermeden.

De diagnostische screening bestaat uit bloed- en urinetesten, abdominale beeldvorming en een echocardiografie.

CONCLUSION Slechts bij 5% tot 10% van de hypertensieve patiënten vindt men een aanwijsbare oorzaak en kan men spreken over secundaire hypertensie. Screening is duur en tijdrovend en wordt bij voorkeur enkel uitgevoerd bij patiënten met een sterk klinisch vermoeden. Vroeg detectie en een snelle behandeling zijn essentieel om een curatieve interventie toe te laten. Indien niet gediagnosticeerd, kan secundaire hypertensie leiden tot refractair verhoogde bloeddrukken, cardiovasculaire en renale complicaties en uiteindelijk tot een verhoogde morbiditeit en cardiovasculaire mortaliteit.

ABSTRACT 2 Clinical impact of CT coronary angiography without exclusion of small coronary artery segments: a real-world and long-term study.

Logghe Y, Van Hoe L, Vanhoenacker P, Van Mieghem C, et al Open Heart 2020, DOI: 10.1136/openhrt-2019-001222

OBJECTIVE CT coronary angiography (CTCA) has become a valuable diagnostic test in the workup of patients with possible coronary artery disease (CAD). Because of inherent limitations in spatial resolution, epicardial vessels with a small diameter, in general less than 1.5–2 mm, have so far been excluded in studies assessing clinical utility of CTCA. This study sought to assess the clinical impact of CTCA taking into account pathology in small coronary arteries.

MATERIALS/METHODS We conducted a retrospective cohort study of all patients with possible CAD who underwent dual-source CTCA and subsequent invasive coronary angiography (ICA) between January 2010 and July 2017. Patients with an Agatston calcium score ≥1000 were reported separately.

Diagnostic accuracy of CTCA on a patient, vessel and segment level was calculated. The physician’s therapeutic decision was defined as conservative, medical antianginal treatment or revascularisation. Using ICA as the reference, we calculated the precision of CTCA to replicate these therapeutic recommendations.

RESULTS In total, 1209 patients underwent both CTCA and ICA. Overall diagnostic performance of CTCA showed a sensitivity of 90% (95% CI 86% to 93%) and specificity of 40% (95% CI 36% to 45%). With regard to clinical decision making, CTCA showed good performance: 91% of patients

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who were treated medically or by revascularisation were correctly identified. Prevalence of disease in small vessel segments was low: 16% showed significant CAD on ICA. Prevalence of significant disease was 70% in patients with an Agatston score ≥1000: the majority underwent revascularisation.

CONCLUSION From a true patient perspective, without exclusion of smaller coronary artery segments, CTCA allows safe patient management.

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ENDOCRINOLOGIE/DIABETOLOGIE ARTIKELS

ABSTRACT

INTRODUCTION

The aims of the ‘Mobile-based lifestyle intervention in women with glucose intolerance after gestational diabetes mellitus (GDM)’ study (MELINDA) are: (1) to evaluate the prevalence and risk factors of glucose intolerance after a recent history of GDM; and (2) to evaluate the efficacy and feasibility of a telephone- and mobile-based lifestyle intervention in women with glucose intolerance after GDM. This is a Belgian multicenter randomized controlled trial (RCT) in seven hospitals with the aim of recruiting 236 women.

Primaire hyperparathyreoïdie (PHPT) is een bekende oorzaak van hypercalciëmie en heeft in de algemene bevolking een prevalentie van ongeveer 0,1%, toenemend met de leeftijd. Exacte data over prevalentie van PHPT tijdens de zwangerschap bestaan er niet. Dit komt enerzijds omdat hiervoor tijdens de zwangerschap niet gescreend wordt en anderzijds omdat PHPT vaak asymptomatisch verloopt. Eventuele symptomen kunnen bovendien gemaskeerd worden door veelvoorkomende zwangerschaps kwalen. Screenen voor PHPT is echter relatief eenvoudig door middel van bepaling van de calciëmie.

We beschrijven hier een geval van primaire hyperparathyreoïdie die zich uitte als hyperemesis gravidarum in de vroege zwangerschap.

Women in the intervention group will receive a blended program, based on one face-to-face education session and further follow-up through a mobile application and monthly telephone advice. Women in the control group will receive follow-up as in normal routine with referral to primary care. Participants will receive an oral glucose tolerance test (OGTT) one year after baseline. Primary endpoint is the frequency of weight goal achievement (≥5% weight loss if pre-pregnancy BMI ≥ 25 Kg/m2 or return to pre-gravid weight if BMI < 25 Kg/m2). At each visit blood samples are collected, anthropometric measurements are obtained, and self-administered questionnaires are completed.

Recruitment began in May 2019.

ABSTRACT 1 Primaire hyperparathyreoïdie, zich presenterend als hyperemesis gravidarum.

Deconinck M, Denys B, Myngheer N Gunaïkeia, 2020, 25 (5), 18-20

MATERIALS/METHODS Beschrijving klinische casus.

ABSTRACT 3

CONCLUSION

Characterisation of testicular function and spermatogenesis in transgender women.

Primaire hyperparathyreoïdie is zeldzaam tijdens de zwangerschap. Hypercalciëmie is geassocieerd met belangrijke complicaties bij zowel moeder als foetus, waardoor een tijdige diagnose en behandeling wenselijk is.

Calciëmiebepaling dient bijgevolg deel uit te maken van de diagnostische uitwerking bij patiënten met aanhoudende of recidiverende episodes van hyperemesis gravidarum .

Parathyreoïdectomie is bij ernstige hypercalciëmie de meest aangewezen behandeling en kan vanaf het tweede trimester veilig worden uitgevoerd.

ABSTRACT 2 Mobile-based lifestyle intervention in women with glucose intolerance after gestational diabetes mellitus (MELINDA), a multicenter randomized controlled trial: methodology and design.

Minschart C, Maes T, De Block C, Myngheer N, et al.

Journal of Clinical Medicine, 2020, 9(8), 2635

Vereecke G, Defreyne J, Van Saen D, et al.

Human Reproduction, Volume 36, Issue 1, January 2021, Pages 5–15, DOI: 10.1093/humrep/deaa254

STUDY QUESTION Does gender-affirming treatment prevent full spermatogenesis in transgender women (TW)?

SUMMARY ANSWER Adequate hormonal therapy (HT) leads to complete suppression of spermatogenesis in most TW, if serum testosterone levels within female reference ranges are obtained.

WHAT IS KNOWN ALREADY Gender-affirming treatment in transgender individuals may involve gender-affirming HT. The effects on spermatogenesis in TW remain unclear. In order to add information from a referral centre for transgender care, we wish to compare results of earlier studies with our population of TW who received a standard hormone treatment.

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STUDY DESIGN, SIZE, DURATION

STUDY FUNDING/COMPETING INTEREST(S)

This was a prospective cohort study part of the European Network for the Investigation of Gender Incongruence (ENIGI), conducted between 15 February 2010 and 30 September 2015. There were 162 TW were included in the ENIGI study at the Ghent University Hospital in Belgium.

Participants are included in ENIGI when they first start HT, and follow-up visits occur over the next 3 years.

D.V.S. is a post-doctoral fellow of the Fonds Wetenschappelijk Onderzoek (FWO; 12M2819N). Processing of the testis specimens was funded by the Biology of The Testes (BITE) research group (Department of Reproduction, Genetics and Regenerative medicine at Vrije Universiteit Brussel (VUB)).

There are no competing interests.

PARTICIPANTS/MATERIALS, SETTING METHODS The study included 97 TW who initiated HT with cyproterone acetate (CPA) plus oestrogens and proceeded with gonadectomy at the Ghent University Hospital. Testicular tissue retrieved during gonadectomy was processed and stained for four different germ cell markers by the Biology of the Testis lab at the Vrije Universiteit Brussel.

Subsequent immunohistochemical staining was performed for melanoma-associated antigen A4 (MAGE-A4, marker for spermatogonia and early spermatocytes), boule homologue, RNA-binding protein (BOLL, marker for secondary spermatocytes and round spermatids), cAMP-responsive element modulator (CREM, marker for round spermatids) and acrosin (marker for acrosome visualization). Serum levels of sex steroids were measured prior to surgery.

MAIN RESULTS AND THE ROLE OF CHANCE Suppressed testosterone levels (<50 ng/dl) were found in 92% of the participants prior to surgery. The mean time between initiation of HT and surgery was 685 days. In 88% (85/97) of the sections, MAGE-A4 staining was positive.

Further staining could not reveal complete spermatogenesis in any participant.

LIMITATIONS, REASONS FOR CAUTION Testicular function of the participants prior to initiation of HT was not assessed, although all participants presented with cisgender male serum testosterone values before initiation of HT. The current study only reports on people using CPA at a fixed dose and may therefore not be applicable to all TW.

WIDER IMPLICATIONS OF THE FINDINGS HT leads to complete suppression of spermatogenesis in most TW, if serum testosterone levels within female reference ranges are obtained. Serum testosterone levels are associated with the sperm maturation rate. It is important to discuss sperm preservation before the start of hormone therapy. If serum testosterone levels remain higher, spermatogenesis may still occur.

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CENTRUM

GYNAECOLOGIE ARTIKELS ABSTRACT 1 Primaire hyperparathyreoïdie, zich presenterend als hyperemesis gravidarum.

Deconinck M, Denys B, Myngheer N, et al.

Gunaïkeia, 2020, 25 (5), 18-20 Zie Endocrinologie/diabetologie pagina 19.

PRESENTATIES ABSTRACT 2 Mid-urethral slings (MUS) at risk of extinction? A prospective single-center study.

Ferong K, Vossaert P, Verleyen P, Ghesquière S, Platteeuw L, Van Bruwaene S November 2020, International Continence Society, Online

OBJECTIVE In many countries, the mid-urethral sling (MUS) for stress urinary incontinence (SUI) is at risk of extinction as collateral damage of the mesh-war. A main criticism is the lack of real-world and long-term data. Therefore a prospective sling database was created in our center.

active, 68% were satisfied with their sexual life preoperatively, while this increased to 84% at 12m. For both pain and incontinence during sexual intercourse and fear of unwanted urine loss, there was a significant improvement at 3m and 12m. Peroperatively, there were 5 vaginal and 4 bladder perforations, none with consequences. At 3m, there were 10% urinary tract infections, 2% erosions, 3% retentions and 4% pain complaints. For these complications, 9 patients underwent re-intervention. After 1y there were 4% asymptomatic erosions and 1.2% persistent pain.

A linear regression analysis showed worse outcome (PGI-I) at 3m in patients with concomitant cystocele repair and higher post-void residual. Higher SIU complaints resulted in better outcome after 3m. At 12m, patients with a higher BMI and more preoperative urge complaints had worse outcome. The cystocele group had a significant lower PGI-I at 3m compared to the exclusively sling group. However, the latter had a significant decline of success at 12m.

CONCLUSION A prospective sling database was created as part of daily clinical practice. With little effort a large amount of data became readily available. While the PROMS data had a satisfactory response rate (72%), only 59% of physician-data were completed at 12m. The MUS showed 83% success with a 2% re-intervention rate. These numbers are used in our center-specific informed consent. A 5 year follow-up is planned.

METHODS/MATERIALS The database was created in 09-2016. Demographics and complications were inserted into an electronic record, linked to the medical file. Patient-reported outcome measures (PROMS) were assessed through validated questionnaires (PGI-I, IIQ-7, UDI-6 and PISQ-12) at 0, 3 and 12 months (m).

ABSTRACT 3 Prospectieve data als verweer tegen uitroeiing midurethrale slings (MUS): pilootproject az groeninge Kortrijk.

RESULTS

Ferong K, Vossaert P, Ghesquière S, Platteeuw L, Van Bruwaene S February 2020, Elautprijs, Dendermonde - België

Between 09-2016 and 10-2019, 460 MUS procedures were performed. Physician-reported data were inserted in 96%, 87% and 59% and PROMS were completed in 88%, 78% and 72% at 0, 3 and 12m respectively. TVT-O was performed in the majority of the procedures (73%). It concerned a primary sling in 89%. Simultaneous surgery was performed in 31% of patients (of which 63% cystocele repair). Success rate (PGI-I 1-2) was 88% at 3m and decreased to 83% at 12m (p = 0.14). IIQ-7 showed a significant improvement at 3m and 12m. According to UDI-6, SUI-related as well as irritative and obstructive symptoms improved after 3 and 12m (p <0.01). In the 57% of patients who were sexually

De transvaginale mesh (TVM) voor de behandeling van prolaps is op een paar jaar tijd volledig uit ons arsenaal verbannen. Primaire schuldige was het gebrek aan prospectieve post-market surveillance data die een tegenpool konden bieden tegen de vele - al dan niet legitieme - aanklachten omtrent complicaties. De midurethrale sling (MUS) heeft in verschillende landen zoals het Verenigd Koninkrijk, de VS en Australië parallel imagoschade geleden en riskeert een gelijkaardig lot als we ons niet wapenen.

Het doel van dit pilootproject is het ontwikkelen van een

OBJECTIVE

GYNAECOLOGIE

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gebruiksvriendelijke, prospectieve database inclusief patiënt-gerapporteerde resultaten.

METHODS/MATERIALS In september 2016 werd een geïntegreerd data-formulier binnen het medisch dossier geactiveerd en werden patiënten op systematische tijdstippen (0m, 3m, 12m) uitgenodigd om gevalideerde vragenlijsten in te vullen. Hiervoor werden de Incontinentie Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI-6) en Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) gebruikt. Na 3 en 12 maanden werd ook de Patient Global Impression of Improvement (PGI-I) ingevuld. De resultaten inclusief complicaties werden geanalyseerd voor de gehele groep.

Het project werd goedgekeurd door het ethisch comité (1479206631415).

RESULTS Tussen september 2016 en oktober 2019 werden 460 MUS procedures uitgevoerd. Er werd door de behandelende arts een data-formulier geïnitieerd in 443/460 (96%) van de patiënten, dat aangevuld werd op 3m in 356/409 (87%) en op 12m in 169/288 (59%) patiënten. De patiënten vragenlijsten werden ingevuld in 389/443 (88%), 317/409 (78%) en 206/288 (72%) op 0m, 3m en 12m respectievelijk.

Er werden 5 verschillende soorten slings gebruikt waarvan 73% TVT-O. Er waren 89% primaire en 11% secundaire slings.

In 20% van de gevallen werd concomitant een colporrafie anterior +/- posterior uitgevoerd. Succes ratio (PGI-I zeer veel beter of veel beter) was 88% (244/277) op 3m en daalde niet-significant naar 83% (165/199) op 12m (p= 0.14). IIQ-7 toonde ten opzichte van pre-operatief (15.4/28) inderdaad een significant verbeterde score op 3m (8.7/28, p < 0.01), die stabiel bleef op 12m (8.8/28, p < 0.01).

Volgens de UDI-6 is er 40% verbetering van de SUI-gerelateerde vragen na 3m (p < 0.01) wat echter afneemt naar 36% na 12m (p < 0.01). Er is eveneens 20% verbetering op OAB klachten na 3m (p < 0.01) wat nog toeneemt tot 27% na 12m (p < 0.01). Obstructieve symptomen verbeteren met 8% (p < 0.01) en blijven stabiel op 9.8% op 12m (p = 0.13).

57% van de patiënten waren seksueel actief.

Urineverlies en angst voor urineverlies, evenals in mindere mate pijn tijdens seksuele betrekkingen verbeterde significant na de ingreep (p < 0.01). Preoperatief waren 68% van de vrouwen tevreden over hun seksueel leven terwijl dit na 1 jaar 84% betrof (p = 0.02).

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ABSTRACTBOEK | 2020

Peroperatief waren er 5 vaginale perforaties en 4 blaasperforaties, allen zonder gevolgen op lange termijn. De postoperatieve complicaties (3m) waren 34 infecties (8%), 9 erosies (2%), 12 retenties (3%) en 13 patiënten met klachten van pijn in de benen (3%). Voor deze complicaties ondergingen 9 patiënten een heringreep (5 klieven sling en 4 excisie erosie). Na 1 jaar waren er nog 2 patiënten met pijn en 7 patiënten met asymptomatische erosie.

CONCLUSION Op 3 jaar tijd werd een grote prospectieve sling-database aangelegd met 1-jaars follow-up data in 72% van de patiënten. De sling heeft een subjectieve succes ratio van 88% na drie maanden, hoewel verschillende indicatoren wijzen op beperkt verval na 1 jaar tijd. Het is opvallend dat ook OAB klachten, obstructieve klachten en seksuele klachten significant verbeteren na deze ingreep.

Complicaties zijn beperkt met gedocumenteerde complicatie-gerelateerde heringreep in 9/443 patiënten (2%).

CENTRUM

INWENDIGE ZIEKTEN/GASTRO-ENTEROLOGIE ARTIKELS

CONCLUSION

ABSTRACT 1

No new safety signal was detected in VDZE pregnancies although larger, prospective studies are required for confirmation.

Pregnancy outcomes in inflammatory bowel disease patients treated with vedolizumab, anti-TNF or conventional therapy: results of the European CONCEIVE study.

ABSTRACT 2 Moens A, Van der Woude C, Julsgaard M, Van Moerkercke W, et al.

Alimentary Pharmacology & Therapeutics, 2020, 51(1), 129-138

INTRODUCTION Women with inflammatory bowel diseases (IBD) often receive biologicals during pregnancy to maintain disease remission. Data on outcome of vedolizumab-exposed pregnancies (VDZE) are sparse

OBJECTIVE To assess pregnancy and child outcomes of VDZE pregnancies and to compare these results to anti-TNF exposed (TNFE) or both immunomodulatory and biologic unexposed (CON IBD) pregnancies.

Developing and evaluating a participatory arts programme for cancer patients and their caregivers.

Lefebvre T, Tack L, Meersman M, Vanneste H, Van Eygen K, Stellamans K, Derijcke S, Vergauwe P, Debruyne P, et al.

Acta Clinica Belgica, 2020, DOI: 10.1080/17843286.2020.1773653

OBJECTIVE Cancer patients, survivors and caregivers often encounter severe distress, having significant consequences to wellbeing, functionality and physical health. This study developed and evaluated a participatory arts programme to determine if such could help to improve the wellbeing of cancer patients and their caregivers.

MATERIALS/METHODS MATERIALS/METHODS A retrospective multicentre case-control observational study was performed.

RESULTS VDZE group included 79 pregnancies in 73 IBD women.

The TNFE and CON IBD group included 186 pregnancies (162 live births) in 164 IBD women and 184 pregnancies (163 live births) in 155 IBD women, respectively. At conception, cases more often had active disease ([VDZE: 36% vs TNFE: 17%, P = .002] and [VDZE: 36% vs CON IBD: 24%, P = .063]). No significant difference in miscarriage rates were found between groups (VDZE and TNFE: 16% vs 13%, P = .567; VDZE and CON IBD: 16% vs 10%, P = .216). In liveborn infants, median gestational age and birthweight were similar between groups. Median Apgar score at birth was numerically equal. Prematurity was similar in the VDZE group compared to the control groups, even when correcting for disease activity during pregnancy. The frequency of congenital anomalies was comparable between groups as were the percentages of breastfed babies. During the first year of life, no malignancies were reported and infants' infection risk did not significantly differ between groups.

To inform the development of a participatory arts programme, cancer patients and their caregivers at an Organisation of European Cancer Institute (OECI)designated cancer centre were asked which activities they would wish to engage in (anonymous survey one).

A programme was then developed and trialled for 1 year.

Following participation, we explored the satisfaction and any benefits of taking part (anonymous survey two).

RESULTS Survey one had a participation rate of 70%. In this survey, participants indicated they preferred group-based activities (61%) over an individual approachto take place on a monthly basis (46%). The developed programme ran from December 2018 to December 2019, with 435 patients and caregivers taking part. Two hundred and eighteen completed survey two and revealed a positive response to both the structure and content of the programme and its impact on the wellbeing of patients and caregivers. The majority indicated they felt (much) betterfrom participating in the participatory arts programme.

CONCLUSION This study points out the interest and potential value of a participatory arts programme to the perceived wellbeing.

This suggests such programmes could be incorporated into

INWENDIGE ZIEKTEN/GASTRO-ENTEROLOGIE

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cancer care provision, to serve as psychosocial support.

The latter is particularly relevant for improving the lives, wellbeing and health of cancer patients and those supporting them.

endoscopy. This case reflects the clinical significance of performing capsule endoscopy in patients with OGIB.

ABSTRACT 6 ABSTRACT 3 Endoscopic removal of an extraluminal, intrapancreatic dislocated common bile duct stone.

Billiet T, Holvoet A, Decock S, et al.

Endoscopy, 2020, 52(2), DOI: 10.1055/a-0992-8832

Effectiveness and persistence of Vedolizumab in patients with inflammatory bowel disease: results from the Belgian REal-LIfe study with VEdolizumab (Be-RELIVE).

Reenaers C, Cremer A, Dewit O, Van Moerkercke W, et al.

Acta Gastroenterologica Belgica, 2020, 83(1), 15-23

INTRODUCTION Er is geen abstract beschikbaar.

ABSTRACT 4 Boerhaave's syndrome: successful conservative treatment in two patients.

Vedolizumab (VDZ) is a gutselective integrin inhibitor used to treat Crohn's disease (CD) and ulcerative colitis (UC). This retrospective study assessed effectiveness and treatment persistence of VDZ in a Belgian reallife cohort of CD and UC patients.

MATERIALS/METHODS Van Geluwe B, Vergauwe P, Van Moerkercke W, et al.

Acta Gastroenterologica Belgica, 2020, 83(4), 654-656

ABSTRACT The Boerhaave syndrome is a spontaneous, post-emetic rupture of the esophagus and a rare but potentially fatal cause of upper gastrointestinal bleeding. There are currently no guidelines on the optimal treatment of these patients, although there is a strong tendency towards a surgical approach. We present 2 cases of male patients, 66- and 77-year old respectively, both admitted to the emergency department with hematemesis. Unexpectedly, these turned out to be caused by the Boerhaave syndrome.

Based on the severity of presentation, either a conservative or endoscopic treatment was adopted, both with good outcome.

ABSTRACT 5

RESULTS Of the 348 patients receiving at least one dose of VDZ, 325 (202 CD, 45 biologic-naïve; and 123 UC, 42 biologic-naïve) patients were included in data analyses. At M6, 87.6% (176/201) of CD and 86.1% (105/122) of UC patients were still on VDZ treatment, 75.6% (34/45) and 83.9% (26/31) achieved clinical response, and 66.7% (44/66) and 42.9% (15/35) were in remission. At M6 remission rates was significantly higher while response rates tended to be higher among biologic-naïve versus biologic-failure CD patients.

Capsule endoscopy: diagnosis of intestinal localisation of systemic follicular B-cell non-Hodgkin lymphoma.

CONCLUSION

Demeester J, Dewint P, Van Moerkercke W, et al.

Acta Gastroenterologica Belgica, 2020, 83(1), 73-75

VDZ offers an effective treatment option in real-life settings and treatment effectiveness appears higher in bio logic-naïve versus biologic-failure CD patients.

ABSTRACT We report the case of a 58 year old man with occult obscure gastro-intestinal bleeding (OGIB) without other significant symptoms, in which systemic localisation of follicular B-cell non-Hodgkin lymphoma was discovered trough capsule

24

CD and UC patients from 15 Belgian centers, who started VDZ between 01/09/2015 and 31/06/2016 and attended ≥1 visit after the first VDZ infusion, were included. Data were collected before first infusion, at week (W)10, W14 (CD patients only), month (M)6 and last follow-up. Treatment response and remission rates (changes in disease activity scores) and treatment persistence (Kaplan-Meier analysis) were assessed.

ABSTRACTBOEK | 2020

ABSTRACT 7 Underrepresentation of vulnerable older patients with cancer in phase II and III oncology registration trials: a case-control study.

Tack L, Ketelaars L, Martens E, Stellamans K, Van Eygen K, Werbrouck P, Vergauwe P, Debruyne P, et al.

Journal of Geriatric Oncology, 2020, 11(2), 320-326

OBJECTIVE We aimed to determine the proportion of “fit” versus “vulnerable” older patients with cancer included in phase II and III oncology registration trials, as compared to the proportions in a real life oncology setting.

MATERIALS/METHODS Trial and patient characteristics of older (≥70 years) patients treated at the OECI-designated clinical cancer centre in Kortrijk and included in a phase II or III oncology registration trial were collected retrospectively. These patients were matched individually with randomly-selected patients from the general oncology setting, based on gender, age, tumour type, tumour stage, and treatment intent. Patients' fitness, based on routine Geriatric-8 (G8) screening, was retrieved from prospectively constructed databases.

RESULTS Between November 2012 and October 2018, 218 older patients with cancer were included in a phase II or III oncology registration trial. Of those, 41 cases with a mean age of 76.0 years were included in the analyses. A Fisher's Exact Test revealed a statistical significant difference between cases and matched controls, with a higher proportion of “fit” patients included in phase II or III oncology registration trials compared to the proportion in the matched control group (respectively 70.7% and 41.5%, p < .010).

CONCLUSION We provide evidence for the hypothesis that older patients included in phase II or III oncology trials are significantly fitter than the real life oncology population. Some form of geriatric evaluation should be integrated in future cancer clinical trials to enable stratification according to this parameter and allow subgroup analysis. This will broaden the application and interpretation of trial results.

INWENDIGE ZIEKTEN/GASTRO-ENTEROLOGIE

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CENTRUM

KINDERGENEESKUNDE

PRESENTATIES ABSTRACT 1 Urinary tract infection, even though urinalysis and culture are negative: a case report of a 5-year-old girl.

Vander Elst Z, George I, Colpaert J, De Muynck B, Bouvry M November 2020, Belgium Pediatric Nephrology Symposium, Leuven-Gent - België

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CENTRUM

KLINISCH LABORATORIUM ARTIKELS

ABSTRACT 2

ABSTRACT 1

Quality of blood samples collected at home does not affect clinical decision making for the administration of systemic cancer treatment.

Interference of anti-streptavidin antibodies in immunoassays: a very rare phenomenon or a more common finding?

Verougstraete N, Berth M, Delanghe J, Callewaert N, et al.

Clinical Chemistry and Laboratory Medicine, 2020, 58(10), 1673-1680

INTRODUCTION Anti-streptavidin antibodies (ASA) may cause analytical interference on certain immunoassay platforms.

Streptavidin is purified from the non-pathogenic Streptomyces avidinii soil bacterium. In contrast to interference with biotin, ASA interference is supposed to be much rarer. In-depth studies on this topic are lacking. Therefore, we carried out an analysis toward the prevalence and the possible underlying cause of this interference.

MATERIALS/METHODS Anti-streptavidin (AS)-immunoglobulin G (IgG) and AS-IgM concentrations were determined on multiple samples from two patients with ASA interference and on 500 random samples. On a subset of 100 samples, thyroid-stimulating hormone (TSH) was measured on a Cobas analyzer before and after performing a neutralization protocol which removes ASA. The relationship between the ratio of TSH after neutralization/TSH before neutralization and the ASA concentration was evaluated. Subsequently, an extract of S. avidinii colonies was analyzed using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting.

RESULTS A positive correlation between AS-IgM concentrations and TSH ratio was obtained. Eight samples out of 500 exceeded the calculated AS-IgM cut-off value. In comparison to the AS-IgM concentrations in the population, titers from the two described cases clearly stood out. The isolated cases represent the end of a broader spectrum as there is a continuum of AS-IgM reactivity in the general population.

We could not observe any differences in the immunoblot patterns between the cases and controls, which may indicate the general presence of ASA in the population.

CONCLUSION Interference due to ASA is more prevalent than initially thought and is caused by IgM antibodies.

Cool L, Callewaert N, Pottel H, Van Eygen K, et al.

Scandinavian Journal of Clinical and Laboratory Investigation, 2020, 80(3), 215-221

OBJECTIVE The aim of this exploratory clinical study was to evaluate whether the preanalytical quality of blood samples subjected to delayed centrifugation and transport – as a result of home-sampling – is affected in a way it alters the clinical decision-making for oncological home-hospitalization.

MATERIALS/METHODS Forty-nine patients with cancer donated two additional blood samples during their ambulatory hospital visit.

Fifteen blood analytes were compared between routine blood samples and samples that were subjected to transport and delayed centrifugation in order to mimic a locally implemented model for oncological home-hospitalisation.

Deviations were analysed by means of Deming regression.

For those analytes showing statistically significant intercepts and/or slopes, the mean deviations were compared to the desirable analytical bias; and the intra-individual differences were compared with the limits for clinical decision-making.

RESULTS Statistically significant intercepts and/or slopes were observed for haematocrit (HCT), mean cellular volume (MCV), platelets count (PLT) and C-reactive protein (CRP).

Differences exceeding the allowable margins of desirable analytical bias were observed for HCT and MCV. Risk of different clinical decision-making couldn’t be observed for any of the analytes showing statistically significant differences.

CONCLUSION These results demonstrate that home-collection of blood samples, transported at room temperature and centrifuged within a mean time of five hours after sampling, has no effect on clinical decision-making with regards to systemic cancer therapy. However, attention should be paid to the potential occurrence of haemolysis during the preanalytical phase, which can negatively influence haemolysis-dependent variables.

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ABSTRACT 3

ABSTRACT 4

An unconscious man with profound drug-induced hypoglycaemia.

Interpretation of EBV serology for human body material donors: is there a need for early antigen IgG and heterophile antibodies testing?

Schiemsky T, Vundelinckx G, Croes K, et al.

Biochemia Medica, 2020, 30(1), DOI: 10.11613/ BM.2020.010802

INTRODUCTION

ABSTRACT

Hypoglycaemia has been reported as an unusual complication of tramadol use and in a few cases of tramadol poisoning, but the exact mechanism is not known. An ambulance crew was dispatched to an unconscious 46-year old man. A glucometer point-of-care measurement revealed a profound hypoglycaemia (1.9 mmol/L).

Treatment with intravenous glucose was started and the patient was transported to the hospital. The patient had several episodes of pulseless electrical activity requiring cardiopulmonary resuscitation in the ambulance and upon arrival in the hospital. Despite continuous glucose infusion the hypoglycaemia was difficult to correct during the next few hours and the patient developed hypokalaemia. Further investigation to identify the cause of hypoglycaemia revealed that insulin and C-peptide were inappropriately raised. A toxicological investigation revealed the presence of tramadol and its metabolites in lethal concentrations.

Also acetaminophen, ibuprofen and lormetazepam were present. Ethanol screening was negative (< 0.1 g/L) and no sulfonylurea were detected. The patient developed multiple organ failure, but eventually recovered.

MATERIALS/METHODS

In this report we evaluated a diagnostic algorithm, proposed by the Belgian Superior Health Council, to detect acute and past Epstein-Barr virus (EBV) infections by means of serology in donors of human body material for transplantation.

The available EBV serology parameters were tested on eighty serum samples on three random access analysers: Architect i2000 SR, Liasion XL and BioPlex 2200. The EBV sero-status was determined according to the proposed algorithm and results were compared between the different analysers. Seventy one % of the samples gave concordant interpretations on the three analysers. Most of the discordant results were attributable to early antigen (EA) IgG. The knowledge of the EA IgG and heterophile antibodies (HA) IgM status provided only limited added value and was only useful to distinguish between a very early acute infection and false positivity of viral capsid antigen IgM. The diagnostic algorithm proposed by the Belgian Superior Health Council is merely directive and each individual lab remains responsible for the interpretation and implementation of test combinations for the detection of EBV infections.

Our study shows the limited added value of testing for EA IgG and HA IgM, based both on clinical and technical performance.

The hypoglycaemia was caused by inappropriate stimulation of insulin secretion in a patient intoxicated with tramadol. The sudden hypokalaemia was caused by a massive intracellular shift of potassium in response to the hyperinsulinemia, triggered by the intravenous administration of glucose.

To pool or not to pool? Screening of Chlamydia trachomatis and Neisseria gonorrhoeae in female sex workers: pooled versus single-site testing.

CONCLUSION To our knowledge, we are the first to document a significant rise in endogenous insulin production in a hypoglycaemic patient presenting with tramadol intoxication. Our observation suggests that hyperinsulinemia could be the cause of the hypoglycaemia associated with tramadol use.

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Verougstraete N, Padalko E, Coorevits L Cell and tissue banking, 2020, 21(1), 167-169

ABSTRACTBOEK | 2020

ABSTRACT 5

Verougstraete N, Verbeke V, De Cannière A-S, Coorevits L, et al.

Sexually transmitted infections, 2020, 96(6), 417-421

INTRODUCTION As Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most commonly reported STIs in Belgium and the majority of women infected are asymptomatic, targeted screening of patients in specified risk groups is indicated.

To prevent long-term complications and interrupt transmission, extragenital samples should be included. As this comes with a substantial extra cost, analysis of a pooled

sample from vaginal and extragenital sites could be a solution. In this study, we evaluated the feasibility of molecular testing for CT and NG in pooled versus single-site samples in a large cohort of female sex workers.

wear and ocular trauma. We present the first case of T. destructans keratomycosis presenting as a superinfection in herpetic keratitis.

MATERIALS/METHODS

We present a case of a 53-year-old woman who presented with a unilateral keratitis since 3 weeks without history of trauma or contact lens wear, not responding to topical ofloxacin. Polymerase Chain Reaction (PCR) of the corneal ulcer was positive for Herpes Simplex Virus type 1 (HSV-1).

Signs and symptoms progressively improved after starting topical and systemic antiviral therapy. Six weeks later however, our patient presented with a new white infiltrate in the previous herpetic epithelial defect. In vivo confocal microscopy showed fungal hyphae and culture from corneal scrapings identified a hyphomycete. Intensive antimycotic therapy could not prevent a corneal perforation 1 week later. Penetrating keratoplasty was performed with intracameral injection of amphotericin B. Culture of the corneal button and PCR and sequence analysis on the fungal isolate confirmed the diagnosis of T. destructans keratomycosis.

Six months after penetrating keratoplasty, biomicroscopy showed a clear graft without recurrence of fungal activity.

RESULTS Women were sampled from three anatomical sites: a pharyngeal, a vaginal and a rectal swab. Each sample was vortexed, and 400 µL of transport medium from each sample site was pooled into an empty tube. NAAT was performed using the Abbott RealTime CT/NG assay on the m2000sp/rt system.

RESULTS We included 489 patients: 5.1% were positive for CT; 2.0% were positive for NG and 1.4% were coinfected, resulting in an overall prevalence of 6.5% (95% CI 4.5% to 9.1%) for CT and 3.5% (95% CI 2.0% to 5.5%) for NG. From the 42 patients positive on at least one non-pooled sample, only 5 gave a negative result on the pooled sample, resulting in a sensitivity of 94% (95% CI 79% to 99%) for CT and 82% (95% CI 57% to 96%) for NG. The missed pooled samples were all derived from single-site infections with low bacterial loads. The possibility of inadequate self-sampling as a cause of false negativity was excluded, as 4/5 were collected by the physician. Testing only vaginal samples would have led to missing 40% of CT infections and 60% of NG infections.

CONCLUSION Pooling of samples is a cost-saving strategy for the detection of CT and NG in women, with minimal decrease in sensitivity. By reducing costs, more patients and more extragenital samples can be tested, resulting in higher detection rates.

CONCLUSION T. destructans is an emerging opportunistic pathogen causing severe keratomycosis. Despite intensive antimycotic therapy, rapid progression to corneal perforation can be seen. Early diagnosis using confocal microscopy, fungal culture and PCR can allow prompt initiation of treatment, which should be guided by in vitro susceptibility testing.

ABSTRACT 7 Sensitivity and specificity of 14 SARS-CoV-2 serological assays and their diagnostic potential in RT-PCR negative COVID-19 infections.

ABSTRACT 6 Tintelnotia destructans as an emerging opportunistic pathogen: first case of T. destructans superinfection in herpetic keratitis.

Roels D, Coorevits L, Lagrou K, et al.

American Journal of Ophthalmology Case Reports, 2020, DOI: 10.1016/j.ajoc.2020.100791

INTRODUCTION Only recently Tintelnotia was described as a new genus in the Phaeosphaeriaceae family of fungi containing two species, T. opuntiae and T. destructans. Until now, T. destructans keratitis was associated with contact lens

Van Honacker E, Coorevits L, Boelens J, et al.

Acta Clinica Belgica, 2020, Dec 22, DOI: 10.1080/17843286.2020.1861885

INTRODUCTION Molecular detection of SARS-CoV-2 in respiratory samples is the gold standard for COVID-19 diagnosis but it has a long turnaround time and struggles to detect low viral loads.

Serology could help to diagnose suspected cases which lack molecular confirmation. Two case reports are presented as illustration.

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OBJECTIVE The aim of this study was to evaluate the performance of several commercial assays for COVID-19 serology. We illustrated the added value of COVID-19 serology testing in suspect COVID-19 cases with negative molecular test.

MATERIALS/METHODS Twenty-three sera from 7 patients with a confirmed molecular diagnosis of SARS-CoV-2 were tested using 14 commercial assays. Additionally, 10 pre-pandemic sera and 9 potentially cross-reactive sera were selected. We calculated sensitivity and specificity. Furthermore, we discuss the diagnostic relevance of COVID-19 serology in a retrospective cohort of 145 COVID-19 cases in which repetitive molecular and serological SARS-CoV-2 tests were applied.

RESULTS The interpretation of the pooled sensitivity of IgM/A and IgG resulted in the highest values (range 14-71% on day 2-7; 88-94% on day 8-18). Overall, the specificity of the assays was high (range 79-100%). Among 145 retrospective cases, 3 cases (2%) remained negative after sequential molecular testing but positive on final SARS-CoV-2 serology.

CONCLUSION Sensitivity of COVID-19 serological diagnosis was variable but consistently increased at >7 days after symptom onset.

Specificity was high. Our data suggest that serology can complement molecular testing for diagnosis of COVID19, especially for patients presenting the 2nd week after symptom onset or later.

ABSTRACT 8 Toilet drain water as a potential source of hospital roomto-room transmission of carbapenemase-producing Klebsiella pneumoniae.

Heireman L, Hamerlinck H, Coorevits L, et al.

The Journal of Hospital Infection, 2020, 106(2), 232-239

INTRODUCTION Carbapenemase-producing Enterobacterales (CPE) have rapidly emerged in Europe, being responsible for nosocomial outbreaks.

OBJECTIVE Following an outbreak in the burn unit of Ghent University Hospital, we investigated whether CPE can spread between toilets through drain water and therefrom be transmitted

30 ABSTRACTBOEK | 2020

to patients.

MATERIALS/METHODS In 2017, the burn centre of our hospital experienced an outbreak of OXA-48-producing Klebsiella pneumoniae that affected five patients staying in three different rooms.

Environmental samples were collected from the sink, shower, shower stretcher, hand rail of the bed, nursing carts, toilets, and drain water to explore a common source.

Whole-genome sequencing and phylogenetic analysis was performed on K. pneumoniae outbreak isolates and two random K. pneumoniae isolates.

RESULTS OXA-48-producing K. pneumoniae was detected in toilet water in four out of six rooms and drain water between two rooms. The strain persisted in two out of six rooms after two months of daily disinfection with bleach. All outbreak isolates belonged to sequence type (ST) 15 and showed isogenicity (<15 allele differences). This suggests that the strain may have spread between rooms by drain water.

Unexpectedly, one random isolate obtained from a patient who became colonized while residing at the geriatric ward clustered with the outbreak isolates, suggesting the outbreak to be larger than expected. Daily application of bleach tended to be superior to acetic acid to disinfect toilet water; however, disinfection did not completely prevent the presence of carbapenemase-producing K. pneumoniae in toilet water.

CONCLUSION Toilet drain water may be a potential source of hospital room-to-room transmission of carbapenemase-producing K. pneumoniae.

ABSTRACT 9 Evaluation of QuantiFERON-TB Gold Plus on Liaison XL in a low-tuberculosis-incidence setting.

De Maertelaere E, Vandendriessche S, Verhasselt B, Coorevits L, et al.

Journal of Clinical Microbiology, 2020, 58(4), 1-2

INTRODUCTION The QuantiFERON-TB Gold Plus assay (QFT; Qiagen, Hilden, Germany) is a frequently used interferon gamma releasing assay (IGRA) for the diagnosis of latent tuberculosis infections (LTBI) (1, 2). Recently, it became available on Liaison XL (DiaSorin S.p.A., Saluggia, Italy), a fully automated analyzer

using chemiluminescense detection within a chemiluminescent immunoassay (CLIA).

PRESENTATIES ABSTRACT 10

OBJECTIVE In this study, we compared this novel method to the commonly used enzyme-linked immunosorbent assay (ELISA) in a low-incidence LTBI setting.

MATERIALS/METHODS Heparin blood samples (n 92) taken for routine QFT assays were analyzed with both assays on two different sites as follows: after incubation and centrifugation as instructed by the manufacturer, QFT CLIA was performed on-site (Ghent University Hospital, Belgium) on one aliquot of the processed plasma sample, while another aliquot was transported at room temperature to site two (University Hospital of Leuven, Belgium) for QFT ELISA on the BEP III platform (Siemens Healthcare Diagnostics, Eschborn, Germany).

Results were interpreted according to the manufacturer’s criteria (positivity threshold 0.35).

Evaluation of the Xpert HBV VL test for cartridge-based quantitative HBV DNA analysis on plasma.

Wallaert A, De Bel A, Boudewijns M October 2020, European Meeting on Molecular Diagnostics, Noordwijk - Nederland

ABSTRACT 11 Whole transcriptome profiling of liquid biopsies from tumor xenografted mouse models enables specific monitoring of tumor-derived RNA. Deleu J, Vermeirssen V, Van Maerken T, et al.

October 2020, SIOP 2020: 52th annual meeting of the International Society of Paediatric Oncology, Online

RESULTS

ABSTRACT 12

Of the 92 samples, 46 were from males and 42 from females, median age of 45 years (range 1 to 91 years). Four samples were from encoded health care workers sent by the occupational medicine department. Eighty-seven samples (95%) returned concordant results: 12 positive, 71 negative, and 4 indeterminate results. Five samples (5%) were discordant (Table 1), of which four samples resulted in a major discrepancy, i.e., positive versus negative. Clinical information on these samples did not bring clarity and follow-up samples were not included within the scope of this comparison. However, the discordant samples were all lowpositive results which, when applying a suitable additional range, could be classified as borderline.

Burkholderia cepacia outbreak due to contaminated wash gloves.

CONCLUSION In conclusion, the QFT CLIA on Liaison XL showed comparable performance to detection with QFT ELISA in a low LTBI incidence setting. There is need to define a borderline range, which possibly needs to be adjusted according to the incidence setting and the detection method, and should be based on clinical diagnostics criteria.

Echahidi F, Peeters C, De Bel A, Boudewijns M, et al.

December 2020, Réunion Interdisciplinaire de Chimiothérapie Anti-Infectieuse 2020, Parijs - Frankrijk

INTRODUCTION Burkholderia cepacia complex (BCC) bacteria cause infections in cystic fibrosis patients as well as in hospitalised immunocompromised patients. BCC can spread among hospitalised patients through contaminated liquids, surfaces and person-to-person transmission. We describe 2 episodes of B. cepacia outbreak at a Belgian intensive care unit due to contaminated wash gloves.

OBJECTIVE We describe 2 episodes of B. cepacia outbreak at a Belgian intensive care unit due to contaminated wash gloves.

MATERIALS/METHODS Samples from 9 patients hospitalised during April-Mai 2019 and during January 2020 as well as suspected lots of wash gloves and other hygienic products were tested for bacterial contamination. BCC isolates were tested by MALDI-TOF MS (Bruker) for identification and genotyped by Random Amplification of Polymorphic DNA.

KLINISCH LABORATORIUM

31

The identification and genotyping were confirmed by recA gene sequence analysis and multi-locus sequence typing, respectively.

RESULTS At the first outbreak episode, B. contaminans was found in 2 patients and B. cepacia in 5 patients. One out of 2 tested packagings of wash gloves was culture positive and the isolate was identified as B. cepacia. RAPD results showed an identical pattern in 4 patients isolates as well as in the wash glove isolate tested. In 1 patient isolate a different RAPD pattern was obtained. MLST confirmed the RAPD results; the 4 B. cepacia patients isolates and the wash glove isolate belonged to ST-1649 and 1 patient isolate, with a different RAPD pattern, belonged to ST-767. The wash gloves company confirmed the contamination of one lot

by Burkholderia. Subsequently, the company promised to take measures to avoid future contamination. At the second outbreak episode B. cepacia ST-767 was isolated from 2 patients and 1 out of 4 tested lots of wash gloves yielded both B. cepacia ST-767 and ST-1649.

CONCLUSION Contaminated wash gloves were the most likely source of the 2 B. cepacia outbreak episodes and contamination seems to occur at the manufacturing process. A similar outbreak linked to contaminated wash gloves has been recently described (1). Possible link between the current and the previously described outbreak should be investigated. The wash gloves company denied BCC contamination at the second outbreak episode. Subsequently, we stopped using these wash gloves and we advise other hospitals to check same products for BCC contamination.

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CENTRUM

LONGZIEKTEN ARTIKELS ABSTRACT 1 Brown-séquard syndrome in a desmoplastic malignant mesothelioma patient: a rare complication.

Ralkie M, Serrien A, Lambert J, Leys M, et al.

Clinical Lung Cancer, 2020, Oct 31, DOI: 10.1016/j. cllc.2020.09.019 Er is geen abstract beschikbaar.

ABSTRACT 2 Van parapneumonische effusie naar polyserositis…

Jacobs A, Schockaert O, Maddens S Tijdschrift voor Geneeskunde, 2020, 16, 790-794

ABSTRACT This article describes a case of new-onset systemic lupus erythematous (SLE), presenting with large unilateral pleural effusion in a male patient. The serositis responded well to high-dose steroid therapy and diseasemodifying antirheumatic drugs (DMARDs), leading to a significant improvement in the symptoms.

Large volume effusions as manifestations of active SLE are rare. When they do occur, they are usually associated with complications of lupus disease.

ABSTRACT 3 Developing and evaluating a participatory arts programme for cancer patients and their caregivers.

Tack L, Meersman M, Vanneste H, Van Eygen K, Stellamans K, Derijcke S, Vergauwe P, Debruyne P, et al.

Acta Clinica Belgica, 2020, DOI: 10.1080/17843286.2020.1773653 Zie Inwendige ziekten/gastro-enterologie pagina 23.

LONGZIEKTEN

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CENTRUM

MEDISCHE BEELDVORMING

ARTIKELS ABSTRACT 1 Delayed post-anoxic white matter injury in an infant.

Degrieck B, Dutoit J, Herregods N Journal of the Belgian Society of Radiology, 2020, 104(1), 31

ABSTRACT Case report teaching point: White matter reversal on diffusion-weighted magnetic resonance imaging is indicative of delayed post-anoxic encephalopathy. This manifests sooner in young infants than in adults.

with mTICI-2B reperfusion. On multivariate analysis VLLC was inversely associated with excellent outcomes (odds ratio 0.075, 95% confidence interval 0.007-0.765, P = 0.029) but not associated with mortality.

CONCLUSION The mTICI-2B grade may be further refined by secondary radiological markers. The VLLC sign is associated with the loss of excellent functional outcomes at 3 months. It is a simple sign to discriminate mTICI-2B into different grades but should be verified in larger populations from other centers.

ABSTRACT 3 ABSTRACT 2 Very late leptomeningeal collaterals-potential new way to subdivide modified thrombolysis in cerebral ischemia (mTICI) 2B. Yeo L, Cervo A, Gopinathan A, Andersson T, et al.

Clinical Neuroradiology, 2020, 30(1), 77-83

INTRODUCTION Studies have shown that the modified thrombolysis in cerebral ischemia (mTICI) 2B score is associated with better functional outcome; however, 50-99% reperfusion is a large range and there may be factors which can differentiate this further. The effects of very late leptomeningeal collaterals (VLLC) on mTICI-2B patients were studied.

Structural analysis of ischemic stroke thrombi: histological indications for therapy resistance.

Staessens S, Denorme F, François O, Andersson T, et al.

Haematologica, 2020, 105(2), 498-507

ABSTRACT Ischemic stroke is caused by a thromboembolic occlusion of cerebral arteries. Treatment is focused on fast and efficient removal of the occluding thrombus, either via intravenous thrombolysis or via endovascular thrombectomy.

Recanalization, however, is not always successful and factors contributing to failure are not completely understood. Although the occluding thrombus is the primary target of acute treatment, little is known about its internal organization and composition.

MATERIALS/METHODS A prospectively collected registry of anterior circulation AIS patients treated with the EmboTrap revascularization device from 2013 to 2016 was evaluated. Imaging parameters and timings, including the mTICI score were verified by an external core laboratory blinded to the clinical data. The final angiogram was examined for the appearance of VLLC in predicting 3‑month outcomes including excellent functional outcomes, defined as modified Rankin scale (mRS) 0-1, bleeding risk and mortality.

The aim of this study, therefore, was to better understand the internal organization of ischemic stroke thrombi on a molecular and cellular level.

RESULTS

Our results show that stroke thrombi are composed of two main types of areas: RBC-rich areas and platelet-rich areas.

RBC-rich areas have limited complexity as they consist of RBC that are entangled in a meshwork of thin fibrin. In contrast, platelet-rich areas are characterized by dense fibrin structures aligned with vWF and abundant amounts of leukocytes and DNA that accumulate around and in these platelet-rich areas. These findings are important to

A total of 177 consecutive anterior circulation stroke patients were included in the analysis. Of these 94 (53.1%) achieved only mTICI-2B reperfusion, 16/94 (17.0%) patients achieved excellent functional outcomes at 3 months and 26 (27.7%) had hyperdensity on follow-up computed tomography (CT). On univariate analysis, the presence of VLLC was inversely associated with excellent functional outcomes at 3 months and positively associated with mortality in patients

34 ABSTRACTBOEK | 2020

A total of 188 thrombi were collected from endovascularly treated ischemic stroke patients and analyzed histologically for fibrin, red blood cells (RBC), von Willebrand factor (vWF), platelets, leukocytes and DNA, using bright field and fluorescence microscopy.

better understand why platelet-rich thrombi are resistant to thrombolysis and difficult to retrieve via thrombectomy, and can guide further improvements of acute ischemic stroke therapy.

CONCLUSION In in vitro three-dimensional models replicating MCA-M1 occlusion, ANCD+SR showed significantly better recanalization rates in fewer passes than other commonly used combinations of devices.

ABSTRACT 4 ANCD thrombectomy device: in vitro evaluation.

Sanchez S, Cortiñas I, Villanova H, Andersson T, et al.

Journal of Neurointerventional Surgery, 2020, 12(1), 77-81

INTRODUCTION Endovascular treatment of stroke, although highly effective, may fail to reach complete recanalization in around 20% of cases. The Advanced Thrombectomy System (ANCD) is a novel stroke thrombectomy device designed to reduce clot fragmentation and facilitate retrieval by inducing local flow arrest and allowing distal aspiration in combination with a stent retriever. We aimed to assess the preclinical efficacy of ANCD.

ABSTRACT 5 Preclinical evaluation of the ANCD thrombectomy device: safety and efficacy in a swine clot model.

Sanchez S, Bailey L, Ducore R, Andersson T, et al.

Journal of Neurointerventional Surgery, 2020, 12(10), 1008-1013

INTRODUCTION The Advanced Thrombectomy System (ANCD) provides a new funnel component designed to reduce clot fragmentation and facilitate retrieval in patients with stroke by locally restricting flow, allowing distal aspiration in combination with a stent retriever (SR).

MATERIALS/METHODS

OBJECTIVE

Soft red blood cell (RBC)-rich (n=20/group) and sticky fibrin-rich (n=30/group) clots were used to create middle cerebral artery (MCA) occlusions in two vascular phantoms.

Three different treatment strategies were tested: (1) balloon guide catheter + Solitaire (BGC+SR); (2) distal access catheter + SR (DAC+SR); and (3) ANCD+SR, until complete recanalization was achieved or to a maximum of three passes.

The recanalization rate was determined after each pass.

To evaluate the preclinical efficacy and safety of the ANCD in a swine clot model.

RESULTS After one pass, ANCD+SR resulted in an increased recanalization rate (94%) for all clots together compared with BGC+SR (66%; p<0.01) or DAC+SR (80%; p=0.04). After the final pass the recanalization rate increased in all three groups but remained higher with ANCD+SR (100%) than with BGC+SR (74%; p<0.01) or DAC+SR (90%; p=0.02). The mean number of passes was lower with ANCD+SR (1.06) than with BGC+SR (1.46) or DAC+SR (1.25) (p=0.01). A logistic regression model adjusted for treatment arm, clot type, and model used showed that both RBC-rich clots (OR 8.1, 95% CI 1.6 to 13.5) and ANCD+SR (OR 3.9, 95% CI 1.01 to 15.8) were independent predictors of first-pass recanalization.

MATERIALS/METHODS Soft and firm clots were implanted in the lingual and cervical arteries of 11 swine to obtain Thrombolysis in Cerebral Infarction (TICI) 0 blood flow. Mechanical thrombectomy was performed with either a balloon guide catheter+Solitaire 2 stent retriever (BGC+SR, n=13) or ANCD+SR (n=13).

TICI flow was evaluated and successful revascularization was defined as TICI 3 (normal perfusion). To characterize safety, a total of 3 passes were performed in each vessel independent of recanalization. Tissues were explanted for histopathological analysis after 3 and 30 days, respectively.

RESULTS First pass reperfusion rates were ANCD+SR: 69% and BGC+SR: 46%. Reperfusion increased after the third pass in both groups (ANCD+SR: 100%, vs BGC+SR: 77%).

Recanalization was achieved after an average of 1.4 and 1.9 passes in ANCD+SR and BGC+SR (p=0.095), respectively.

Vessel injury was comparable in both groups; endothelial loss at 3 days was the most common injury seen (ANCD+SR: 1.78±1.22; BGC+SR: 2.03±1.20; p=0.73), while other histopathological markers were absent or minimal. Tissues downstream from targeted vessels also showed absence or minimal lesions across both groups.

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CONCLUSION

CONCLUSION

Results in a swine clot model support the high efficacy of the ANCD+SR without causing clinically significant vessel injury potentially related to the new funnel component.

ICS after failed thrombectomy appears to effectively improve recanalization rates in patients with moderately severe strokes. Thus, ICS should be considered also for patients with baseline NIHSS ≤9 if thrombectomy fails.

ABSTRACT 6 Intracranial stenting after failed thrombectomy in patients with moderately severe stroke: a multicenter cohort study.

Meyer L, Fiehler J, Thomalla G, Andersson T, et al.

Frontiers in Neurology, 2020, 11, 97

ABSTRACT 7 Emergency intracranial stenting in acute stroke: predictors for poor outcome and for complications.

Stracke C, Fiehler J, Meyer L, Andersson T, et al.

Journal of the American Heart Association, 2020, 9(5), DOI: 10.1161/JAHA.119.012795

INTRODUCTION Recently, acute intracranial stenting (ICS) has gained more interest as a potential bailout strategy for large vessel occlusions (LVO) that are refractory to thrombectomy. However, there are currently no reports on ICS in patients with moderately severe stroke discussing the question if implementing a permanent stent is feasible and leads to improved recanalization after failed thrombectomy.

INTRODUCTION Stent-retriever thrombectomy is the first-line therapy in acute stroke with intracranial large vessel occlusion. In case of failure of stent-retriever thrombectomy, rescue stent angioplasty might be the only treatment option to achieve permanent recanalization. This study aims at identifying predictors for poor outcome and complications in a large, multicenter cohort receiving rescue stent angioplasty.

MATERIALS/METHODS We analyzed a large multicenter database of patients receiving ICS for anterior circulation LVO after failed thrombectomy. Inclusion criteria were defined as: Moderately severe stroke (National Institute Health Stroke Scale (NIHSS) ≤9 on admission), anterior circulation LVO, acute ICS after failed stent retriever MT. Primary endpoint was the rate of improved successful recanalization after ICS defined as a modified Thrombolysis In cerebral Infarction (mTICI) score≥2b. Favorable neurological outcome was defined as an early neurological improvement (ENI) of 4 points or reaching 0 with respect to baseline NIHSS.

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MATERIALS/METHODS We performed a retrospective analysis of patients with large vessel occlusion who were treated with rescue stent angioplasty after stent-retriever thrombectomy between 2012 and 2018 in 7 neurovascular centers. We defined 2 binary outcomes: (1) functional clinical outcome (good modified Rankin Scale, 0–2; and poor modified Rankin Scale, 4–6) and (2) early symptomatic intracerebral hemorrhage.

Impacts of clinical, radiological, and interventional parameters on outcomewere assessed in uni- and multivariable logistic regression models.

RESULTS

RESULTS

Forty-one patients met the inclusion criteria. A median of 2 retrievals were performed (IQR 1-4) prior decision-making for ICS. ICS led in 90.2% (37/41) of cases to a final mTICI≥2b with significant improvement (p < 0.001) after the last retrieval attempt. The median NIHSS decreased (p = 0.178) from 7 (IQR 3.5-8) on admission to 2.5 (IQR 0-8.25) at discharge. ENI was observed in 47.4% (18/38). sICH occurred in 4.8% (2/41).

Two hundred ten patients were included with target vessels located within the anterior circulation (136 of 210; 64.8%) and posterior circulation (74 of 210; 35.2%). Symptomatic intracerebral hemorrhage occured in 22 patients, 86.4% (19 of 22) after anterior and 13.6% (3 of 22) after posterior circulation large vessel occlusion. Good functional outcome was observed in 44.8% (73 of 163). A higher National Institutes of Health Stroke Scale on admission (adjusted odds ratio, 1.10; P=0.002), a higher premorbid modified Rankin Scale (adjusted odds ratio, 2.02; P=0.049), and a modified Thrombolysis in Cerebral Infarction score of 0 to 2a after stenting (adjusted odds ratio, 23.24; P<0.001) were independent predictors of poor functional outcome.

ABSTRACTBOEK | 2020

CONCLUSION Use of rescue stent angioplasty can be considered for acute intracranial large vessel occlusion in cases after unsuccessful stent-retriever thrombectomy. Likelihood of symptomatic intracerebral hemorrhage is higher in anterior circulation stroke.

from CT to MRI is necessary to improve the appropriateness of lumbar spine imaging referrals and to reduce the collective radiation dose.

ABSTRACT 9 Case series: dual-energy CT in extra-articular manifestations of gout.

ABSTRACT 8 Belgian multicentre study on lumbar spine imaging: radiation dose and cost analysis: evaluation of compliance with recommendations for efficient use of medical imaging.

De Vulder N, Chen M, Huysse W, Verstraete K, et al.

Journal of the Belgian Society of Radiology, 2020, 104(1), 27

De Roo B, Hoste P, Stichelbaut N, Verstraete K, et al.

European Journal of Radiology, 2020, Apr, DOI: 10.1016/j. ejrad.2020.108864

Extra-articular manifestations of gout are common. The Achilles tendon is a frequently affected site, and uric acid deposition may have harmful effects on tendon structure and function. Advanced imaging can aid in early diagnosis, follow-up of disease activity and therapy efficacy. This case series highlights the use of dual-energy CT as a tool in diagnosing gout and in detecting extra-articular manifestations.

ABSTRACT

OBJECTIVE To assess compliance of lumbar spine imaging referrals with national imaging recommendations and to evaluate the impact of inappropriate imaging on the collective radiation dose and health insurance costs.

ABSTRACT 10 MATERIALS/METHODS In 2011 and 2015, 633 lumbar spine imaging referrals were evaluated across 9 Belgian hospitals. For each patient, a new clinical anamnesis and physical examination were performed. Together with the referral, this data were confronted with the national imaging recommendations.

Collective radiation dose was estimated for the radiography and CT procedures. Cost analysis was based on national reimbursement fees. Statistical analysis was performed using multilevel linear and logistic regression models.

RESULTS The fraction of unjustified imaging referrals decreased from 50 % in 2011 to 41 % in 2015 (p = 0.255). The odds of a justified examination are 3.1 times higher when the referral is done by a specialist instead of a general practitioner. The highest percentage of unjustified examinations was found for CT (85 % in 2011, 81 % in 2015; p = 0.044). Seventyfive percent of the collective dose of both the 2011 and the 2015 study population was not justified. Adherence to the recommendations could result in an estimated 16 % and 5 % cost reduction for the 2011 and 2015 study samples, respectively.

CONCLUSION Between 2011 and 2015, no significant improvement was found in requesting justified lumbar spine imaging procedures, although a positive trend was observed for CT. A shift

Dental and skeletal imaging in forensic age estimation: disparities in current approaches and the continuing search for optimization.

De Tobel J, Ottow C, Widek T, Verstraete K, et al.

Seminars in Musculoskeletal Radiology, 2020, 24(5), 510-522

ABSTRACT Medical imaging for forensic age estimation in living adolescents and young adults continues to be controversial and a subject of discussion. Because age estimation based on medical imaging is well studied, it is the current gold standard. However, large disparities exist between the centers conducting age estimation, both between and within countries. This review provides an overview of the most common approaches applied in Europe, with case examples illustrating the differences in imaging modalities, in staging of development, and in statistical processing of the age data. Additionally, the review looks toward the future because several European research groups have intensified studies on age estimation, exploring four strategies for optimization: (1) increasing sample sizes of the reference populations, (2) combining single-site information into multifactorial information, (3) avoiding ionizing radiation, and (4) conducting a fully automated analysis.

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ABSTRACT 11

OBJECTIVE

Magnetic resonance imaging for forensic age estimation in living children and young adults: a systematic review.

To study age estimation performance of combined magnetic resonance imaging (MRI) data of all four third molars, the left wrist and both clavicles in a reference population of females and males. To study the value of adding anthropometric and sexual maturation data.

De Tobel J, Bauwens J, Parmentier G, Verstraete K, et al.

Pediatric Radiology, 2020, 50, 1691-1708

ABSTRACT

MATERIALS/METHODS

The use of MRI in forensic age estimation has been explored extensively during the last decade. The authors of this paper synthesized the available MRI data for forensic age estimation in living children and young adults to provide a comprehensive overview that can guide age estimation practice and future research. To do so, the authors searched MEDLINE, Embase and Web of Science, along with cited and citing articles and study registers. Two authors independently selected articles, conducted data extraction, and assessed risk of bias. They considered study populations including living subjects up to 30 years old. Fifty-five studies were included in qualitative analysis and 33 in quantitative analysis. Most studies had biases including use of relatively small European (Caucasian) populations, varying MR approaches and varying staging techniques. Therefore, it was not appropriate to pool the age distribution data.

Three Tesla MRI of the three anatomical sites was prospectively conducted from March 2012 to May 2017 in 14- to 26-year-old healthy Caucasian volunteers (160 females, 138 males). Development was assessed by allocating stages, anthropometric measurements were taken, and self-reported sexual maturation data were collected. All data was incorporated in a continuation-ratio model to estimate age, applying Bayes’ rule to calculate point and interval predictions. Two performance aspects were studied: (1) accuracy and uncertainty of the point prediction, and (2) diagnostic ability to discern minors from adults (≥18 years).

The authors found that reproducibility of staging was remarkably lower in clavicles than in any other anatomical structure. Age estimation performance was in line with the gold standard, radiography, with mean absolute errors ranging from 0.85 years to 2.0 years. The proportion of correctly classified minors ranged from 65% to 91%. Multifactorial age estimation performed better than that based on a single anatomical site. The authors found that more multifactorial age estimation studies are necessary, together with studies testing whether the MRI data can safely be pooled. The current review results can guide future studies, help medical professionals to decide on the preferred approach for specific cases, and help judicial professionals to interpret the evidential value of age estimation results.

RESULTS Combining information from different anatomical sites decreased the mean absolute error (MAE) compared to incorporating only one site (P < 0.0001). By contrast, adding anthropometric and sexual maturation data did not further improve MAE (P = 0.11). In females, combining all three anatomical sites rendered a MAE equal to 1.41 years, a mean width of the 95% prediction intervals of 5.91 years, 93% correctly classified adults and 91% correctly classified minors. In males, the corresponding results were 1.36 years, 5.49 years, 94%, and 90%, respectively.

CONCLUSION All aspects of age estimation improve when multi-factorial MRI data of the three anatomical sites are incorporated.

Anthropometric and sexual maturation data do not seem to add relevant information.

ABSTRACT 13 Staging clavicular development on MRI: pitfalls and suggestions for age estimation.

ABSTRACT 12 Multi-factorial age estimation: a Bayesian approach combining dental and skeletal magnetic resonance imaging.

De Tobel J, Fieuws S, Hillewig E, Verstraete K, et al.

Forensic Science International, 2020, Jan, DOI: 10.1016/j. forsciint.2019.110054

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De Tobel J, Hillewig E, Van Wijk M, Verstraete K, et al.

Journal of Magnetic Resonance Imaging, 2020, 51(2), 377-388

INTRODUCTION MRI of the clavicle's sternal end has been studied for age estimation. Several pitfalls have been noted, but how they affect age estimation performance remains unclear.

OBJECTIVE

ABSTRACT 14

To further study these pitfalls and to make suggestions for a proper use of clavicle MRI for forensic age estimation.

Our hypotheses were that age estimation would benefit from 1) discarding stages 1 and 4/5; 2) including advanced substages 3aa, 3ab, and 3ac; 3) taking both clavicles into account; and 4) excluding morphological variants.

Subsynovial epidermal inclusion cyst of the knee.

MATERIALS/METHODS Population: Healthy Caucasian volunteers between 11 and 30 years old (524; 277 females, 247 males). Field Strength/ Sequence: 3T, T1-weighted gradient echo volumetric interpolated breath-hold examination (VIBE) MR-sequence.

ASSESSMENT Four observers applied the most elaborate staging technique for long bone development that has been described in the current literature (including stages, substages, and advanced substages). One of the observers repeated a random selection of the assessments in 110 participants after a 2-week interval. Furthermore, all observers documented morphological variants.

STATISTICAL TESTS Weighted kappa quantified reproducibility of staging. Bayes' rule was applied for age estimation with a continuation ratio model for the distribution of the stages. According to the hypotheses, different models were tested. Mean absolute error (MAE) differences between models were compared, as were MAEs between cases with and without morphological variants.

Seynaeve P, Vanrietvelde F, Verstraete K, et al.

Skeletal Radiology, 2020, 49(2), 317-319

ABSTRACT We report a case of a subsynovial epidermal inclusion cyst in a 47-year-old woman with a painful spontaneous swelling of the right knee and a 2-year history of puncture and arthroscopy. Epidermal inclusion cysts are one of the most common benign subcutaneous tumours. Very rarely, they are located in an articulation and can cause an inflammatory reaction when rupture occurs. Simple surgical excision is the preferred therapy. The main goal of this case report is to include the possibility of an intra-articular epidermal inclusion cyst into the differential when imaging shows an intra-articular structure, and more so if there is a history of trauma, intra-articular puncture or arthroscopy.

ABSTRACT 15 The influence of motion artefacts on magnetic resonance imaging of the clavicles for age estimation.

De Tobel J, Van Wijk M, Alberink I, Verstraete K, et al.

International Journal of Legal Medicine, 2020, 134(2), 753-768

INTRODUCTION To determine how motion affects stage allocation to the clavicle’s sternal end on MRI.

RESULTS Weighted kappa equaled 0.82 for intraobserver and ranged between 0.60 and 0.64 for interobserver agreement.

Stages 1 and 4/5 were allocated interchangeably in 4.3% (54/1258). Age increased steadily in advanced substages of stage 3, but improvement in age estimation was not significant (right P = 0.596; left P = 0.313). The model that included both clavicles and discarded stages 1 and 4/5 yielded an MAE of 1.97 years, a root mean squared error of 2.60 years, and 69% correctly classified minors. Morphological variants rendered significantly higher MAEs (right 3.84 years, P = 0.015; left 2.93 years, P = 0.022).

CONCLUSION Our results confirmed hypotheses 3) and 4), while hypotheses 1) and 2) remain to be investigated in larger studies.

MATERIALS/METHODS Eighteen volunteers (9 females, 9 males) between 14 and 30 years old were prospectively scanned with 3-T MRI. One resting-state scan was followed by five intentional motion scans. Additionally, a control group of 72 resting-state scans were selected from previous research. Firstly, six observers allocated developmental stages to the clavicles independently. Secondly, they re-assessed the images, allocating developmental statuses (immature, mature).

Finally, the resting-state scans of the 18 volunteers were assessed in consensus to decide on the “correct” stage/ status. Results were compared between groups (control, prospective resting state, prospective motion), and between staging techniques (stages/statuses).

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RESULTS Inter-observer agreement was low (Krippendorff a 0.23– 0.67). The proportion of correctly allocated stages (64%) was lower than correctly allocated statuses (83%). Overall, intentional motion resulted in fewer assessable images and less images of sufficient evidential value. The proportion of correctly allocated stages did not differ between resting-state (64%) and motion scans (65%), while correctly allocated statuses were more prevalent in resting-state scans (83% versus 77%). Remarkably, motion scans did not render a systematically higher or lower stage/status, compared to the consensus.

CONCLUSION Intentional motion impedes clavicle MRI for age estimation.

Still, in case of obvious disturbances, the forensic expert will consider the MRI unsuitable as evidence. Thus, the development of the clavicle as such and the staging technique seem to play a more important role in allocating a faulty stage for age estimation.

compared between groups. Costs from peer-reviewed literature were applied to assess cost consequences from the perspectives of the United States (USA), France, Germany, Italy, Spain, Sweden, and United Kingdom (UK).

RESULTS Among patients who achieved mTICI 2c-3 (n=172), FPE was achieved in 53% (n=91). A higher proportion of patients in the FPE group reached good functional outcomes (90-day modified Rankin Scale score 0-2 80.46% vs 61.04%, p<0.01). The patients in the FPE group had a shorter mean length of stay (6.10 vs 9.48 days, p<0.01) and required only a single stent retriever, whereas 35% of patients in the non-FPE group required at least one additional device.

Driven by improvement in clinical outcomes, the FPE group had lower procedural/hospitalization-related (24-33% reduction) and annual care (11-27% reduction) costs across all countries.

CONCLUSION FPE resulted in improved clinical outcomes, translating into lower healthcare resource use and lower estimated costs.

ABSTRACT 16 Health economic impact of first-pass success among patients with acute ischemic stroke treated with mechanical thrombectomy: a United States and European perspective.

Mechanical thrombectomy with a novel device: initial clinical experience with the ANA thrombectomy device.

Zaidat O, Ribo M, Mattle H, Andersson T, et al.

Journal of Neurointerventional Surgery, 2020, DOI: 10.1136/neurintsurg-2020-016930

Tomasello A, Hernandez D, Pinana C, Andersson T, et al.

Journal of Neuroradiology, 2020, Dec 16, DOI: 10.1016/j. neurad.2020.11.003

ABSTRACT 17

INTRODUCTION

INTRODUCTION

First-pass effect (FPE), restoring complete or near complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) in a single pass, is an independent predictor for good functional outcomes in the endovascular treatment of acute ischemic stroke. The economic implications of achieving FPE have not been assessed.

The ANA™ (Anaconda Biomed) thrombectomy system is a novel stroke thrombectomy device comprising a self-expanding funnel designed to reduce clot fragmentation by locally restricting flow while becoming as wide as the lodging artery. Once deployed, ANA allows distal aspiration in combination with a stentretriever (SR) to mobilize the clot into the funnel where it remains copped during extraction. We investigate safety and efficacy of ANA™ in a first-in-man study.

OBJECTIVE To assess the economic impact of achieving complete or near complete reperfusion after the first pass.

MATERIALS/METHODS MATERIALS/METHODS Post hoc analyses were conducted using ARISE II study data. The target population consisted of patients in whom mTICI 2c-3 was achieved, stratified into two groups: (1) mTICI 2c-3 achieved after the first pass (FPE group) or (2) after multiple passes (non-FPE group). Baseline characteristics, clinical outcomes, and healthcare resource use were

40 ABSTRACTBOEK | 2020

Prospective data was collected on 35 consecutive patients treated as first line with ANA™ at a single centre. Outcome measures included per-pass reperfusion scores, symptomatic intracerebral hemorrhage (sICH), NIHSS at day 5, and mRS at 90 days.

RESULTS

RESULTS

Median NIHSS was 12(9-18). Sites of primary occlusion were: 5 ICA, 15 M1-MCA, 15 M2-MCA. Primary performance endpoint, mTICI 2b-3 within 3 passes without rescue therapy was achieved in 91.4% (n = 32) of patients; rate of complete recanalization (mTICI 2c-3) was 65.7%. First pass complete recanalization rate was 42.9%, and median number of ANA passes 1(IQR: 1-2). In 17.1% (n = 6) rescue treatment was used; median number of rescue passes was 2(1-7), leading to a final mTICI2b-3rate of 94.3% (n = 33).

There were no device related serious adverse events, and rate of sICH was 5.7% (n = 2). At 5 days median NIHSS was 1 (IQR 1-6) and 90 days mRS 0-2 was achieved in 60% of patients.

We included 183 patients, of whom 126 (69%) had M1 occlusion and 57 (31%) had M2 occlusion. There was no difference in the reperfusion rates or adverse events between M2 and M1 occlusions. The rate of good outcome was not different in M2 versus M1 occlusions (70.2% vs 69.7%, p=0.946). In a logistic regression model adjusted for age, sex, and baseline National Institutes of Health Stroke Scale score, M2 occlusions did not have a significantly different odds of good outcome compared with M1 occlusions (OR 0.94, 95% CI 0.47 to 1.88, p=0.87).

CONCLUSION In this initial clinical experience, the ANA™ device achieved a high rate of complete recanalization with a good safety profile and favourable 90 days clinical outcomes.

CONCLUSION In ARISE II, M2 occlusions achieved a 70.2% rate of good outcome at 90 days, which is above published rates for untreated M2 occlusions and superior to prior reports of M2 occlusions treated with endovascular thrombectomy. We also report similar rates of good outcome, successful reperfusion, death, and other adverse events when comparing the M1 and M2 occlusions.

ABSTRACT 18 Benefit of endovascular thrombectomy for M2 middle cerebral artery occlusion in the ARISE II study.

De Havenon A, Narata A, Amelot A, Andersson T, et al.

Journal of Neurointerventional Surgery, 2020, DOI: 10.1136/neurintsurg-2020-016427

INTRODUCTION The benefit of endovascular thrombectomy for acute ischemic stroke with M2 segment middle cerebral artery occlusion remains controversial, with uncertainty and paucity of data specific to this population.

OBJECTIVE To compare outcomes between M1 and M2 occlusions in the Analysis of Revascularization in Ischemic Stroke with EmboTrap (ARISE II) trial.

ABSTRACT 19 Left ventricular systolic dysfunction is associated with poor functional outcomes after endovascular thrombectomy.

Tan B, Leow A, Lee T, Andersson T, et al.

Journal of Neurointerventional Surgery, 2020, DOI: 10.1136/neurintsurg-2020-016216

INTRODUCTION Endovascular thrombectomy (ET) has transformed acute ischemic stroke (AIS) therapy in patients with large vessel occlusion (LVO). Left ventricular systolic dysfunction (LVSD) decreases global cerebral blood flow and predisposes to hypoperfusion. We evaluated the relationship between LVSD, as measured by LV ejection fraction (LVEF), and clinical outcomes in patients with anterior cerebral circulation LVO who underwent ET.

MATERIALS/METHODS We performed a prespecified analysis of the ARISE II trial with the primary outcome of 90-day modified Rankin Scale score of 0-2, which we termed good outcome. Secondary outcomes included reperfusion rates and major adverse events. The primary predictor was M2 occlusion, which we compared with M1 occlusion.

MATERIALS/METHODS This multicenter retrospective cohort study examined anterior circulation LVO AIS patients from six international stroke centers. LVSD was measured by assessment of the echocardiographic LVEF using Simpson's biplane method of discs according to international guidelines. LVSD was defined as LVEF <50%. The primary outcome was defined as a good functional outcome using a modified Rankin Scale (mRS) of 0-2 at 3 months.

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RESULTS

RESULTS

We included 440 AIS patients with LVO who underwent ET. On multivariate analyses, pre-existing diabetes mellitus (OR 2.05, 95% CI 1.24 to 3.39;p=0.005), unsuccessful reperfusion (Treatment in Cerebral Infarction (TICI) grade 0-2a) status (OR 4.21, 95% CI 2.04 to 8.66; p<0.001) and LVSD (OR 2.08, 95% CI 1.18 to 3.68; p=0.011) were independent predictors of poor functional outcomes at 3 months.

On ordinal (shift) analyses, LVSD was associated with an unfavorable shift in the mRS outcomes (OR 2.32, 95% CI 1.52 to 3.53; p<0.001) after adjusting for age and ischemic heart disease.

Inclusion of 112 nonagenarians (mean age 93.3 ± 2.5 years; 76.8% women; pre-mRS ≤2 in 69.4%). Pretreatment with IVT was performed in 54.7%. In 74.6% successful recanalization (mTICI ≥2b) was achieved. Favorable outcome (mRS ≤2) was seen in 16.4% and 3-months mortality was 62.3%.

Multivariate logistic regression analysis showed younger age (odds ratio [OR] 2.99; 1.29-6.95; P = .011) and lower prestroke mRS (OR 13.46; 2.32-78.30; P = .004) as significant predictors for good clinical outcome at 90 days.

CONCLUSION Anterior circulation LVO AIS patients with LVSD have poorer outcomes after ET, suggesting the need to consider cardiac factors for ET, the degree of monitoring and prognostication post-procedure.

ABSTRACT 20

CONCLUSION Our observational study on EVT in nonagenarians demonstrates the need for careful patient selection. A substantial proportion of nonagenarians shows an unfavorable clinical outcome and high mortality, despite acceptable recanalization rates. A high prestroke disability (mRS) and advancing age predict an unfavorable outcome. Treatment decisions should be made on case-by-case evaluation, keeping in mind limited chances of favorable outcome and high risk of mortality.

Multicenter, retrospective analysis of endovascular treatment for acute ischemic stroke in nonagenarians.

ABSTRACT 21 Janssen H, Nannoni S, François O, Andersson T, et al.

Journal of stroke and Cerebrovascular Diseases, 2020, 29(8), DOI: 10.1016/j.jstrokecerebrovasdis.2020.104817

INTRODUCTION With the increasing age of acute stroke patients being admitted to hospitals, more data are needed on indications, complications and outcome of endovascular treatment (EVT) in the very elderly.

MATERIALS/METHODS Retrospective observational study with data collection from Belgian, Swiss, Canadian comprehensive stroke centers and Swedish EVT National database. All patients with acute ischemic stroke were eligible if aged older than or ≥90 years and treated with EVT ± pretreatment with intravenous thrombolysis (IVT). Safety assessment comprised presence of periprocedural complications, hemorrhagic transformation or other adverse events (<7days). Efficacy and outcome measures were successful recanalization (modified Treatment In Cerebral Infarction (mTICI) score ≥2b), favorable clinical outcome (modified Rankin Score (mRS) 0-2) and 3-months mortality.

Histological stroke clot analysis after thrombectomy: technical aspects and recommendations.

Staessens S, Fitzgerald S, Andersson T, et al.

International Journal of Stroke, 2020, 15(5), 467-476

ABSTRACT The recent advent of endovascular procedures has created the unique opportunity to collect and analyze thrombi removed from cerebral arteries, instigating a novel subfield in stroke research. Insights into thrombus characteristics and composition could play an important role in ongoing efforts to improve acute ischemic stroke therapy. An increasing number of centers are collecting stroke thrombi.

This paper aims at providing guiding information on thrombus handling, procedures, and analysis in order to facilitate and standardize this emerging research field.

ABSTRACT 22 Intracranial stenting after failed thrombectomy in patients with moderately severe stroke: a multicenter cohort study.

Meyer L, Fiehler J, Thomalla G, Andersson T, et al.

Frontiers in Neurology, 2020, 11, 97

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INTRODUCTION Recently, acute intracranial stenting (ICS) has gained more interest as a potential bailout strategy for large vessel occlusions (LVO) that are refractory to thrombectomy.

However, there are currently no reports on ICS in patients with moderately severe stroke discussing the question if implementing a permanent stent is feasible and leads to improved recanalization after failed thrombectomy.

the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL).

OBJECTIVE The purpose of this study is to compare proposed directions for drilling this fibular tunnel and to assess potential tunnel length, using a 5-mm diameter tunnel and surrounding bone.

MATERIALS/METHODS

MATERIALS/METHODS

We analyzed a large multicenter database of patients receiving ICS for anterior circulation LVO after failed thrombectomy. Inclusion criteria were defined as: Moderately severe stroke (National Institute Health Stroke Scale (NIHSS) ≤9 on admission), anterior circulation LVO, acute ICS after failed stent retriever MT. Primary endpoint was the rate of improved successful recanalization after ICS defined as a modified Thrombolysis In cerebral Infarction (mTICI) score≥2b. Favorable neurological outcome was defined as an early neurological improvement (ENI) of 4 points or reaching 0 with respect to baseline NIHSS.

Anonymous DICOM data from spiral CT-scan images of the ankle were obtained from 12 Caucasian patients: 6 females and 6 males. Virtual tunnels were generated in a 3D bone model with angles of 30, 45, 60 and 90 degrees in relation to the fibular long axis. Several measurements were performed: distance from entrance to perforation of opposing cortex, shortening of the tunnel, distance from tunnel centre to bone surface.

RESULTS Forty-one patients met the inclusion criteria. A median of 2 retrievals were performed (IQR 1-4) prior decision-making for ICS. ICS led in 90.2% (37/41) of cases to a final mTICI≥2b with significant improvement (p < 0.001) after the last retrieval attempt. The median NIHSS decreased (p = 0.178) from 7 (IQR 3.5-8) on admission to 2.5 (IQR 0-8.25) at discharge. ENI was observed in 47.4% (18/38). sICH occurred in 4.8% (2/41).

RESULTS A tunnel in a perpendicular direction resulted in an average possible tunnel length of 16.8 (± 2.7) mm in the female group and 20.3 (± 3.4) mm in the male group. A tunnel directed at 30 degrees offered the longest length: 30.9 (± 2.5) mm in the female group and 34.4 (± 2.9) mm in the male group. The use of a 5-mm diameter tunnel in a perpendicular direction caused important shortening of the tunnel at the entrance in some cases. The perpendicular tunnel was very near to the digital fossa while the most obliquely directed tunnels avoided this region.

CONCLUSION CONCLUSION ICS after failed thrombectomy appears to effectively improve recanalization rates in patients with moderately severe strokes. Thus, ICS should be considered also for patients with baseline NIHSS ≤9 if thrombectomy fails.

ABSTRACT 23

An oblique tunnel allows for a longer tunnel and avoids the region of the digital fossa, thereby retaining more surrounding bone. In addition, absolute values of tunnel length are given, which can be useful when considering the use of certain implants. We recommend to drill an oblique fibular tunnel when reconstructing the ATFL and CFL.

An oblique fibular tunnel is recommended when reconstructing the ATFL and CFL.

PRESENTATIES

Michels F, Matrical, G, Guillo S, Vanrietvelde F, Stockmans F, et al.

Knee Surgery, Sports Traumatology, Arthroscopy, 2020, 28(1), 124-131

Posterior circulation MT.

ABSTRACT 24

Andersson T December 2020, BRAIN (Barts Research and Advanced Interventional Neuroradiology) Conference 2020, Londen - Verenigd Koninkrijk

INTRODUCTION A bone tunnel is often used during the reconstruction of

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ABSTRACT 25

ABSTRACT 30

Intracranial atherosclerotic disease (ICAD).

Flow diversion in intracranial aneurysms - the final solution?

Andersson T December 2020, BRAIN (Barts Research and Advanced Interventional Neuroradiology) Conference 2020, Londen - Verenigd Koninkrijk

Andersson T February 2020, 9th Annual Conference of Neurological Surgeons' Society of India (NSSICON 2020), Kolkata - India

ABSTRACT 26

ABSTRACT 31

How to achieve first pass success in mechanical thrombectomy?

Histological analysis of an almost irretrievable thrombus in AIS.

Andersson T October 2020, Oriental Conference on Interventional Neurovascology (OCIN), Shanghai – China October 2020, Japan Neurosurgical Society Annual Congress 2020, Okayama – Japan October 2020, SLICE Worldwide Conference 2020, Montpellier – Frankrijk September 2020, 12th congress of the Minimally Invasive Neurological Therapy (ESMINT), Nice – Frankrijk

Andersson T January 2020, ABC-WIN conference, Val D'Isère - Frankrijk

ABSTRACT 32 Flow diversion for intracranial aneurysms: the final solution?

Andersson T February 2020, 9th Annual Conference of the Neurological Society of India, Kolkata - India

ABSTRACT 27 Different approaches to different tandem occlusions.

ABSTRACT 33 Andersson T October 2020, SLICE Worldwide Conference 2020, Montpellier - Frankrijk

ABSTRACT 28 Anti-aggregation in relation to mechanical thrombectomy.

Andersson T September 2020, Symposium on anti-thrombotic treatment in vascular diseases, Stockholm - Zweden

ABSTRACT 29 Endovascular treatment in ischemic stroke - tools of the trade yesterday, today and tomorrow.

Andersson T February 2020, 9th Annual Conference of Neurological Surgeons' Society of India (NSSICON 2020), Kolkata - India

44 ABSTRACTBOEK | 2020

A differential diagnosis pathway to guide genetic testing for SHH mutation.

Xu J, Seynaeve L, Vanovermeire O, van den Hauwe L, Seynaeve P March 2020, European Society of Radioloogy, EPOS, Wenen – Oostenrijk

ABSTRACT 34 Combined ablation and resection (care) for colorectal liver metastasis in the era of minimal invasive surgery.

Vandeputte M, Saveyn T, Lutin B, De Meyere C, Parementier I, D'Hondt M November 2020, Belgian Surgical Week, Antwerpen – België

ABSTRACT 35 Detailed histological analysis of ischemic stroke thrombi reveals a platelet-dominant thrombus composition in patients with cardioembolic etiology.

Staessens S, François O, Desender L, Dewaele T, Vanacker P, et al.

November 2020, BSTH congress, Brussel – België

ABSTRACT 36 Histological analysis of a thrombectomy-resistant ischemic stroke thrombus: a case report.

Staessens S, François O, Dewaele T, Vanacker P, Andersson T, et al.

November 2020, BSTH 2019 & ESO-WSO Conference 2020, Wenen - Oostenrijk

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CENTRUM

NEFROLOGIE

ARTIKELS ABSTRACT 1 Facial deformity in a patient with chronic secondary hyperparathyroidism.

D'Hondt S, Viaene L, Evenepoel P Kidney News, 2020, 1(5), 430-431 Er is geen abstract beschikbaar.

ABSTRACT 2 Van parapneumonische effusie naar polyserositis…

Jacobs A, Schockaert O, Maddens S, et al.

Tijdschrift voor Geneeskunde, 2020, 16, 790-794 Zie Longziekten pagina 33.

ABSTRACT 3 Adult-onset ANCA-associated vasculitis in SAVI: extension of the phenotypic spectrum, case report and review of the literature.

Staels F, Betrains A, Doubel P, et al.

Frontiers in Immunologie, 2020, 11, DOI: 10.3389/ fimmu.2020.575219

ABSTRACT STING-associated vasculopathy with onset in infancy (SAVI) is an autosomal dominant disorder due to gain-of-function mutations in STING1, also known as TMEM173, encoding for STING. It was reported as a vasculopathy of infancy.

However, since its description a wider spectrum of associated manifestations and disease-onset has been observed.

We report a kindred with a heterozygous STING mutation (p.V155M) in which the 19-year-old proband suffered from isolated adult-onset ANCA-associated vasculitis. His father suffered from childhood-onset pulmonary fibrosis and renal failure attributed to ANCA-associated vasculitis, and died at the age of 30 years due to respiratory failure. In addition, an overview of the phenotypic spectrum of SAVI is provided highlighting (a) a high phenotypic variability with in some cases isolated manifestations, (b) the potential of adult-onset disease, and (c) a novel manifestation with ANCA-associated vasculitis.

46 ABSTRACTBOEK | 2020

CENTRUM

NEUROLOGIE ARTIKELS

ABSTRACT 2

ABSTRACT 1

Structural analysis of ischemic stroke thrombi: histological indications for therapy resistance.

Timing of initiation of oral anticoagulants in patients with acute ischemic stroke and atrial fibrillation comparing posterior and anterior circulation strokes.

Staessens S, Denorme F, François O, Vanacker P, et al.

Haematologica, 2020, 105(2), 498-507

Paciaroni M, Agnelli G, Gastuzzi M, Vanacker P, et al.

European Stroke Journal, 2020, 5(4), 374-383

Zie Medische beeldvorming pagina 34.

INTRODUCTION

ABSTRACT 3

The aim of this study in patients with acute posterior ischaemic stroke (PS) and atrial fibrillation (AF) was to evaluate (1) the risks of recurrent ischaemic event and severe bleeding and (2) these risks in relation with oral anticoagulant therapy (OAT) and its timing.

Quantitative signal intensity in fluid-attenuated inversion recovery and treatment effect in the WAKE-UP trial.

Cheng B, Boutitie F, Nickel A, Vanacker P, et al.

Stroke, 2020, 51(1), 209-215

MATERIALS/METHODS

INTRODUCTION

Patients with PS were prospectively included; the outcome events of these patients were compared with those of patients with anterior stroke (AS) which were taken from previous registries. The primary outcome was the composite of stroke recurrence, transient ischaemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding occurring within 90 days from acute stroke.

Relative signal intensity of acute ischemic stroke lesions in fluid-attenuated inversion recovery (fluid-attenuated inversion recovery relative signal intensity [FLAIR-rSI]) magnetic resonance imaging is associated with time elapsed since stroke onset with higher intensities signifying longer time intervals. In the randomized controlled WAKE-UP trial (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke Trial), intravenous alteplase was effective in patients with unknown onset stroke selected by visual assessment of diffusion weighted imaging fluid-attenuated inversion recovery mismatch, that is, in those with no marked fluid-attenuated inversion recovery hyperintensity in the region of the acute diffusion weighted imaging lesion. In this post hoc analysis, we investigated whether quantitatively measured FLAIR-rSI modifies treatment effect of intravenous alteplase.

RESULTS A total of 2470 patients were available for the analysis: 473 (19.1%) with PS and 1997 (80.9%) with AS. Over 90 days, 213 (8.6%) primary outcome events were recorded: 175 (8.7%) in patients with AS and 38 (8.0%) in those with PS. In patients who initiated OAT within 2 days, the primary outcome occurred in 5 out of 95 patients (5.3%) with PS compared to 21 out of 373 patients (4.3%) with AS (OR 1.07; 95% CI 0.39-2.94). In patients who initiated OAT between days 3 and 7, the primary outcome occurred in 3 out of 103 patients (2.9%) with PS compared to 26 out of 490 patients (5.3%) with AS (OR 0.54; 95% CI 0.16-1.80).

CONCLUSION Our findings suggest that, when deciding the time to initiate oral anticoagulation, the location of stroke, either anterior or posterior, does not predict the risk of outcome events.

MATERIALS/METHODS FLAIR-rSI of stroke lesions was measured relative to signal intensity in a mirrored region in the contralesional hemisphere. The relationship between FLAIR-rSI and treatment effect on functional outcome assessed by the modified Rankin Scale (mRS) after 90 days was analyzed by binary logistic regression using different end points, that is, favorable outcome defined as mRS score of 0 to 1, independent outcome defined as mRS score of 0 to 2, ordinal analysis of mRS scores (shift analysis). All models were adjusted for National Institutes of Health Stroke Scale at symptom onset and stroke lesion volume.

NEUROLOGIE

47

RESULTS

RESULTS

FLAIR-rSI was successfully quantified in stroke lesions in 433 patients (86% of 503 patients included in WAKEUP). Mean FLAIR-rSI was 1.06 (SD, 0.09). Interaction of FLAIR-rSI and treatment effect was not significant for mRS score of 0 to 1 (P=0.169) and shift analysis (P=0.086) but reached significance for mRS score of 0 to 2 (P=0.004).

We observed a smooth continuing trend of decreasing treatment effects in relation to clinical end points with increasing FLAIR-rSI.

A total of 147 patients were included for a follow-up period of 6 months. The mean SCORE in the intervention group showed a statistically significant reduction of 3.2 (p < 0.001) at 6 months. However, comparison between control and intervention groups was non-significant (p = 0.55).

Secondary endpoints are promising with a medication adherence of 96%. Reported quality of life also improved (p < 0.001). No significant improvement in the modified Rankin scale (mRS) was observed (p = 0.720). Five percent of patients suffered a recurrent stroke.

CONCLUSION In patients in whom no marked parenchymal fluid-attenuated inversion recovery hyperintensity was detected by visual judgement in the WAKE-UP trial, higher FLAIR-rSI of diffusion weighted imaging lesions was associated with decreased treatment effects of intravenous thrombolysis.

This parallels the known association of treatment effect and elapsing time of stroke onset.

CONCLUSION Our project consisting of a coached lifestyle intervention and digital platform shows promise in improving stroke recurrence rates, therapeutic adherence and quality of life in a Belgian healthcare setting.

ABSTRACT 5 ABSTRACT 4 Stroke coach: a pilot study of a personal digital coaching program for patients after ischemic stroke.

Kamoen O, Maqueda V, Yperzeele L, Vanacker P, et al.

Acta Neurologica Belgica, 2020, 120(1), 91-97

Eligibility for late endovascular treatment using DAWN, DEFUSE-3, and more liberal selection criteria in a stroke center.

Nannoni S, Strambo D, Sirimarco G, Vanacker P, et al.

Journal of Neurointerventional Surgery, 2020, 12(9), 842-847

INTRODUCTION

INTRODUCTION

Despite recent advances in acute stroke care, the risk of recurrent stroke remains high. On behalf of the Belgian Stroke Council (BSC), a nurse-led self-management program was developed, using a personal coach and digital platform with the aim of improving cardiovascular risk factor control in patients after ischemic stroke.

The real-life application of DAWN and DEFUSE-3 trials has been poorly investigated. We aimed to identify the proportion of patients with acute ischemic stroke (AIS) eligible for late endovascular treatment (EVT) in our stroke center based on trial and more liberal selection criteria.

MATERIALS/METHODS

All consecutive patients in our stroke registry (2003-2017) admitted within 5-23 hours of last proof of good health were selected if they had complete clinical and radiological datasets. We calculated the proportion of patients eligible for late EVT according to trial (DAWN and/or DEFUSE-3) and more liberal clinical/imaging mismatch criteria (including lower admission National Institutes of Health Stroke Scale score and Alberta Stroke Program Early CT Score for core estimation).

MATERIALS/METHODS The program was implemented in four Belgian hospitals.

The stroke coach provided one educational session during hospitalization. After discharge, the patient received tips and tricks concerning a healthy lifestyle through the customized platform. The stroke coach set up video appointments through the platform at regular intervals.

Primary endpoint of our study was the change in SCORE (Systematic COronary Risk Evaluation: High and Low cardiovascular Risk Charts) risk at baseline and 6 months compared with a historical control group who received standard care.

48 ABSTRACTBOEK | 2020

RESULTS Of 1705 patients with AIS admitted to our comprehensive stroke center in the late time window, we identified 925 patients with complete clinical and radiological data.

Among them, the proportions of late EVT eligibility were

2.5% (n=23) with DAWN, 5.1% (n=47) with DEFUSE-3, and 11.1% (n=103) with more liberal criteria. Considering late-arriving patients with large vessel occlusion (n=221), the percentages of eligible patients were 10.4%, 21.3%, and 46.6%, respectively. A favorable outcome was observed at comparable rates in treated patients selected by trial or liberal criteria (67% vs 58%, p=0.49).

Primary outcome was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding within 90 days from the inclusion. Treated-patients were propensity matched to untreated-patients in a 1:1 ratio after stratification by baseline clinical features.

CONCLUSION

A total of 2159 patients were included, 564 (26%) patients received acute reperfusion therapies. After the index event, 505 (90%) patients treated with acute reperfusion therapies and 1287 of 1595 (81%) patients untreated started oral anticoagulation. Timing of starting oral anticoagulant was similar in reperfusion-treated and untreated patients (median 7.5 versus 7.0 days, respectively). At 90 days, the primary study outcome occurred in 37 (7%) patients treated with reperfusion and in 146 (9%) untreated patients (odds ratio, 0.74 [95% CI, 0.50-1.07]). After propensity score matching, risk of primary outcome was comparable between the 2 groups (odds ratio, 1.06 [95% CI, 0.53-2.02]).

RESULTS In a long-term stroke registry, the proportion of late EVT eligibility varied greatly according to selection criteria and referral pattern. Among late-arriving patients referred to our comprehensive stroke center, we found 5.6% eligible according to trial (DAWN/DEFUSE-3) and 11.1% according to liberal criteria. These data indicate that late EVT could be offered to a larger population of patients if more liberal criteria are applied.

ABSTRACT 6 Safety of anticoagulation in patients treated with urgent reperfusion for ischemic stroke related to atrial fibrillation.

Giustozzi M, Acciarresi M, Agnelli G, Vanacker P, et al.

Stroke, 2020, 51(8), 2347-2354

CONCLUSION Acute reperfusion treatment did not influence the risk of early recurrence and major bleeding in patients with atrial fibrillation-related acute ischemic stroke, who started on oral anticoagulant.

INTRODUCTION The optimal timing for starting oral anticoagulant after an ischemic stroke related to atrial fibrillation remains a challenge, mainly in patients treated with systemic thrombolysis or mechanical thrombectomy. We aimed at assessing the incidence of early recurrence and major bleeding in patients with acute ischemic stroke and atrial fibrillation treated with thrombolytic therapy and/or thrombectomy, who then received oral anticoagulants for secondary prevention.

MATERIALS/METHODS We combined the dataset of the RAF and the RAF-NOACs (Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin K Oral Anticoagulants) studies, which were prospective observational studies carried out from January 2012 to March 2014 and April 2014 to June 2016, respectively. We included consecutive patients with acute ischemic stroke and atrial fibrillation treated with either vitamin K antagonists or nonvitamin K oral anticoagulants.

ABSTRACT 7 Ticagrelor and aspirin or aspirin alone in acute ischemic stroke or TIA. Johnston C, Amarenco P, Denison H, Vanacker P, et al.

The New England Journal of Medicine, 2020, 383, 207-217

INTRODUCTION Trials have evaluated the use of clopidogrel and aspirin to prevent stroke after an ischemic stroke or transient ischemic attack (TIA). In a previous trial, ticagrelor was not better than aspirin in preventing vascular events or death after stroke or TIA. The effect of the combination of ticagrelor and aspirin on prevention of stroke has not been well studied.

MATERIALS/METHODS We conducted a randomized, placebo-controlled, doubleblind trial involving patients who had had a mild-to-moderate acute noncardioembolic ischemic stroke, with a National Institutes of Health Stroke Scale (NIHSS) score of 5 or less (range, 0 to 42, with higher scores indicating more severe stroke), or TIA and who were not undergoing thrombolysis

NEUROLOGIE

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or thrombectomy. The patients were assigned within 24 hours after symptom onset, in a 1:1 ratio, to receive a 30-day regimen of either ticagrelor (180-mg loading dose followed by 90 mg twice daily) plus aspirin (300 to 325 mg on the first day followed by 75 to 100 mg daily) or matching placebo plus aspirin. The primary outcome was a composite of stroke or death within 30 days. Secondary outcomes were first subsequent ischemic stroke and the incidence of disability within 30 days. The primary safety outcome was severe bleeding.

RESULTS A total of 11,016 patients underwent randomization (5523 in the ticagrelor-aspirin group and 5493 in the aspirin group). A primary-outcome event occurred in 303 patients (5.5%) in the ticagrelor-aspirin group and in 362 patients (6.6%) in the aspirin group (hazard ratio, 0.83; 95% confidence interval [CI], 0.71 to 0.96; P = 0.02). Ischemic stroke occurred in 276 patients (5.0%) in the ticagrelor-aspirin group and in 345 patients (6.3%) in the aspirin group (hazard ratio, 0.79; 95% CI, 0.68 to 0.93; P = 0.004). The incidence of disability did not differ significantly between the two groups. Severe bleeding occurred in 28 patients (0.5%) in the ticagrelor-aspirin group and in 7 patients (0.1%) in the aspirin group (P = 0.001).

ABSTRACT 9 Ticagrelor added to aspirin in acute ischemic stroke or transient ischemic attack in prevention of disabling stroke: a randomized clinical trial.

Amarenco P, Densison H, Evans S, Vanacker P, et al.

JAMA Neurology, 2020, 78(2), 1-9

INTRODUCTION Reduction of subsequent disabling stroke is the main goal of preventive treatment in the acute setting after transient ischemic attack (TIA) or minor ischemic stroke.

MATERIALS/METHODS The Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and Aspirin for Prevention of Stroke and Death (THALES) was a randomized clinical trial conducted between January 22, 2018, and December 13, 2019, with a 30-day follow-up, at 414 hospitals in 28 countries. The trial included 11 016 patients with a noncardioembolic, nonsevere ischemic stroke or high-risk TIA, including 10 803 with modified Rankin Scale score (mRS) recorded at 30 days.

Ticagrelor (180-mg loading dose on day 1 followed by 90 mg twice daily for days 2-30) or placebo within 24 hours of symptom onset. All patients received aspirin, 300 to 325 mg on day 1 followed by 75 to 100 mg daily for days 2 to 30.

CONCLUSION Among patients with a mild-to-moderate acute noncardioembolic ischemic stroke (NIHSS score ≤5) or TIA who were not undergoing intravenous or endovascular thrombolysis, the risk of the composite of stroke or death within 30 days was lower with ticagrelor-aspirin than with aspirin alone, but the incidence of disability did not differ significantly between the two groups. Severe bleeding was more frequent with ticagrelor. (Funded by AstraZeneca; THALES ClinicalTrial.gov number, NCT03354429).

ABSTRACT 8 Multicenter, retrospective analysis of endovascular treatment for acute ischemic stroke in nonagenarians.

Jannsen H, Nannoni S, François O, Vanacker P, et al.

Zie Medische beeldvorming pagina 42.

RESULTS Among participants with 30-day mRS greater than 1, mean age was 68.1 years, 1098 were female (42.6%), and 2670 had an ischemic stroke (95.8%) as a qualifying event. Among 11 016 patients, a primary end point with mRS greater than 1 at 30 days occurred in 221 of 5511 patients (4.0%) randomized to ticagrelor and in 260 of 5478 patients (4.7%) randomized to placebo (hazard ratio [HR], 0.83; 95% CI, 0.69-0.99, P = .04). A primary end point with mRS 0 or 1 at 30 days occurred in 70 of 5511 patients (1.3%) and 87 of 5478 patients (1.6%) (HR, 0.79; 95% CI, 0.57-1.08; P = .14). The ordinal analysis of mRS in patients with recurrent stroke showed a shift of the disability burden following a recurrent ischemic stroke in favor of ticagrelor (odds ratio, 0.77; 95% CI, 0.65-0.91; P = .002). Factors associated with disability were baseline National Institutes of Health Stroke Scale score 4 to 5, ipsilateral stenosis of at least 30%, Asian race/ethnicity, older age, and higher systolic blood pressure, while treatment with ticagrelor was associated with less disability.

CONCLUSION In patients with TIA and minor ischemic stroke, ticagrelor added to aspirin was superior to aspirin alone in preventing

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disabling stroke or death at 30 days and reduced the total burden of disability owing to ischemic stroke recurrence.

ABSTRACT 10 Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data.

Thomalla G, Boutitie F, Ma H, Vanacker P, et al.

Lancet, 2020, 396(10262), 1574-1584

outcome (adjusted OR 1·50 [1·06-2·12]; p=0·022). In the alteplase group, 90 (21%) patients were severely disabled or died (mRS score 4-6), compared with 102 (25%) patients in the control group (adjusted OR 0·76 [0·52-1·11]; p=0·15).

27 (6%) patients died in the alteplase group and 14 (3%) patients died among controls (adjusted OR 2·06 [1·034·09]; p=0·040). The prevalence of symptomatic intracranial haemorrhage was higher in the alteplase group than among controls (11 [3%] vs two [<1%], adjusted OR 5·58 [1·22-25·50]; p=0·024).

CONCLUSION INTRODUCTION Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis.

We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers.

MATERIALS/METHODS We did a systematic review and meta-analysis of individual patient data for trials published before Sept 21, 2020.

Randomised trials of intravenous alteplase versus standard of care or placebo in adults with stroke with unknown time of onset with perfusion-diffusion MRI, perfusion CT, or MRI with diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch were eligible. The primary outcome was favourable functional outcome (score of 0-1 on the modified Rankin Scale [mRS]) at 90 days indicating no disability using an unconditional mixed-effect logistic-regression model fitted to estimate the treatment effect.

Secondary outcomes were mRS shift towards a better functional outcome and independent outcome (mRS 0-2) at 90 days. Safety outcomes included death, severe disability or death (mRS score 4-6), and symptomatic intracranial haemorrhage. This study is registered with PROSPERO, CRD42020166903.

RESULTS Of 249 identified abstracts, four trials met our eligibility criteria for inclusion: WAKE-UP, EXTEND, THAWS, and ECASS-4. The four trials provided individual patient data for 843 individuals, of whom 429 (51%) were assigned to alteplase and 414 (49%) to placebo or standard care. A favourable outcome occurred in 199 (47%) of 420 patients with alteplase and in 160 (39%) of 409 patients among controls (adjusted odds ratio [OR] 1·49 [95% CI 1·10-2·03]; p=0·011), with low heterogeneity across studies (I2=27%).

Alteplase was associated with a significant shift towards better functional outcome (adjusted common OR 1·38 [95% CI 1·05-1·80]; p=0·019), and a higher odds of independent

In patients who have had a stroke with unknown time of onset with a DWI-FLAIR or perfusion mismatch, intravenous alteplase resulted in better functional outcome at 90 days than placebo or standard care. A net benefit was observed for all functional outcomes despite an increased risk of symptomatic intracranial haemorrhage. Although there were more deaths with alteplase than placebo, there were fewer cases of severe disability or death.

ABSTRACT 11 Ticagrelor added to aspirin in acute nonsevere ischemic stroke or transient ischemic attack of atherosclerotic origin.

Amarenco P, Denison H, Evans S, Vanacker P, et al.

Stroke, 2020, 51(12), 3504-3513

INTRODUCTION Among patients with a transient ischemic attack or minor ischemic strokes, those with ipsilateral atherosclerotic stenosis of cervicocranial vasculature have the highest risk of recurrent vascular events.

MATERIALS/METHODS In the double-blind THALES (The Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death) trial, we randomized patients with a noncardioembolic, nonsevere ischemic stroke, or high-risk transient ischemic attack to ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2-30) or placebo added to aspirin (300-325 mg on day 1 followed by 75-100 mg daily for days 2-30) within 24 hours of symptom onset. The present paper reports a prespecified analysis in patients with and without ipsilateral, potentially causal atherosclerotic stenosis ≥30% of cervicocranial vasculature. The primary end point was time to the occurrence of stroke or death within 30 days.

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RESULTS Of 11,016 randomized patients, 2351 (21.3%) patients had an ipsilateral atherosclerotic stenosis. After 30 days, a primary end point occurred in 92/1136 (8.1%) patients with ipsilateral stenosis randomized to ticagrelor and in 132/1215 (10.9%) randomized to placebo (hazard ratio 0.73 [95% CI, 0.56-0.96], P=0.023) resulting in a number needed to treat of 34 (95% CI, 19-171). In patients without ipsilateral stenosis, the corresponding event rate was 211/4387 (4.8%) and 230/4278 (5.4%), respectively (hazard ratio, 0.89 [95% CI, 0.74-1.08]; P=0.23, Pinteraction=0.245).

Severe bleeding occurred in 4 (0.4%) and 3 (0.2%) patients with ipsilateral atherosclerotic stenosis on ticagrelor and on placebo, respectively (P=NS), and in 24 (0.5%) and 4 (0.1%), respectively, in 8665 patients without ipsilateral stenosis (hazard ratio=5.87 [95% CI, 2.04-16.9], P=0.001).

CONCLUSION In this exploratory analysis comparing ticagrelor added to aspirin to aspirin alone, we found no treatment by ipsilateral atherosclerosis stenosis subgroup interaction but did identify a higher absolute risk and a greater absolute risk reduction of stroke or death at 30 days in patients with ipsilateral atherosclerosis stenosis than in those without. In this easily identified population, ticagrelor added to aspirin provided a clinically meaningful benefit with a number needed to treat of 34 (95% CI, 19-171).

outcome was any sign of hemorrhagic transformation on follow-up MRI. The primary efficacy outcome was favorable functional outcome defined by a score of 0-1 on the modified Rankin scale at 90 days after stroke, adjusted for age and baseline stroke severity. Logistic regression models were fitted to study the association of prior antiplatelet treatment with outcome and treatment effect of intravenous alteplase.

RESULTS Of 503 randomized patients, 164 (32.6%) were on antiplatelet treatment. Patients on antiplatelet treatment were older (70.3 vs. 62.8 years, p < 0.001), and more frequently had a history of hypertension, atrial fibrillation, diabetes, hypercholesterolemia, and previous stroke or transient ischaemic attack. Rates of symptomatic intracranial hemorrhage and hemorrhagic transformation on follow-up imaging did not differ between patients with and without antiplatelet treatment. Patients on prior antiplatelet treatment were less likely to achieve a favorable outcome (37.3% vs. 52.6%, p = 0.014), but there was no interaction of prior antiplatelet treatment with intravenous alteplase concerning favorable outcome (p = 0.355). Intravenous alteplase was associated with higher rates of favorable outcome in patients on prior antiplatelet treatment with an adjusted odds ratio of 2.106 (95% CI 1.047-4.236).

CONCLUSION ABSTRACT 12 Safety and efficacy of intravenous thrombolysis in stroke patients on prior antiplatelet therapy in the WAKE-UP trial.

Frey B, Boutitie F, Cheng B, Vanacker P, et al.

Neurological Research and Practice, 2020, 2, 40

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Treatment benefit of intravenous alteplase and rates of post-treatment hemorrhagic transformation were not modified by prior antiplatelet intake among MRI-selected patients with unknown onset stroke. Worse functional outcome in patients on antiplatelets may result from a higher load of cardiovascular co-morbidities in these patients.

INTRODUCTION

ABSTRACT 13

One quarter to one third of patients eligible for systemic thrombolysis are on antiplatelet therapy at presentation.

In this study, we aimed to assess the safety and efficacy of intravenous thrombolysis in stroke patients on prescribed antiplatelet therapy in the WAKE-UP trial.

Anticoagulant selection in relation to the SAMe-TT 2 R 2 score in patients with atrial fibrillation: the GLORIA-AF registry.

MATERIALS/METHODS

Ntaios G, Huisman M, Diener H, Vanacker P, et al.

Hellenic Journal of Cardiology, 2020, 15, DOI: 10.1016/j. hjc.2020.11.009

WAKE-UP was a multicenter, randomized, double-blind, placebo-controlled clinical trial to study the efficacy and safety of MRI-guided intravenous thrombolysis with alteplase in patients with an acute stroke of unknown onset time. The medication history of all patients randomized in the WAKE-UP trial was documented. The primary safety

The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a

ABSTRACTBOEK | 2020

INTRODUCTION

target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores.

MATERIALS/METHODS We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMeTT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2.

RESULTS The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial.

ABSTRACT 14 Improvements in dyskinesia with levodopa-carbidopa intestinal gel in advanced Parkinson's disease patients in a "real-world" study: interim results of the multinational DUOGLOBE study with up to 24 months follow-up.

Aldred J, Kovacs N, Pontieri F, Bourgeois P, et al.

Neurology, 2020, 94 (15 supplement)

dyskinesia symptoms and associated effects on QoL and caregiver burden in a real-world setting are limited.

MATERIALS/METHODS DUOGLOBE is a multinational observational study (including US sites) of LCIG naïve patients treated during routine clinical practice with 3-years follow-up planned (NCT02611713).

This is the first multinational LCIG study using the Unified Dyskinesia Rating Scale (UDysRS). Other assessments included the UPDRS Part IV, “Off” time, Non-Motor Symptoms Scale (NMSS), QoL (8-item PD questionnaire [PDQ-8]), caregiver burden (MCSI), and Serious Adverse Events (SAEs). Interim outcomes from baseline to month (M) 24 are presented.

RESULTS In this interim analysis, 196 patients were included (62% male, 78% ≥65 years old; 51% ≥10 years’ PD duration.

Median daily duration of LCIG infusion was 16.0 h/d LCIG through M24, with up to 9% of patients on 24h LCIG infusion. Significant improvements (mean change from baseline to M24) were observed in “Off” time (−3.6 h/d) and NMSS total scores (−27.0). LCIG treatment significantly improved dyskinesia symptoms and signs assessed by the UDysRS and UPDRS Part IV items 33 and 34 through M18.

QoL and caregiver burden were improved through M18.

Overall, 41% of patients experienced SAEs; 31% (n=60) discontinued participation in DUOGLOBE with 13 patients continuing LCIG outside the study.

CONCLUSION This interim analysis shows sustained improvements of dyskinesia symptoms and signs, measured using the UDysRS, with LCIG in routine clinical practice and supports real-world effectiveness of LCIG on “Off” time, NMS, QoL, and caregiver burden in aPD patients. Safety was consistent with the established LCIG profile.

ABSTRACT 15 Application of the '5-2-1' screening criteria in advanced Parkinson's disease: interim analysis of DUOGLOBEaldres.

INTRODUCTION Evaluate effect of levodopa-carbidopa intestinal gel (LCIG) on dyskinesia symptoms, quality of life (QoL) and caregiver burden in advanced Parkinson’s disease (aPD) patients treated with LCIG in routine clinical practice.

Aldred J, Anca-Herschkovitsch M, Bourgeois P, et al.

Neurodegenerative Disease Management, 2020, 10(5), 309-323

BACKGROUND

A Delphi expert consensus panel proposed that fulfilling >1 of the '5-2-1' criteria suggests advanced Parkinson's disease (PD).

OBJECTIVE LCIG has established benefit in reducing “Off” time, but prospective long-term data on the effect of LCIG on

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MATERIALS/METHODS DUOdopa/Duopa in Patients weth Advanced PD - a Global OBservational Sudy Evaluating >Long-Term Effectiveness (DUOGLOBE) - is a single-arm, postmarketing, observational, long-term effectiveness levodopa-carbidopa intestinal gel (LCIG) for advance PD.

RESULTS This 6-month interim analysis(n= 139) affirms tha most (98%) enrolled patients fulfill > of the 5-2-1 criteria. These patients responded favorably to LCIG treatment. Safety was consistent with other LCIG studies.

in this post hoc analysis of an interim dataset.

RESULTS For this dataset, the baseline UDysRS score was 33.7 ± 21.1 points (n = 152), and the baseline PDQ-8 score was 45.1 ± 18.1 points (n = 171) with a Pearson correlation coefficient between the 2 measures of 0.2732 (P < .001), indicating a weak, yet significant correlation. After 12 months of receiving LCIG treatment, patients’ UDysRS scores reduced by an average of 9.6 ± 22.5 points (n = 117) and PDQ-8 scores reduced by 9.0 ± 21.6 points (n = 135) with a Pearson correlation coefficient of 0.2345, indicating a significant positive correlation between the improvements (P = .011).

CONCLUSION In advanced PD patients, the 5-2-1 criteria generally aligns with clinician assessment. Clinical Trial Resgistration: NCT02611713 ( ClinicalTrials.gov).

PRESENTATIES

CONCLUSION In this cohort of patients with advanced PD, UDysRS and PDQ-8 scores were significantly correlated at baseline, suggesting that dyskinesia negatively impacts patients’ QoL. After 12 months of LCIG treatment, improvement in QoL was positively correlated with improvement of dyskinesia.

ABSTRACT 16 Correlation between dyskinesia and quality of life at baseline and after 12 months of treatment with LCIG in patients with advanced Parkinson’s disease.

Aldred J, Pontieri F, Bergmann L, Bourgeois P, et al.

International Parkinson and Movement Disorder Society, Virtual Congress, 2020

INTRODUCTION

ABSTRACT 17 Detailed histological analysis of ischemic stroke thrombi reveals a platelet-dominant thrombus composition in patients with cardioembolic etiology.

Staessens S, François O, Desender L, Dewaele T, Vanacker P, et al.

November 2020, BSTH congress, Brussel - België

To provide optimal treatment regimens for patients in advanced stages of PD, it is important to understand how changes in dyskinesia affect patients’ quality of life.

ABSTRACT 18

OBJECTIVE

Occurrence of ischemic stroke in patients treated with NOAC: a neglected population group.

Evaluate the correlation between dyskinesia and quality of life (QoL) at baseline and after 12 months of treatment with levodopa-carbidopa intestinal gel (LCIG) in patients with advanced Parkinson’s disease (PD).

Vanacker P, Simons S, Verhaeghe A, Geebels A, Meeus G November 2020, ESO-WSO Conference 2020, Wenen - Oostenrijk

MATERIALS/METHODS DUOdopa/Duopa in Patients with Advanced Parkinson’s Disease—a GLobal OBservational Study Evaluating Long-Term Effectiveness (DUOGLOBE)—is an ongoing multi-country, single-arm, post-marketing observational study assessing the long-term effectiveness of LCIG in patients with advanced PD (NCT02611713). Assessments included the Unified Dyskinesia Rating Scale (UDysRS) and Parkinson’s Disease Questionnaire (PDQ-8) prior to and at 12 months LCIG therapy. Patients who were followed up for 12 months and completed all 4 assessments were included

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ABSTRACT 19 Concordance between guidelines on perioperative management of NOACS and ITS implementation: preventable cause of ischemic stroke.

Vanacker P, Simons S, Verhaeghe A, Geebels A, Meeus G November 2020, ESO-WSO Conference 2020, Wenen - Oostenrijk

ABSTRACT 20 Intravenous thrombolysis in acute spinal cord ischaemia syndrome: a retrospective analysis of registry data.

Rosner J, Vanacker P, Heldner M, et al.

November 2020, ESO-WSO 2020, Wenen - Oostenrijk

ABSTRACT 21 Histological analysis of a thrombectomy-resistant ischemic stroke thrombus: a case report.

Staessens S, François O, Dewaele T, Vanacker P, Andersson T, et al.

November 2020, ESO-WSO Conference 2020, Wenen - Oostenrijk

ABSTRACT 22 DIGITAL AF: impact of smartphone-based atrial fibrillation screening in the general population for primary stroke prevention.

years, 58% was male. In 791 subjects (1.3%), AF was diagnosed by the algorithm and offline confirmed. This group was older (62±11 years, p<0.001), more frequently male (76%, p<0.001) and had a higher CHA2DS2-VASc score (1.00±1.00 vs 2.00±2.00, p<0.001). The proportion with CHA2DS2-VASc ≥ 1 is 81.3% for the AF cohort vs 64.3% in non-AF cohort. The AF yield increased from 0.52% with 1 recording to 1.84% after 8 days. Of the AF patients, 335 (42%) were known, 373 (47%) newly identified, and 83 (11%) did not give this information. A physician was consulted by 138 (17%) newly identified patients, findings were confirmed in 71 (9%), 46 (6%) received antithrombotic therapy.

CONCLUSION This digital screening, targeting the general population and using only smartphones, demonstrates the feasibility to collect data in a scalable and low-cost way. Next to single timepoint ECG, twice-daily PPG may detect a significant number of asymptomatic AF patients.

Proesmans T, Vanacker P, et al.

February 2020, International Stroke Conference 2020, Los Angeles - USA (Published in Stroke 2020 Suppl. 1)

INTRODUCTION Opportunistic AF screening for primary stroke prevention is recommended in patients aged above 65 based on stroke risk models. Logistics hamper uniform screening with 12-lead ECG. Novel technologies, e.g. photoplethysmography-based (PPG) apps, may overcome this, providing readily available screening at low cost. We assessed the feasibility of smartphone screening and the impact on subsequent clinical care.

MATERIALS/METHODS A media campaign educated on AF, recruited subjects, and gave access to a PPG-based app to assess the heart rhythm.

Subjects were instructed to measure twice daily for 8 days.

An algorithm classified the traces as regular, possible AF, non-AF irregularity, or insufficient quality. PPGs of possible irregularities or AF were reviewed by medical technicians and cardiologists. If AF was confirmed, a physician visit was recommended. Questionnaires collected data on clinical care.

RESULTS In 2 weeks, 62,821 subjects onboarded, resulting in 588,336 60-second PPG traces. The screened population was 49±15

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CENTRUM

NEUS-, KEEL- EN OORZIEKTEN

ARTIKELS ABSTRACT 1 Real-life assessment of chronic rhinosinusitis patients using mobile technology: the mySinusitisCoach project

by EUFOREA Seys S, De Bont S, Vierstraete K, et al.

European Academy of Allergy and Clinical Immunology, 2020, 75(11),2867-2876

BACKGROUND Chronic rhinosinusitis (CRS) is a chronic inflammatory disease associated with a substantial personal and socioeconomic burden. Monitoring of patient-reported outcomes by mobile technology offers the possibility to better understand real-life burden of CRS.

MATERIALS/METHODS This study reports on the cross-sectional evaluation of data of 626 users of mySinusitisCoach (mSC), a mobile application for CRS patients. Patient characteristics of mSC users were analysed as well as the level of disease control based on VAS global rhinosinusitis symptom score and adapted EPOS criteria.

RESULTS The mSC cohort represents a heterogeneous group of CRS patients with a diverse pattern of major symptoms.

Approximately half of patients reported nasal polyps. 47.3% of all CRS patients were uncontrolled based on evaluation of VAS global rhinosinusitis symptom score compared to 40.9% based on adapted EPOS criteria.

The impact of CRS on sleep quality and daily life activities was significantly higher in uncontrolled versus well-controlled patients. Half of patients had a history of FESS (functional endoscopic sinus surgery) and reported lower symptom severity compared to patients without a history of FESS, except for patients with a history of more than 3 procedures. Patients with a history of FESS reported higher VAS levels for impaired smell.

CONCLUSION Real-life data confirm the high disease burden in uncontrolled CRS patients, clearly impacting quality of life. Sinus surgery improves patient-reported outcomes, but not in patients with a history of more than 3 procedures. Mobile technology opens a new era of real-life monitoring, supporting the evolution of care towards precision medicine.

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NUCLEAIRE GENEESKUNDE ARTIKELS ABSTRACT 1 The effects of ARBs, ACEis, and statins on clinical outcomes of COVID-19 infection among nursing home residents. de Spiegeleer A, Bronselaer A, Teo J, Van de Wiele C, et al.

Journal of the American Medical Directors Association, 2020, 21(7), 909-914

OBJECTIVE Angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), and HMG-CoA reductase inhibitors ("statins") have been hypothesized to affect COVID-19 severity. However, up to now, no studies investigating this association have been conducted in the most vulnerable and affected population groups (ie, older adults residing in nursing homes). The objective of this study was to explore the association of ACEi/ARB and/or statins with clinical manifestations in COVID-19–infected older adults residing in nursing homes.

MATERIALS/METHODS We undertook a retrospective multicenter cohort study to analyze the association between ACEi/ARB and/or statin use with clinical outcome of COVID-19. The outcomes were (1) serious COVID-19 defined as long-stay hospital admission or death within 14 days of disease onset, and (2) asymptomatic (ie, no disease symptoms in the whole study period while still being diagnosed by polymerase chain reaction).

A total of 154 COVID-19-positive subjects were identified, residing in 1 of 2 Belgian nursing homes that experienced similar COVID-19 outbreaks.Logistic regression models were applied with age, sex, functional status, diabetes, and hypertension as covariates.

RESULTS We found a statistically significant association between statin intake and the absence of symptoms during COVID19 (odds ratio [OR] 2.91; confidence interval [CI] 1.27-6.71), which remained statistically significant after adjusting for covariates (OR 2.65; CI 1.13-6.68). Although the effects of statin intake on serious clinical outcome were in the same beneficial direction, these were not statistically significant (OR 0.75; CI 0.24-1.87). There was also no statistically significant association between ACEi/ARB and asymptomatic status (OR 2.72; CI 0.59-25.1) or serious clinical outcome (OR 0.48; CI 0.10-1.97).

CONCLUSION Our data indicate that statin intake in older, frail adults could be associated with a considerable beneficial effect on COVID-19 clinical symptoms. The role of statins and renin-angiotensin system drugs needs to be further explored in larger observational studies as well as randomized clinical trials.

ABSTRACT 2 The role of imaging techniques to define a peri-prosthetic hip and knee joint infection: multidisciplinary consensus statements.

Romanò C, Petrosillo N, Argento G, Maes A, et al.

Journal of Clinical Medicine, 2020, 9(8), 2548-2568

ABSTRACT Diagnosing a peri-prosthetic joint infection (PJI) remains challenging despite the availability of a variety of clinical signs, serum and synovial markers, imaging techniques, microbiological and histological findings. Moreover, the one and only true definition of PJI does not exist, which is reflected by the existence of at least six different definitions by independent societies. These definitions are composed of major and minor criteria for defining a PJI, but most of them do not include imaging techniques.

This paper highlights the pros and cons of available imaging techniques-X-ray, ultrasound, computed tomography (CT), Magnetic Resonance Imaging (MRI), bone scintigraphy, white blood cell scintigraphy (WBC), anti-granulocyte scintigraphy, and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), discusses the added value of hybrid camera systems-single photon emission tomography/computed tomography (SPECT/CT), PET/ CT and PET/MRI and reports consensus answers on important clinical questions that were discussed during the Third European Congress on Inflammation/Infection Imaging in Rome, December 2019.

ABSTRACT 3 Characterization of FDG PET images using texture analysis in tumors of the gastro-intestinal tract: a review.

Deleu A, Sathekge M, Maes A, Van de Wiele C, et al.

Biomedicines, 2020, 8(9), 304

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ABSTRACT Radiomics or textural feature extraction obtained from positron emission tomography (PET) images through complex mathematical models of the spatial relationship between multiple image voxels is currently emerging as a new tool for assessing intra-tumoral heterogeneity in medical imaging. In this paper, available literature on texture analysis using FDG PET imaging in patients suffering from tumors of the gastro-intestinal tract is reviewed.

While texture analysis of FDG PET images appears clinically promising, due to the lack of technical specifications, a large variability in the implemented methodology used for texture analysis and lack of statistical robustness, at present, no firm conclusions can be drawn regarding the predictive or prognostic value of FDG PET texture analysis derived indices in patients suffering from gastro- enterologic tumors. In order to move forward in this field, a harmonized image acquisition and processing protocol as well as a harmonized protocol for texture analysis of tumor volumes, allowing multi-center studies excluding statistical biases should be considered. Furthermore, the complementary and additional value of CT-imaging, as part of the PET/CT imaging technique, warrants exploration.

ABSTRACT 4 Predictors of overall and disease-free survival in metastatic castration-resistant prostate cancer patients receiving 225 Ac-PSMA-617 radioligand therapy.

Sathekge M, Bruchertseifer F, Maes A, Van de Wiele C, et al.

Journal of Nuclear Medicine, 2020, 61(1), 62-69

evaluation of toxicity. 68Ga-PSMA PET/CT was obtained at baseline, before every treatment cycle, and on follow-up for selection of patients for treatment, to determine the activity of the treatment agent to be administered, and for response assessment. Serial prostate-specific antigen (PSA) was obtained for PSA response assessment.

RESULTS Seventy-three men (mean age, 69 y; range, 45-85 y) with metastatic castration-resistant prostate carcinoma were treated with 210 cycles of 225Ac-PSMA-617. In 70% of patients, a PSA decline of greater than or equal to 50% was obtained; 82% of patients had any PSA decline. In 29% of patients, all lesions on 68Ga-PSMA PET resolved in response to treatment. During follow-up, 23 patients experienced disease progression, whereas 13 patients died from their disease. The estimated median PFS and OS were 15.2 mo (95% CI, 13.1-17.4) and 18 mo (95% CI, 16.2-19.9), respectively. In univariate analyses, factors such as baseline PSA, any PSA decline, PSA decline of greater than or equal to 50%, prior chemotherapy, prior radiation therapy, and baseline hemoglobin level were associated with longer PFS and OS (all Ps < 0.05).

In multivariate analyses, there was a negative association between prior 177Lu-PSMA therapy and PFS, and a positive association between PSA decline of greater or equal to 50% and PFS. Only a PSA decline of greater than or equal to 50% remained significantly associated with OS on multivariate analyses. Xerostomia was seen in 85% of patients but was not severe enough to warrant discontinuing treatment.

Anemia was seen in 27 patients; no patients had grade IV bone marrow toxicity. Renal failure of grade III or IV was seen in 5 patients with baseline renal impairment.

INTRODUCTION Metastatic prostate carcinoma overexpresses prostate-specific membrane antigen (PSMA), making this antigen a suitable target for radioligand therapy of the disease. Here we report on our experience with a series of 73 castration-resistant prostate carcinoma patients treated with 225Ac-PSMA-617, identifying variables predictive for overall survival (OS) and progression-free survival (PFS) after 225Ac-PSMA-617 treatment.

MATERIALS/METHODS 225Ac-PSMA-617 was administered to patients who had metastatic castration-resistant prostate carcinoma and who had exhausted available therapy options for their disease. Full blood count, glomerular filtration rate, and liver function test were obtained at baseline and on follow-up for

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CONCLUSION In this study, a PSA decline of greater than or equal to 50% after treatment with 225Ac-PSMA-617 was proven by multivariate analyses to be significantly associated with OS and PFS. Furthermore, previous 177Lu-PSMA treatment was negatively associated with PFS in both univariate and multivariate analyses.

ABSTRACT 5 Quantification of 18F-fluorodeoxyglucose uptake to detect residual nodal disease in locally advanced head and neck squamous cell carcinoma after chemoradiotherapy: results from the ECLYPS study.

In this setting, the diagnostic value of quantification is comparable to the Hopkins criteria.

ABSTRACT 6 PSMA expression on neovasculature of solid tumors.

Helsen N, Maes A, Beels L, Debruyne P, Goethals L, et al.

European Journal of Nuclear Medicine and Molecular Imaging, 2020, 47(5), 1075-1082

Van de Wiele C, Sathekge M, De Jonghe P, Debruyne P, Borms M, Beels L, Maes A, et al.

Histology and Histopathology, 2020, 35(9), 919-927

INTRODUCTION The Hopkins criteria were introduced for nodal response evaluation after therapy in head and neck cancer, but its superiority over quantification is not yet confirmed.

MATERIALS/METHODS SUVbody weight thresholds and lesion-to-background ratios were explored in a prospective multicenter study of standardized FDG-PET/CT 12 weeks after CRT in newly diagnosed locally advanced head and neck squamous cell carcinoma (LAHNSCC) patients (ECLYPS). Reference standard was histology, negative FDG-PET/CT at 12 months after treatment or ≥ 2 years of negative follow-up. Area under the receiver operator characteristics curves (AUROC) were estimated and obtained thresholds were validated in an independent cohort of HNSCC patients (n = 127).

RESULTS In ECLYPS, 124 patients were available for quantification. With a median follow-up of 20.4 months, 23 (18.5%) nodal neck recurrences were observed. A SUV70 threshold of 2.2 (AUROC = 0.89; sensitivity = 79.7%; specificity = 80.8%) was identified as optimal metric to identify nodal recurrence within 1 year after therapy. For lesion-tobackground ratios, an SUV50/SUVliver threshold of 0.96 (AUROC = 0.89; sensitivity = 79.7%; specificity = 82.8%) had the best performance. Compared with Hopkins criteria (AUROC = 0.81), SUV70 and SUV50/SUVliver provided a borderline significant (p = 0.040 and p = 0.094, respectively) improvement. Validation of thresholds yielded similar AUROC values (SUV70 = 0.93, SUV50/SUVliver = 0.95), and were comparable to the Hopkins score (AUROC = 0.91; not statistically significant).

ABSTRACT The use of prostate specific membrane antigen (PSMA) binding agents, labelled with diagnostic and therapeutic radio-isotopes is opening the potential for a new era of personalized management of prostate carcinoma. A wide variety of immunohistochemistry studies have shown PSMA also to be upregulated on the endothelial cells of the neovasculature of a wide variety of other solid tumors where it may facilitate endothelial cell sprouting and invasion through its regulation of lytic proteases that have the ability to cleave the extracellular matrix.

Similar to the introduction of PSMA-targeting theranostics in prostate carcinoma, overexpression of PSMA on newly formed tumor vessels may serve as a target for imaging and subsequent treatment of cancer through the use of agents that are capable of blocking PSMA in its function or through PSMA-mediated delivery of chemotherapeutics or radiation agents. In this review, the available data on PSMA expression on tumor neovasculature in human solid tumors assessed by using immunohistochemistry are discussed.

PRESENTATIES ABSTRACT 7 Calibration of instrumentation for dosimetry: principles and applications.

Beels L October 2020, 33rd Annual congress of the European Association of Nuclear Medicine, Online

ABSTRACT CONCLUSION FDG quantification detects nodal relapse in LAHNSCC patients. When using EARL standardized PET acquisitions and reconstruction, absolute SUV metrics (SUV70 threshold 2.2) prove robust, yet ratios (SUV50/SUVliver, threshold 0.96) may be more useful in routine clinical care.

Radionuclide therapy uses radiopharmaceuticals that target specific tumours and therefore deliver radiation to lesions as part of a therapeutic strategy to cure, mitigate or control the tumour. The radiopharmaceuticals that are suited for radionuclide therapy are those that strongly bind with the tumour and transport targeted doses of radiation

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directly to the tumour and its metastases, thereby minimizing normal healthy tissue radiation. The radionuclides best suited for therapy are those emitting ionizing radiation with short penetration into the tissue, such as α or ß emitters.

Radionuclide therapy is nowadays often given as a fixed activity instead of a patient-specific activity. Prospective, randomised trials with adequate methodology can provide the evidence that applied clinical dosimetry results in better patient outcome than is achieved with fixed activity dosing methods. Individual patient dosimetry has the following goals: • Establish individual minimum effective and maximum tolerated absorbed doses • Establish a dose-response relation to predict tumour response and normal organ toxicity on the basis of pre-therapy dosimetry • Compare the dose-response results of different radionuclide therapies or with the results obtained with external radiotherapy • Increase the knowledge of clinical radionuclide radiobiology Patient-specific treatment planning and dosimetry include the individual quantitative measurement of bio-kinetics in the patient, integration of the time-activity curves, calculation of the absorbed dose, inclusion of model-based predictions of toxicity, patient-specific prediction of the activities at which absorbed dose limits will be reached for organs at risk and determination if the tumour absorbed doses are sufficient to induce a significant therapeutic effect.

A very important step in individual patient dosimetry is quantitative imaging to obtain reliable absorbed doses.

Calibration of non-imaging and imaging instrumentation in a nuclear medicine department is a prerequisite for quantitative imaging.

ABSTRACT 8 68Ga PSMA PET/CT in het PET-centrum West-Vlaanderen: wat kunnen we leren uit 2 jaar ervaring in een secundair centrum?

Dewulf K, Lesage K, Beels L, Van Bruwaene S, et al.

February 2020, Elautprijs, Dendermonde - België

OBJECTIVE De beeldvorming van prostaatkanker kende recent een grote evolutie dankzij de komst van de 68Ga PSMA PET/ CT scan. Deze scan wordt aanbevolen door de European

60 ABSTRACTBOEK | 2020

Association of Urology (EAU) bij biochemisch recidief na een behandeling met curatieve intentie bij prostaat specifiek antigen (PSA) ≥ 0,2 ng/mL. In augustus 2017 werd in het PET-centrum West-Vlaanderen gestart met 68Ga PSMA PET/CT. Het doel van deze studie is de indicatiestelling voor 68Ga PSMA PET/CT in secundaire centra onderzoeken en nagaan welk gevolg deze beeldvorming heeft voor de behandeling van prostaatkanker.

MATERIALS/METHODS Dit is een retrospectieve, multicentrische studie van 16 refererende centra naar het PET-centrum West-Vlaanderen tussen 08/2017 en 08/2019. Een interim analyse van 157 68Ga PSMA PET/CT scans in 145 patiënten werd uitgevoerd, 5 patiënten werden ge-ëxcludeerd. 15% van de scans werden uitgevoerd in de castratieresistente setting, 75% biochemisch recidief of persisterend PSA na behandeling met curatieve intentie, 7% was primaire staging van prostaatcarcinoom, 2% biochemisch recidief na oligometastatische behandeling en 1% PSA-stijging bij watchfull waiting. Verdere analyses werden uitgevoerd op 114 68Ga PSMA PET/CT scans in 104 patiënten met biochemisch recidief of persisterende PSA na behandeling met curatieve intentie. Goedkeuring van de commissie medische ethiek is aangevraagd onder nummer AZGS2019073.

RESULTS Mediane PSA voor 68Ga PSMA PET/CT scans was 0,95 ng/ mL (range 0,03 – 21,70). 41% van de scans waren negatief, 43% toonden oligometastasen (≤3 letsels), 16% heeft ≥ 4 PSMApositieve letsels. Univariate analyse toonde een hogere kans op een positieve 68Ga PSMA scan bij hogere PSA-waarde (p<0,0001). De EAU PSA-cutoff van 0,2 ng/ml resulteert in een positief predictieve waarde (PPV) van 62% en negatieve predictieve waarde (NPW) van 80%. Voor een cutoff van 0,5 ng/ml zou PPV 69% en NPW slechts 64% bedragen.

Er was geen relatie tussen kans op positieve 68Ga PSMA scan en PSA doubling time of EAU biochemical recurrence risk group (respectievelijk p=0,46 en p=0,89). In geval van een negatieve 68Ga PSMA scan kwamen nog 44 patiënten in aanmerking voor salvage radiotherapie wat slechts werd aangeboden in 45% van de gevallen. In geval van een positieve 68Ga PSMA scan betrof dit lokaal recidief in 17%, N1 in 32%, M1a in 17%, M1b in 31% en Mc1 in 3% (patiënten met meerdere letsels werden hierbij onderverdeeld in de hoogste categorie). In oligometastastische patiënten (≤3 letsels) werd slechts 4% behandeld met androgeen deprivatie monotherapie, 72% kreeg oligometastase-gerichte

therapie (34% heelkunde, 66% radio- therapie) en in 24% werd afwachtend beleid verkozen. In 92,5% van de patiënten met oligometastase-gerichte therapie werd een PSA-respons gezien (onduidelijk welk percentage concomittant ADT kreeg). Bij polymetastatische patiënten werd ADT monotherapie opgestart in 72% van de gevallen.

CONCLUSION Dankzij 68Ga PSMA PET/CT scans kunnen recidieven van prostaatkanker vroegtijdig worden gedetecteerd. De EAU PSA-cutoff van 0,2 ng/ml lijkt adequaat gezien hoge NPW (80%) en toch aanvaardbare PPW (62%). PSA doubling time of risicogroep had geen bijkomende waarde. Patiënten riskeren hun kans op salvage radiotherapie te ontlopen na/door negatieve 68Ga PSMA scan resultaten (45%).

Oligometastase-gerichte behandeling, hoewel nog experimenteel volgens de richtlijnen, lijkt in de regio ondertussen de standaardbehandeling (72%).

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CENTRUM

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ARTIKELS

ABSTRACT 2

ABSTRACT 1

Underrepresentation of vulnerable older patients with cancer in phase II and III oncology registration trials: a case-control study.

The prognostic value of patient-reported health-related quality of life and geriatric assessment in predicting early death in 6769 older (≥ 70 years) patients with different cancer tumors.

Quinten C, Kenis C, Decoster L, Debruyne P, et al.

Journal of Geriatric Oncology, 2020, DOI: 10.1016/j. jgo.2020.03.017

Tack L, Ketelaars L, Martens E, Stellamans K, Van Eygen K, Werbrouck P, Vergauwe P, Debruyne P, et al.

Journal of Geriatric Oncology, 2020, 11(2), 320-326 Zie Inwendige ziekten/gastro-enterologie pagina 25.

OBJECTIVE

ABSTRACT 3

We aimed to determine the prognostic value of baseline Health-Related Quality Of Life (HRQOL) and geriatric assessment (GA) to predict three-month mortality in older patients with cancer undergoing treatment.

PSMA expression on neovasculature of solid tumors.

Van de Wiele C, De Jonge P, Debruyne P, Borms M, Beels L, Maes A, et al.

Histology and Histopathology, 2020, 35(9), 919-927

MATERIALS/METHODS Logistic regressions analysed HRQOL, as measured with the EORTC Global Health Status (GHS) scale, and geriatric information prognostic for early mortality controlling for oncology variables. The assessment was established with the odds ratio (OR), 95% confidence interval (CI) and level of significance set at p < 0.05. Discriminative power was evaluated with area under the curve (AUC).

Zie Nucleaire geneeskunde pagina 59.

RESULTS

Haaker L, Tryssesoone L, Renders I, Debruyne P, et al.

Urologic oncology, 2020, 38(8), DOI: 10.1016/j. urolonc.2020.04.031

In total, 6769 patients were included in the study, of whom 1259 (18.60%) died at three months. Our model showed higher odds of early death for patients with lower HRQOL (GHS, OR 0.98, 95% CI 0.98–0.99; p < 0.001), a geriatric risk profile (G8 Screening Tool, 1.94, 1.14–3.29; p = 0.014), cognitive decline (Mini Mental State Examination, 1.41, 1.15–1.72; p = 0.001), being at risk for malnutrition (Mini Nutritional Assessment–Short Form, 1.54, 1.21–1.98; p = 0.001), fatigue (Visual Analogue Scale for Fatigue, 1.45, 1.16–1.82; p = 0.012) and comorbidities (Charlson Comorbidity index, 1.23, 1.02–1.49; p = 0.033). Additionally, older age, poor ECOG PS and being male increased the odds of early death, although the magnitude differed depending on tumor site and stage, and treatment (all p < 0.05).

Predictive accuracy increased with 3.7% when including HRQOL and GA in the model.

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ABSTRACT 4 Bone metastasis is associated with poor prognosis in metastatic papillary renal cell carcinoma patients treated with first agent angiogenesis inhibitors.

OBJECTIVE Papillary renal cell carcinoma (papRCC) is a rare (10%-15%) subtype of renal cancer. Few prognostic biomarkers have been described in metastatic papRCC (m-papRCC) patients treated with vascular endothelial growth factor receptor tyrosine kinase inhibitors.

MATERIALS/METHODS A multicentric, retrospective analysis of patient records was conducted. BM were detected by computed tomography and/or bone scintigraphy. The International Metastatic RCC Database Consortium (IMDC) score was calculated at start of first agent VEGFR-TKI treatment.

CONCLUSION

RESULTS

The results suggest that, in addition to traditional clinical measures, HRQOL and GA provide additional prognostic information for early death, but the odds differ by patient and tumor characteristics.

Forty-nine patients were included. Best objective response was partial response in 20%, stable disease in 60% and early progressive disease in 20% of patients. Median PFS (mPFS) was 6.0 months and median OS (mOS) 14.0 months after start of first agent VEGFR-TKI. The IMDC score

ABSTRACTBOEK | 2020

correlated with mOS: 77.5 months in good, 17.0 months in intermediate and 8.0 months in poor risk patients (P = 0.002). Patients with BM had a poorer outcome compared to patients without BM: mPFS was 4.0 vs. 7.0 months (P = 0.006) and mOS 7.5 vs. 19.0 months (P = 0.002). On bivariate analysis, the presence of BM was independently associated with PFS (P = 0.02) and OS (P = 0.049), independent of the IMDC risk groups.

CONCLUSION In m-papRCC patients treated with first agent VEGFR-TKIs, the presence of BM is an unfavorable prognostic factor, associated with shorter PFS and OS.

ABSTRACT 8 One-stage laparoscopic parenchymal sparing liver resection for bilobar colorectal surgical.

D’Hondt M, Parmentier I, De Meyere C, Pironet Z, Vansteenkiste F, et al.

Endoscopy, 2021, Mar 8, DOI: 10.1007/ s00464-021-08366-5 Zie Abdominale chirurgie pagina 7.

ABSTRACT 9 The financial impact of SBRT for oligometastatic disease: a population-level analysis in Belgium.

ABSTRACT 5 Developing and evaluating a participatory arts programme for cancer patients and their caregivers.

Tack L, Meersman M, Vanneste H, Van Eygen K, Stellamans K, Derijcke S, Vergauwe P, Debruyne P, et al.

Acta Clinica Belgica, 2020, DOI: 10.1080/17843286.2020.1773653 Zie Inwendige ziekten/gastro-enterologie pagina 23.

ABSTRACT 6 Quality of blood samples collected at home does not affect clinical decision making for the administration of systemic cancer treatment.

Cool L, Callewaert N, Pottel H, Van Eygen K, et al.

Scandinavian Journal of Clinical and Laboratory Investigation, 2020, 80(3), 215-221 Zie Klinisch laboratorium pagina 27.

ABSTRACT 7 Quantification of 18F-fluorodeoxyglucose uptake to detect residual nodal disease in locally advanced head and neck squamous cell carcinoma after chemoradiotherapy: results from the ECLYPS study.

Helsen N, Maes A, Beels L, Debruyne P, Goethals L, et al.

European Journal of Nuclear Medicine and Molecular Imaging, 2020, 47(5), 1075-1082 Zie Nucleaire geneeskunde pagina 59.

Nevens D, Kindts I, Defourny N, et al.

Radiotherapy and Oncology, 2020, 145, 215-222

INTRODUCTION There is a steady rise in Stereotactic Body RadioTherapy (SBRT) utilization in oligometastatic disease (OMD). This may generate important financial consequences for radiotherapy budgets.The National Institute for Health and Disability Insurance of Belgium (NIHDI) initiated a coverage with evidence development (CED) project for innovative radiotherapy, including SBRT, in 2011. A cost calculation and budget estimation for SBRT in the OMD setting was carried out.

MATERIALS/METHODS Predictive growth scenarios for future uptake of SBRT for OMD in Belgium were developed using demographics and CED data. The provider cost of SBRT for OMD in Belgium was calculated using the Time-Driven Activity-Based Costing (TD-ABC) model developed by ESTRO-HERO, alimented with national data on resources, treatments and operational parameters, and compared to the new reimbursement.

Combining these, the future financial impact of this novel treatment indication for healthcare providers and payers in Belgium was evaluated.

RESULTS The number of 428 OMDs treated with SBRT in Belgium in 2017 is expected to increase between 484 and 2073 courses annually by 2025. A provider cost of €4360 per SBRT was calculated (range: €3488–€5654), whereas the reimbursement covers between €4139 and €4654. Large variations in potential extra provider costs by 2025 ensue from the different scenarios, ranging between €1,765,993

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and €9,038,754.Provider costs and reimbursement show good agreement.

local control, toxicity and quality-of-life should be reported; uncommon endpoints as deferral of systemic therapy and cost were endorsed.

CONCLUSION Although the financial impact of SBRT for OMD in Belgium is forecasted to remain acceptable, even in extreme scenarios, further clinical trials and real-life clinical and financial monitoring with prospective data gathering are necessary to refine the data.

ABSTRACT 10 Defining oligometastatic disease from a radiation oncology perspective: an ESTRO-ASTRO consensus document.

Lievens Y, Guckenberger M, Gomez D, Kindts I, et al.

Radiotherapy Oncology, 2020, 148, 157-166

INTRODUCTION Recognizing the rapidly increasing interest and evidence in using metastasis-directed radiotherapy (MDRT) for oligometastatic disease (OMD), ESTRO and ASTRO convened a committee to establish consensus regarding definitions of OMD and define gaps in current evidence.

CONCLUSION While significant heterogeneity exists in the current OMD definitions in the literature, consensus was reached on multiple key questions. Based on available data, OMD can to date be defined as 1-5 metastatic lesions, a controlled primary tumor being optional, but where all metastatic sites must be safely treatable. Consistent definitions and reporting are warranted and encouraged in ongoing trials and reports generating further evidence to optimize patient benefits.

ABSTRACT 11 Quality of life after breast-conserving therapy and adjuvant radiotherapy for non-low-risk ductal carcinoma in situ (BIG 3-07/TROG 07.01): 2-year results of a randomised, controlled, phase 3 trial.

King M, Link E, Whelan T, Stellamans K, et al.

Lancet Oncology, 2020, 21(5), 685-698

MATERIALS/METHODS

INTRODUCTION

A systematic literature review focused on curative intent MDRT was performed in Medline, Embase and Cochrane.

Subsequent consensus opinion, using a Delphi process, highlighted the current state of evidence and the limitations in the available literature.

BIG 3-07/TROG 07.01 is an international, multicentre, randomised, controlled, phase 3 trial evaluating tumour bed boost and hypofractionation in patients with non-lowrisk ductal carcinoma in situ following breast-conserving surgery and whole breast radiotherapy. Here, we report the effects of diagnosis and treatment on health-related quality of life (HRQOL) at 2 years.

RESULTS Available evidence regarding the use of MDRT for OMD mostly derives from retrospective, single-centre series, with significant heterogeneity in patient inclusion criteria, definition of OMD, and outcomes reported. Consensus was reached that OMD is largely independent of primary tumour, metastatic location and the presence or length of a disease-free interval, supporting both synchronous and metachronous OMD. In the absence of clinical data supporting a maximum number of metastases and organs to define OMD, and of validated molecular biomarkers, consensus supported the ability to deliver safe and clinically meaningful radiotherapy with curative intent to all metastatic sites as a minimum requirement for defining OMD in the context of radiotherapy. Systemic therapy induced OMD was identified as a distinct state of OMD. High-resolution imaging to assess and confirm OMD is crucial, including brain imaging when indicated. Minimum common endpoints such as progression-free and overall survival,

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MATERIALS/METHODS The BIG 3-07/TROG 07.01 trial is ongoing at 118 hospitals in 11 countries. Women aged 18 years or older with completely excised non-low-risk ductal carcinoma in situ were randomly assigned, by use of a minimisation algorithm, to tumour bed boost or no tumour bed boost, following conventional whole breast radiotherapy or hypofractionated whole breast radiotherapy using one of three randomisation categories. Category A was a 4-arm randomisation of tumour bed boost versus no boost following conventional whole breast radiotherapy (50 Gy in 25 fractions over 5 weeks) versus hypofractionated whole breast radiotherapy (42·5 Gy in 16 fractions over 3·5 weeks). Category B was a 2-arm randomisation between tumour bed boost versus no boost following conventional whole breast radiotherapy, and category C was a 2-arm

randomisation between tumour bed boost versus no boost following hypofractionated whole breast radiotherapy.

Stratification factors were age at diagnosis, planned endocrine therapy, and treating centre. The primary endpoint, time to local recurrence, will be reported when participants have completed 5 years of follow-up. The HRQOL statistical analysis plan prespecified eight aspects of HRQOL, assessed by four questionnaires at baseline, end of treatment, and at 6, 12, and 24 months after radiotherapy: fatigue and physical functioning (EORTC QLQ-C30); cosmetic status, breast-specific symptoms, arm and shoulder functional status (Breast Cancer Treatment Outcome Scale); body image and sexuality (Body Image Scale); and perceived risk of invasive breast cancer (Cancer Worry Scale and a study-specific question). For each of these measures, tumour bed boost was compared with no boost, and conventional whole breast radiotherapy compared with hypofractionated whole breast radiotherapy, by use of generalised estimating equation models. Analyses were by intention to treat, with Hochberg adjustment for multiple testing. This trial is registered with ClinicalTrials.gov, NCT00470236.

RESULTS Between June 1, 2007, and Aug 14, 2013, 1208 women were enrolled and randomly assigned to receive no tumour bed boost (n=605) or tumour bed boost (n=603). 396 of 1208 women were assigned to category A: conventional whole breast radiotherapy with tumour bed boost (n=100) or no boost (n=98), or to hypofractionated whole breast radiotherapy with tumour bed boost (n=98) or no boost (n=100). 447 were assigned to category B: conventional whole breast radiotherapy with tumour bed boost (n=223) or no boost (n=224). 365 were assigned to category C: hypofractionated whole breast radiotherapy with tumour bed boost (n=182) or no boost (n=183). All patients were followed up at 2 years for the HRQOL analysis. 1098 (91%) of 1208 patients received their allocated treatment, and most completed their scheduled HRQOL assessments (1147 [95%] of 1208 at baseline; 988 [87%] of 1141 at 2 years). Cosmetic status was worse with tumour bed boost than with no boost across all timepoints (difference 0·10 [95% CI 0·05-0·15], global p=0·00014, Hochberg-adjusted p=0·0016); at the end of treatment, the estimated difference between tumour bed boost and no boost was 0·13 (95% CI 0·06-0·20; p=0·00021), persisting at 24 months (0·13 [0·06-0·20]; p=0·00021).

0·03-0·13], global p=0·0033, Hochberg adjusted p=0·045); the difference between tumour bed boost and no boost at the end of treatment was 0·08 (0·01 to 0·15, p=0·021), and did not persist at 24 months (0·04 [-0·03 to 0·11], p=0·29). None of the other six prespecified aspects of HRQOL differed significantly after adjustment for multiple testing. Conventional whole breast radiotherapy was associated with worse body image than hypofractionated whole breast radiotherapy at the end of treatment (difference -1·10 [95% CI -1·79 to -0·42], p=0·0016). No significant differences were reported in the other PROs between conventional whole breast radiotherapy compared with hypofractionated whole breast radiotherapy.

CONCLUSION Tumour bed boost was associated with persistent adverse effects on cosmetic status and arm and shoulder functional status, which might inform shared decision making while local recurrence analysis is pending.

ABSTRACT 12 PEACE V – Salvage Treatment of OligoRecurrent nodal prostate cancer Metastases (STORM): a study protocol for a randomized controlled phase II trial.

De Bruycker A, Spiessens A, Dirix P, Liefhooghe N, et al.

BMC Cancer, 2020, 20(1), 406

INTRODUCTION Pelvic nodal recurrences are being increasingly diagnosed with the introduction of new molecular imaging techniques, like choline and PSMA PET-CT, in the restaging of recurrent prostate cancer (PCa). At this moment, there are no specific treatment recommendations for patients with limited nodal recurrences and different locoregional treatment approaches are currently being used, mostly by means of metastasis-directed therapies (MDT): salvage lymph node dissection (sLND) or stereotactic body radiotherapy (SBRT).

Since the majority of patients treated with MDT relapse within 2 years in adjacent lymph node regions, with an estimated median time to progression of 12-18 months, combining MDT with whole pelvic radiotherapy (WPRT) may improve oncological outcomes in these patients. The aim of this prospective multicentre randomized controlled phase II trial is to assess the impact of the addition of WPRT to MDT and short-term androgen deprivation therapy (ADT) on metastasis-free survival (MFS) in the setting of oligorecurrent pelvic nodal recurrence.

Arm and shoulder function was also adversely affected by tumour bed boost across all timepoints (0·08 [95% CI

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MATERIALS/METHODS

ABSTRACT 14

Patients diagnosed with PET-detected pelvic nodal oligorecurrence (≤5 nodes) following radical local treatment for PCa, will be randomized in a 1:1 ratio between arm A: MDT and 6 months of ADT, or arm B: WPRT added to MDT and 6 months of ADT. Patients will be stratified by type of PET-tracer (choline, FACBC or PSMA) and by type of MDT (sLND or SBRT). The primary endpoint is MFS and the secondary endpoints include clinical and biochemical progression-free survival (PFS), prostate cancer specific survival, quality of life (QoL), toxicity and time to castration-resistant prostate cancer (CRPC) and to palliative ADT. Estimated study completion: December 31, 2023.

Quality of blood samples collected at home does not affect clinical decision making for the administration of systemic cancer treatment.

CONCLUSION This is the first prospective multicentre randomized phase II trial assessing the potential of combined WPRT and MDT as compared to MDT alone on MFS for patients with nodal oligorecurrent PCa.

ABSTRACT 13 Phase II open-label study investigating apalutamide in patients with biochemical progression after radical prostatectomy.

Dirix P, Strijbos M, Van den Mooter T, Liefhooghe N, et al.

Future Oncology, 2020, DOI: 10.2217/fon-2020-0056

ABSTRACT Apalutamide, a competent inhibitor of the androgen receptor, has shown promising clinical efficacy results for patients with advanced prostate cancer. Here, we describe the rationale and design for the SAVE trial, a multi-center, Phase II study, wherein 202 men with biochemical progression after radical prostatectomy are randomly assigned 1:1 to apalutamide plus salvage radiotherapy (SRT) or androgen-deprivation therapy with an luteinizing hormone-releasing hormone agonist or antagonist plus SRT. The primary objective is to compare sexual function between the two treatment arms based on the expanded prostate cancer index-26 sexual domain score at nine months after start of hormonal treatment. The key secondary objectives are to assess quality of life, to evaluate the safety profile and the short-term efficacy of apalutamide in combination with SRT.

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Cool L, Callewaert N, Pottel H, Van Eygen K, et al.

Scandinavian Journal of Clinical and Laboratory Investigation, 2020, 80(3), 215-221 Zie Klinisch laboratorium pagina 27.

CENTRUM

ORTHOPEDIE ARTIKELS ABSTRACT 1 Bunionette- is there a minimally invasive solution?

Michels F, Guillo S Foot Ankle Clinics of North America, 2020, 25(3), 425-439

ABSTRACT A bunionette deformity, is a painful prominence on the lateral aspect of the fifth metatarsal head. Surgical treatment can be considered if conservative treatment has failed to relieve the symptoms. The percutaneous approach consists of 2 steps: a condylectomy and an osteotomy of the fifth metatarsal. The clinical and radiographic results are similar to conventional open procedures.

The learning curve is small and the final results are similar to the open techniques. The main advantages is are the hardware free technique and the minimally invasive approach.

This percutaneous approach avoids complications related to hardware and soft tissue healing. Due to this low complication rate the percutaneous technique may become the new gold standard.

MATERIALS/METHODS A survey was sent to 50 orthopedic surgeons with specific experience in percutaneous techniques. The questions were related to different aspects of the surgical bunionette procedure and the perioperative protocol.

RESULTS A response rate of 92.0 % was obtained. Several points of agreement were found. A condylectomy is rarely used while an osteotomy is performed in almost all procedures. This osteotomy is single (95.7%), complete (66.2-72.7%) and performed with a Shannon long burr (73.9%). The location of the osteotomy depends of the deformity (63.0%).

CONCLUSION This study demonstrates some consensus in the use of the surgical technique and the peri operative protocol. The percutaneous oblique osteotomy is the preferred technique while a condylectomy is only rarely used.

ABSTRACT 3 Does subtalar instability really exist? A systematic review.

Michels F, Clockaerts S, Van Der Bauwhede J, et al.

Foot and Ankle Surgery, 2020, 26(2), 119-127

ABSTRACT 2 Consensus in percutaneous bunionette correction.

Michels F, Demeulenaere B, Cordier G Orthopedics Traumatoly Surgery Research, 2020, DOI: 10.1016/j.otsr.2020.03.029

INTRODUCTION Subtalar joint instability (STI) is considered as a potential source of chronic lateral hindfoot instability. However, clinical diagnosis of STI is still challenging.

OBJECTIVE INTRODUCTION The percutaneous treatment of bunionette deformity has been demonstrated as a reliable and satisfying technique with low risk of complications. However, there are some obvious variations in the surgical technique and perioperative protocol.

OBJECTIVE The purpose of this study is to analyze the currently used techniques and to look for some agreements.

HYPOTHESIS There are some points of agreement in surgical technique and perioperative protocol when using a percutaneous technique to treat bunionette deformity.

This systematic review was conducted to assess the consistency of the clinical entity "subtalar instability", to investigate the reliability of available diagnostic tools and to provide a critical overview of related studies.

MATERIALS/METHODS A systematic review of the Medline, Web of Sciences and EMBASE databases was performed for studies reporting on tests to investigate subtalar instability or lesions of the subtalar ligaments. To investigate the relation with chronic STI, studies focusing on sinus tarsi syndrome (STS) or acute lesions of the subtalar ligaments were also included in the search strategy and were assessed separately.

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RESULTS

ABSTRACT 7

This review identified 25 studies focusing on different topics: chronic STI (16), acute lesions of the subtalar ligaments (5) and STS (4). Twelve studies, assessing STI, demonstrated the existence of a subgroup with instability complaints related to abnormal increased subtalar motion (7) or abnormalities of the subtalar ligaments (6). We found insufficient evidence for measuring subtalar tilting using stress radiographs. MRI was able to assess abnormalities of the ligaments and stress-MRI detected abnormally increased motion.

Pearls in MIS hammertoe surgery.

CONCLUSION Complaints of instability can be related to subtalar ligaments injuries and an abnormally increased motion of the subtalar joint. Stress radiographs should be interpreted with caution and should not have the status of a reference test. Clinical diagnosis should rely on several parameters including MRI.

ABSTRACT 4 An oblique fibular tunnel is recommended when reconstructing the ATFL and CFL. Michels F, Matrical, G, Vanrietvelde F, Stockmans F, et al.

Knee Surgery, Sports Traumatology, Arthroscopy, 2020, 28(1), 124-131 Zie Medische beeldvorming pagina 43.

PRESENTATIES ABSTRACT 5 Ankle instability: surgical decisions – indications, technique, subtalar and Chopart instability.

Michels F November 2020, Hindfoot instability meeting Belgian Foot and Ankle Society, National webinar

ABSTRACT 6 Complications in MIS hammertoe surgery.

Michels F October 2020, Minimally Invasive Surgery Virtual Course American Orthopaedic Foot and Ankle Society, USA, Online

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Michels F October 2020, Minimally Invasive Surgery Virtual Course American Orthopaedic Foot and Ankle Society, USA, Online

ABSTRACT 8 MIS postoperative care.

Michels F May 2020, 10th GRECMIP MIFAS Webinar “MIS: postoperative care and complications”, Online .

CENTRUM

PSYCHIATRIE ARTIKELS

ABSTRACT 4

ABSTRACT 1

The engagement of psychiatrists in the assessment of euthanasia requests from psychiatric patients in Belgium: a survey study.

Een delirium of een acute psychose na een cerebrovasculair accident rechts frontaal: een belangrijke differentiaaldiagnose.

Casselman L, Titeca K, Geerts P Tijdschrift voor Geneeskunde, 2020, 76(7), 339-344

Verhofstadt M, Audenaert K, Van den Broeck K, Titeca K, et al.

BMC Psychiatry, 2020, 20, article 400, DOI: 10.1186/ s12888-020-02792-w

ABSTRACT

INTRODUCTION

Dit abstract beschrijft de casus van een 84-jarige dame die een psychose ontwikkelt na een cerebrovasculair accident (CVA). Een goede observatie en een correcte klinische beschrijving op basis van diagnostische criteria en gestandaardiseerde meetinstrument.

Since its legalisation in 2002, the number of times euthanasia has been carried out in response to requests from adults with psychiatric conditions (APC) has continued to increase. However, little is known about why and how psychiatrists become engaged in the assessment of such euthanasia requests.

ABSTRACT 2

MATERIALS/METHODS

Electroconvulsive therapy in a patient with multiple cerebral cavernous malformations.

A cross-sectional survey study was conducted between November 2018 and April 2019 of 499 psychiatrists affiliated with the Flemish Psychiatry Association. Chi square/ Fisher’s exact tests were performed to examine if, and to what extent, psychiatrists’ backgrounds relate to their concrete experiences. The answers to the open question regarding motives for (non-) engagement were thematically coded.

Boonen I, Titeca K, Geerts P The Journal of ECT, 2020, 36(3), DOI: 10.1097/ YCT.0000000000000654 Er is geen abstract beschikbaar

RESULTS ABSTRACT 3 Phenibut: harmless dietary supplement or dangerous drug?

Evenepoel J, Titeca K Tijdschrift voor Psychiatrie, 2020, 62(2), 157-160

ABSTRACT In clinical practice, more and more alarming signals are picked up concerning addiction and withdrawal after the use of Phenibut. Phenibut is a psychotropic agent that acts on gaba receptors. Phenibut is freely available online as a dietary supplement, but appears to have potent and potentially harmful psychotropic effects. We describe the case of a 19-year-old man with social anxiety who self-medicated by using Phenibut, which he subsequently got addicted to.

We outline the dangers linked to the use of Phenibut and offer suggestions for treatment.

Two hundred one psychiatrists participated, a response rate of 40%. During their careers, 80% of those responding have been confronted with at least one euthanasia request from an APC patient and 73% have become involved in the assessment procedure. Their engagement was limited to the roles of: referring physician (in 44% of the psychiatrists), attending physician (30%), legally required ‘advising physician’ (22%), and physician participating in the actual administration of the lethal drugs (5%). Within the most recent 12 months of practice, 61% of the respondents have been actively engaged in a euthanasia assessment procedure and 9% have refused at least once to be actively engaged due to their own conscientious objections and/or the complexity of the assessment. The main motive for psychiatrists to engage in euthanasia is the patient’s fundamental right in Belgian law to ask for euthanasia and the psychiatrist’s duty to respect that. The perception that they were sufficiently competent to engage in a euthanasia procedure was greater in psychiatrists who have already had concrete experience in the procedure.

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CONCLUSION Although the majority of psychiatrists have been confronted with euthanasia requests from their APC patients, their engagement is often limited to referring the request to a colleague physician for further assessment. More research is needed to identify the determinants of a psychiatrist’s engagement in euthanasia for their APC patients and to discover the consequences of their non-, or their restricted or full engagement, on both the psychotherapeutic relationship and the course of the euthanasia request.

ABSTRACT 5 Belgian psychiatrists’ attitudes towards, and readiness to engage in, euthanasia assessment procedures with adults with psychiatric conditions: a survey.

Verhofstadt M, Audenaert K, Van den Broeck K, Titeca K, et al.

BMC Psychiatry, 2020, 20, article 374

INTRODUCTION Although the Belgian assessment pathway for legal euthanasia requires the engagement of at least one psychiatrist, little is known about psychiatrists’ attitudes towards euthanasia for adults with psychiatric conditions (APC).

This study aims to gauge psychiatrists’ attitudes towards and readiness to engage in euthanasiaassessment and/or performance procedures in APC.

MATERIALS/METHODS This cross-sectional survey study was performed between November 2018 and April 2019. The survey was sent to a sample of 499 eligible psychiatrists affiliated to the Flemish Association for Psychiatry, a professional association that aims to unite and represent all psychiatrists working in Flanders, the Dutch-speaking, northern part of Belgium. The Association’s members comprise an estimated 80–90% of all psychiatrists active in Flanders. Only psychiatrists working with APC (83% of the association’s total membership) were included. Factorial Anova and Chi Square tests were performed to examine if and to what extent psychiatrists’ backgrounds were associated with, respectively, their attitudes and their readiness to play a role in euthanasia procedures concerning APC.

RESULTS One hundred eighty-four psychiatrists completed the questionnaire (response rate 40.2%); 74.5% agree that euthanasia should remain permissible for APC. However, 68.9% question some of the approaches taken by other physicians

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during the euthanasia assessment and only half consider euthanasia assessment procedures compatible with the psychiatric care relationship. Where active engagement is concerned, an informal referral (68%) or preliminary advisory role (43.8%) is preferred to a formal role as a legally required advising physician (30.3%), let alone as performing physician (< 10%).

CONCLUSION Although three quarters agree with maintaining the legal option of euthanasia for APC, their readiness to take a formal role in euthanasia procedures appears to be limited. More insight is required into the barriers preventing engagement and what psychiatrists need, be it education or clarification of the legal requirements, to ensure that patients can have their euthanasia requests assessed adequately.

CENTRUM

UROLOGIE ARTIKELS

ABSTRACT 2

ABSTRACT 1

Rates and predictors of perioperative complications in cytoreductive nephrectomy: analysis of the registry for metastatic renal cell carcinoma.

Office-based approach to urinary tract infections in 50 000 patients: results from the REWIND study.

Cai T, Palagin I, Brunelli R, Van Bruwaene S, et al.

International Journal of Antimicrobial Agents, 2020, 56(1), DOI: 10.1016/j.ijantimicag.2020.105966

OBJECTIVE The REWIND study sought to describe the real-world clinical and prescribing practices for the management of urinary tract infection (UTI) in Italy, Belgium, Russia and Brazil in order to compare current practices with international, European and national guidelines.

Roussel E, Campi R, Larcher A, Van Bruwaene S, et al.

European urology oncology, 2020, 3(4), 523-529

INTRODUCTION Cytoreductive nephrectomy (CN) plays an important role in the treatment of a subgroup of metastatic renal cell carcinoma (mRCC) patients.

OBJECTIVE

MATERIALS/METHODS

We aimed to evaluate morbidity associated with this procedure and identify potential predictors thereof to aid patient selection for this procedure and potentially improve patient outcomes.

An integrated mixed-methods approach was adopted that used information from primary care electronic medical records in longitudinal patient databases available in Italy and Belgium, and surveys of physicians in Russia (general practitioners) and Brazil (gynaecologists).

Data from 736 mRCC patients undergoing CN at 14 institutions were retrospectively recorded in the Registry for Metastatic RCC (REMARCC).

RESULTS In total, 49 548 female patients were included in the study.

Antibiotics were the most common management option for UTI in Italy (71.1%, n = 27 600), Belgium (92.4%, n = 7703), Russia (81.9%, n = 1231) and Brazil (82.4%, n = 740).

Fosfomycin trometamol was the first-choice antibiotic for the treatment of UTI in all countries. Ciprofloxacin was also commonly prescribed in Italy (24.6%, n = 6796), Belgium (17.8%, n = 1373), Russia (14.9%, n = 184) and Brazil (9.6%, n = 71), while prescription of nitrofurantoin was common in Belgium (24.5%, n = 1890) alone.

CONCLUSION Despite differences in study designs and data sources, fosfomycin trometamol was found to be the most commonly prescribed treatment for UTI in all participating countries. In Belgium, real- world prescribing practices for UTI adhered more closely to European guidelines than national guidelines. Although not recommended in international and European guidelines for lower UTI management, the use of fluoroquinolones was still widespread.

MATERIALS/METHODS

Outcome measurements and statistical analysis: Logistic regression analysis was used to identify predictors for intraoperative, any-grade (AGCs), low-grade, and high-grade (HGCs) postoperative complications (according to the Clavien-Dindo classification) as well as 30-d readmission rates.

RESULTS Intraoperative complications were observed in 69 patients (10.9%). Thrombectomy (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.08-1.75, p = 0.009) and adjacent organ removal (OR 2.7, 95% CI 1.38-5.30) were significant predictors of intraoperative complications at multivariable analysis. Two hundred seventeen patients (29.5%) encountered AGCs, while 45 (6.1%) encountered an HGC, of whom 10 (1.4%) died. Twenty-four (3.3%) patients had multiple postoperative complications. Estimated blood loss (EBL; OR 1.49, 95% CI 1.08-2.05, p = 0.01) was a significant predictor of AGCs at multivariable analysis. CN case load (OR 0.13, 95% CI 0.03-0.59, p = 0.009) and EBL (OR 2.93, 95% CI 1.20-7.15, p = 0.02) were significant predictors solely for HGCs at multivariable analysis. Forty-one patients (11.5%) were readmitted within 30 d of surgery. No significant predictors were identified. Results were confirmed in a subanalysis focusing solely on patients treated in the contemporary targeted therapy era.

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CONCLUSION Morbidity associated with CN is not negligible. Predictors of high-grade postoperative morbidity are predominantly indicators of complex surgery. EBL is a strong predictor of postoperative complications. CN case load correlates with lower high-grade morbidity and highlights the benefit of centralization of complex surgery. However, risks and benefits should be balanced when considering CN in mRCC patients.

PATIENT SUMMARY We studied patients with metastatic renal cancer to evaluate the outcomes associated with the surgical removal of the primary kidney tumor. We found that this procedure is often complex and adverse events are not uncommon.

High intraoperative blood loss and a small number of cases performed at the treating center are associated with a higher rate of postoperative complications.

ABSTRACT 3 Surgical safety.

Van Bruwaene S World Journal of Urology, 2020, 38, 1349–1350

ABSTRACT I am writing this editorial in the heat of the COVID-19 crisis.

A huge challenge in dealing with this pandemic is the lack of knowledge about the treatment, risk factors, preventive measures, economic impact of such measures, etc. due to the speed at which it hit us. The current topic issue about surgical safety is the exact opposite of that situation.

About 200 years ago, abdominal procedures were almost uniformly fatal due to infection and surgeons chose speed over precision to limit the horrible screaming of their unanesthetized patients. Thousands of scientific breakthroughs later we have perfected the craft and scrutinized every little detail of it. But, we must continue to be vigilant. In 2004, the World Health Organization (WHO) still counted 7 million surgical patients worldwide who suffered significant (often avoidable) complications with 1 million of them dying during or immediately following surgery. What efforts are possible in everyday practice to get those numbers as low as possible?

Each surgery starts with selecting the right patient and balancing risks versus benefits. The safest form of surgery is sometimes not performing surgery at all—primum non nocere. The patient, family, anesthetist and surgeon need to be on the same page with all parties properly informed,

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prepared and consented. Many other stakeholders have their own specific responsibility in that pre-surgical space like hospitals, medical device companies, governments through reimbursement criteria, etc.

Within the confines of the operating theatre, it is mainly focus, teamwork and skill that improve outcomes. The efficiency of the WHO checklist is purported to result from behavioral change in the operating theatre, creating an atmosphere of effective communication and a culture of safety, just as much as from actually ticking the boxes.

The anesthetist, our indispensable ally on the other side of the blood–brain barrier, can make or break the surgery by appropriate fluid and pharmacological management.

Trained nurses who master the magical skill of reading a surgeons’ mind can make that life-saving difference.

And then, whether we like it or not, the surgeon obviously plays a lead role in the success of any procedure. The years of see one, do one, teach one have long gone. Surgical training has improved, learning curves are calculated and proficiency criteria are defined. But training does not stop after residency. High-volume centers are showing better outcomes, experienced surgeons show better results.

Even 200 years ago, specialization was a leading force in improvement of quality. Subspecialization or centralization might be the modern extension to this.

Last but not least, the evolution of the world into digitalization, big data, artificial intelligence, etc. takes surgical safety to another level. Keeping track of complications, patient-reported outcomes and success rates is at the verge of being common practice. Trustworthy feedback on performance drives intrinsic motivation for improvement.

Furthermore, an unprecedented amount of surgical knowledge is at the surgeons’ fingertips thanks to the internet, social media, online courses, etc.

In summary, surgeons around the world have been motivated and creative at successfully improving their craft.

When we finally beat COVID-19, with similar determination, there is definitely more growth ahead.

Development and external validation of a multiparametric Magnetic Resonance Imaging and international society of urological pathology based add-on prediction tool to identify prostate cancer candidates for pelvic lymph node dissection.

ABSTRACT 4

ABSTRACT 5

Development and external validation of a multiparametric Magnetic Resonance Imaging and international society of urological pathology based add-on prediction tool to identify prostate cancer candidates for pelvic lymph node dissection.

Treatment of high-grade non-muscle-invasive bladder carcinoma by standard number and dose of BCG instillations versus reduced number and standard dose of BCG instillations: results of the European Association of Urology Research Foundation Randomised Phase III clinical trial “NIMBUS”.

Everaerts W, Isebaert S, Van Bruwaene S, et al.

Journal of Urology, 2020, 203(4), 713-718

OBJECTIVE We sought to expand current prediction tools for lymph node invasion in patients with prostate cancer using current state-of-the-art available tumor information, including multiparametric magnetic resonance imaging based tumor stage and detailed biopsy information.

Grimm M, van der Heijden A, Colombel M, Van Bruwaene S, et al.

European Urology, 2020, 78(5), 690-698

INTRODUCTION Intravesical instillation of bacillus Calmette-Guérin (BCG) is an accepted strategy to prevent recurrence of non– muscle-invasive bladder cancer (NMIBC) but associated with significant toxicity.

MATERIALS/METHODS We selected patients with prostate cancer for study who had available registered information on ISUP (International Society of Urological Pathology) based biopsy grading and multiparametric magnetic resonance imaging, and who had undergone radical prostatectomy with extended pelvic lymph node dissection. We developed a lymph node invasion prediction tool in 420 patients and externally validated it in 187. A concordance index was estimated to quantify the discriminative performance of the model.

RESULTS In the development cohort a median of 21 lymph nodes were removed per patient and 71 patients (16.9%) were diagnosed with lymph node invasion. Statistically significant predictors of lymph node invasion were the initial prostate specific antigen value, multiparametric magnetic resonance imaging based T stage, maximum tumor length in 1 core in mm and ISUP grade group corresponding to the maximum tumor involvement in 1 core. The predictive accuracy of this lymph node invasion prediction tool was 79.7% after fivefold internal cross validation and 72.5% after external validation.

CONCLUSION We report a contemporary, externally validated prediction tool for lymph node invasion in patients with prostate cancer. This prediction tool is a response to the paradigm shift from systematic to targeted biopsies by incorporating additional core specific biopsy information instead of the percent of positive cores. This new tool will also overcome stage migration, which is a potential risk when multiparametric magnetic resonance imaging information is used in digital rectal examination based nomograms.

OBJECTIVE NIMBUS assessed whether a reduced number of standard-dose BCG instillations are noninferior to the standard number and dose in patients with high-grade NMIBC.

MATERIALS/METHODS A total of 345 patients from 51 sites were randomised between December 2013 and July 2019. We report results after a data review and safety analysis by the Independent Data Monitoring Committee based on the cut-off date of July 1, 2019.

The standard BCG schedule was 6 wk of induction followed by 3 wk of maintenance at 3, 6, and 12 mo (15 instillations).

The reduced frequency BCG schedule was induction at wks 1, 2, and 6 followed by 2 wk (wks 1 and 3) of maintenance at 3, 6, and 12 mo (nine instillations). The primary endpoint was time to first recurrence. Secondary endpoints included progression to ≥ T2 and toxicity.

RESULTS In total, 170 patients were randomised to reduced frequency and 175 to standard BCG. Prognostic factors at initial resection were as follows: Ta/T1: 46/54%; primary/recurrent: 92/8%; single/multiple: 57/43%; and concomitant carcinoma in situ: 27%. After 12 mo of median follow-up, the intention-to-treat analysis showed a safety-relevant difference in recurrences between treatment arms: 46/170 (reduced frequency) versus 21/175 patients (standard).

Additional safety analyses showed a hazard ratio of 0.40 with the upper part of the one-sided 97.5% confidence interval of 0.68, meeting a predefined stopping criterion for inferiority.

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CONCLUSION The reduced frequency schedule was inferior to the standard schedule regarding the time to first recurrence. Further recruitment of patients was stopped immediately to avoid harm in the reduced frequency BCG arm.

threshold exceeds €10,000 (Figure 1). The ICER is most sensitive to the utilities in the different health states and the first month MDT cost. At a WTP threshold of €40,000 per QALY, the first month MDT and SBRT costs should not exceed €8,136 and €7,435, respectively, to be cost-effective compared to surveillance.

ABSTRACT 6

CONCLUSION

A trial-based cost-utility analysis of metastasis-directed therapy for oligorecurrent prostate cancer.

The Markov-model suggests that MDT for oligorecurrent PCa is potentially cost-effective in comparison with surveillance and delayed ADT, and in comparison, with immediate ADT. However, larger phase III trials are needed to confirm the efficacy of MDT.

De Bleser E, Willems R, Decaestecker K, Billiet I, et al.

Cancers, 2020, 12(1), 132

INTRODUCTION The optimal management of patients with oligorecurrent prostate cancer (PCa) is unknown. There is growing interest in metastasis-directed therapy (MDT) for this population.

ABSTRACT 7 Quality control indicators for transurethral resections of bladder tumors: benchmarking centers in a Belgian multi-center prospective registry.

OBJECTIVE The objective was to assess cost-utility from a healthcare payer’s perspective of MDT and delayed androgen deprivation therapy (ADT) in comparison with surveillance and delayed ADT, and with immediate ADT.

Muilwijk T, Akand M, Raskin Y, Van Bruwaene S, et al.

European Urology Open Science, 2020, 19, DOI:10.1097/ JU.0000000000000846.03

MATERIALS/METHODS

Quality control indicators (QCIs) can objectively evaluate guideline adherence and may serve as benchmark between hospitals. We assessed the performance of 3 Belgian centers on 6 QCIs in the treatment of NMIBC using a prospective transurethral resection of bladder tumor (TURBT) registry and compared clinical outcome between centers.

INTRODUCTION A Markov decision-analytic trial-based model was developed, projecting health and economic outcomes over a 5-year time horizon with one-month cycles. Clinical data were derived from the STOMP trial and literature.

Utility data were obtained from literature. MDT was either performed via stereotactic body radiotherapy (SBRT) or surgically by means of metastasectomy. Treatment costs were derived from official government documents. The main outcome was the incremental cost-effectiveness ratio (ICER) that assessed value for money of MDT versus surveillance with delayed ADT and of MDT versus immediate ADT. A willingness-to-pay (WTP) threshold of €40,000 per quality adjusted life year (QALY) was used. Probabilistic and one-way sensitivity analysis were performed to capture the uncertainty related to key input parameters. Finally, scenario analyses were conducted to determine the impact of input parameters with different scenarios.

RESULTS The analysis showed that MDT is cost-effective compared to surveillance (ICER: €8,393/QALY) and immediate ADT (dominant strategy).The multiple cost-effectiveness acceptability curve (CEAC), based on the probabilistic analysis, showed that, of the three treatment options, MDT has the highest probability of being cost-effective if the WTP

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MATERIALS/METHODS TURBT procedures were collected using eCRFs in a prospective TURBT registry in 3 centers between 06-2013 and 03-2017. Exclusion criteria were: pT0 (except for re-TUR), pT2 before current TURBT, cN+, or cM+ disease. Outcomes of interest were recurrence-free survival (RFS), overall survival (OS), and cystectomy-free survival (CFS). 6 QCIs were assessed for their indication: complete resection status (CRS), repeat resection (re-TUR), detrusor muscle (DM) in resection specimen, single instillation of Mitomycin C (MMC), adjuvant intravesical BCG, and therapy ≤6 weeks after diagnosis.Centers were anonymized. QCIs were assessed per center and compared using X2 square test.

Kaplan-Meier plots were used for visualization of outcome and log-rank to compare between centers.

RESULTS A total of 1350 TURBTs were collected, 1165 TURBTs met inclusion criteria for a total of 907 patients. Median follow

up was 21.8 mo (IQR: 12.1-34.3). RFS, OS, and CFS at 4-yr were 63.5%, 78.9%, and 93.1% respectively. There was no significant difference in RFS and OS between centers; CFS differed significantly. There was a significant difference in the following QCIs between centers: re-TUR (p=5E-6), DM (p=1.1E-10), MMC (p=0.0001), BCG (p=4.2E-5), and timing ≤6 weeks (p=0.0001). There was no significant difference for CRS between centers (p=0.09). We found a significant difference between centers: in RFS for the subgroup QCI MMC (p=0.02); and in RFS for the subgroup QCI timing ≤6 weeks (p=0.013). A significant higher score on QCI MMC and on QCI timing ≤6 weeks correlated with a lower recurrencerate in both of these subgroups.

ABSTRACT 8 Update in prostate cancer 2019.

Van Bruwaene S, Dirix P, Van Poppel H Belgian Journal of Medical Oncology, 2020, 14(1), 13-21

ABSTRACT The prostate cancer (PCa) landscape has changed dramatically over the past few years. New paradigm-shifting data are published nearly every month. This review aims to give a brief overview of the most important publications of 2018-2019. From the ever-lasting discussion about PSA screening, with the recent publication of the CAP trial, over diagnostics where multi-parametric MRI has caused a true revolution, to hypofractionation in radiotherapy and the dramatic treatment shifts in metastatic hormone sensitive and non-metastatic castrate resistant PCa. All exciting data that will change clinical practice.

ABSTRACT 9 Making surgery safer in an increasingly digital world: the internet—friend or foe?

Van Puyvelde H, Basto M, Chung ASJ, Van Bruwaene S World Journal of Urology, 2020, 38(6), 1391-1395

MATERIALS/METHODS A MEDLINE review was performed using MeSH terms “health care” and “information technology.” Cross-referencing was used to explore the different opportunities and challenges the internet has to offer.

RESULTS As health professionals, we are fast adopting technologies at our fingertips, such as WhatsApp and video capabilities, into our clinical practice to increase productivity and improve patient care. However, the potential security breaches are significant for the health professional and health service.

Further, electronic medical records have theoretical advantages to improve patient care, reduce medication errors, and expedite referrals. The downside is a less personalized approach to patient care, as well as the potential for these systems to be even more cumbersome. In regard to the acquisition of knowledge, there is no doubt the internet is our friend. Health care professionals as well as patients have unlimited resources for learning, including podcasts videos, apps, simulators, and wearable devices. Unfortunately, this comes with a risk of misinformation and poorly referenced data with little to no regulation of content.

CONCLUSION In this increasing digital world, it is our task as health care providers to embrace these new technologies but develop guidelines and control systems to minimize the pitfalls.

ABSTRACT 10 REWIND (REal World INternational Database) study: what is the office-based approach to treating urinary tract infections?

Cai T, Van Bruwaene S, Plalagin I, et al.

European Urology Open Science, 2020, 19(2), DOI: 10.1016/j.ijantimicag.2020.105966 Er is geen abstract beschikbaar.

OBJECTIVE

ABSTRACT 11

The internet has resulted in huge efficiency gains in health care, the ability to deal with massive data accumulation and better manage patient data. However, potential and real pitfalls exist, including breeches in security of data and patient confidentiality, data storage issues, errors, and user interface issues.

Surveillance or metastasis-directed therapy for oligometastatic prostate cancer recurrence (STOMP): five-year results of a randomized phase II trial.

Ost P, Reynders D, Decaestecker K, Billiet I, et al.

Journal of Clinical Oncology, 2020, 38(6 suppl), 10

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INTRODUCTION

PRESENTATIES

Multiple randomized phase II trials suggest that metastasis-directed therapy (MDT) for oligometastatic prostate cancer (PCa) improves progression-free survival, but the majority of trials lack longer follow-up. We present the updated 5-year results from the STOMP-trial.

68Ga PSMA PET/CT in het PET-centrum West-Vlaanderen: wat kunnen we leren uit 2 jaar ervaring in een secundair centrum?

MATERIALS/METHODS In this multicentre, randomised, phase II study, asymptomatic PCa patients were eligible in case of a biochemical recurrence following primary PCa treatment with curative intent and presenting with up to 3 extracranial on choline PET-CT and a serum testosterone levels > 50 ng/ml.

Patients were randomly assigned (1:1) to either surveillance or MDT of all detected lesions. Randomisation was balanced dynamically on two factors: PSA doubling time (≤3 vs. > 3 months) and nodal vs non-nodal metastases. The primary endpoint was androgen deprivation therapy (ADT)-free survival. Castrate resistant prostate cancer-free survival (CRPC) was a secondary endpoint. Tests were performed two-sided; p values less than 0.20 were deemed significant.

ABSTRACT 12

Dewulf K, Lesage K, Beels L, Van Bruwaene S, et al.

February 2020, Elautprijs, Dendermonde - België Zie Nucleaire geneeskunde pagina 60.

ABSTRACT 13 Prospectieve data als verweer tegen uitroeiing midurethrale slings (MUS): pilootproject az groeninge Kortrijk.

Ferong K, Vossaert P, Ghesquière S, Platteeuw L, Van Bruwaene S February 2020, Elautprijs, Dendermonde - België Zie Gynaecologie pagina 21.

RESULTS The 5-year ADT-free survival was 8% for the surveillance group and 34% for the MDT group (Figure 1, hazard ratio 0.57 [80% CI: 0.38-0.84], log-rank p = 0.06). There was no significant difference in effect for the different stratification factors (interaction test). The 5-year CRPC-free survival was 53% for the surveillance group and 76% for the MDT group (hazard ratio 0.62 [80% CI: 0.35−1.09]; log−rank p = 0.27).

At a median follow for survival of 5.3 years (IQR 4.3-6.3), the 5-year overall survival was 85%, with 6 out of 14 deaths attributed to prostate cancer.

CONCLUSION The updated STOMP trial outcomes confirm the earlier reported significant difference in ADT free survival in favor of the MDT group compared to surveillance. Prostatecancer related mortality is low within the first 5 years of diagnosis of oligorecurrent prostate cancer.

ABSTRACT 14 Automatische data extractie en machine learning: een pilootproject in prostaatkanker.

Van Puyvelde H, Van Bruwaene S February 2020, Elautprijs, Dendermonde - België

INTRODUCTION In medische dossiers liggen eindeloze schatten aan informatie verborgen. Deze data zijn gegeerd voor wetenschappelijke analyses, facturatiedoeleinden, kwaliteitscontroles,…

Momenteel is de enige manier om deze informatie in gestructureerde data om te zetten, het manueel ingeven inclusief urenlang uitpluizen van medische verslagen. In tijden van machine learning, big data analysis en artificiële intelligentie biedt geautomatiseerde data-extractie nieuwe perspectieven. In dit pilootproject werd een software oplossing getest in het kader van KPI (Key Performance Indicators) voor prostaatkanker. Hierbij werd geëvalueerd of de gewenste parameters volledig en correct konden worden geëxtraheerd.

Het bedrijf BT Clinical Computing ontwikkelde een Snomed CT®-assisted Natural Language Parser (taalontleding door computer) om relevante termen uit medische dossiers te extraheren. Er werden 9 chirurgische prostaatkankerpatiënten geïncludeerd in de studie. Vooropgestelde

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parameters die automatisch dienden geëxtraheerd te worden waren initieel PSA (iPSA), finale Gleason score, gebruik radiotherapie en gebruik hormonale therapie.

Alle urologisch relevante verslagen werden geanalyseerd door de zoekmachine. In eerste instantie werden Snomed CT® termen uit de dossiers geëxtraheerd. Vervolgens werden de dossiers gescreend op outcome-gerelateerde termen die ontbraken in de Snomed- terminologie om op die manier een groot aantal gedetailleerde ruwe data te bekomen. Hierna werd duplicate en incorrecte informatie via een automatisch ETL (Extraction Transformation Load) algoritme geëlimineerd. Uiteindelijk werden op de data extra parameter-specifieke regels toegepast op basis van het studieprotocol van de medische onderzoekers. De eindresultaten, bekomen via manuele en automatische data - extractie, werden vergeleken met het dossier. Een resultaat werd geklasseerd als ‘False positive’ als dit niet overeenkwam met de juiste waarde uit het dossier en ‘True Positive’ als de juiste waarde wel gevonden werd. Voor elke variabele werd de Precisie (TP/TP+FP) berekend. Bij fouten in automatische extractie werd nagegaan of dit te wijten was aan onvoldoende ruwe data extractie uit het dossier (type 1 fout), niet selecteren van gevonden ruwe data door het ETL algoritme (type 2 fout) of incorrect behouden ruwe data die door ETL algoritme had moeten geëlimineerd worden (type 3 fout). Toestemming ethische commisie is lopende: AZGS2019088.

CONCLUSION Automatische data-extractie uit medische verslagen kan een extreme efficiëntie-winst betekenen. Voor de betrokken variabelen schommelde de accuraatheid van de automatische extractie tussen de 55-100%. Dit was het gevolg van onvoldoende extractie van relevante outcome-variabelen uit de dossiers, alsook te stricte dan wel onvoldoende eliminiatie via het ETL algoritme.

Optimalisatie en uitbreiding van de huidige resultaten lijkt met parameter-specifieke aanpassingen mogelijk.

De studie toonde ook aan dat manueel ingegeven data niet feilloos zijn. Verdere validatie op een grote dataset is noodzakelijk voor verdere oppuntstelling van de technologie.

ABSTRACT 15 Mid-urethral slings (MUS) at risk of extinction? A prospective single-center study.

Ferong K, Vossaert P, Verleyen P, Ghesquière S, Platteeuw L, Van Bruwaene S November 2020, International Continence Society, Online Zie Gynaecologie pagina 21.

Uit de medische dossiers van 9 patiënten werden in totaal 228 relevante brieven geanalyseerd. Hieruit werden 1262 relevante outcome-variabelen geëxtraheerd als ruwe data. Deze ruwe Snomed CT codes werden na ETL gereduceerd tot 279 outcome-variabelen. Hieruit werd de hoogst genoteerde PSA binnen 3 maanden na study entry gedefinieerd als iPSA. Verder werd de meest gedetailleerde (Gleason 3+4 ipv Gleason 7) en laatst genoteerde als finale Gleason score gedefinieerd. Indien radiotherapie termen werden weerhouden < 1 jaar na study entry werd dit als adjuvant en daarna als salvage gedefinieerd. Voor hormonale therapie werd gekeken of patiënt dit gekregen heeft (term gevonden ja/nee) en werd ook het zwaarst vermelde product (androgeen deprivatie > bicalutamide) weerhouden.

UROLOGIE

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AZ Groeninge is internationaal erkend door jci voor veilige zorg en kwaliteit. www.azgroeninge.be/kwaliteit

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