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Hydrolyzed egg yolk prepared composite emulsions possessed better thermal resistance, but with poorer oxidative stability as compared to natural egg yolk. In combination with chitosan it also displayed a negative effect on the oxidative stability of the emulsion system.

The research revealed the effect of chitosan addition on the physical and chemical stability of emulsions prepared with egg yolk hydrolysates. The results could provide guidance on expanding the application of egg yolk as an emulsifier in water-abundant food systems such as beverages. © 2021 Society of Chemical Industry.
The research revealed the effect of chitosan addition on the physical and chemical stability of emulsions prepared with egg yolk hydrolysates. The results could provide guidance on expanding the application of egg yolk as an emulsifier in water-abundant food systems such as beverages. © 2021 Society of Chemical Industry.
Arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis patients. A correct microsurgical vascular anastomoses is essential to the optimal care of patients. Loupes can help surgeons perform such procedures, but often cause neck or back pain and fatigue.

This study aimed to evaluate whether a video telescopic operating microscope (VITOM®; Karl Storz Endoscopy GmbH, Tuttlingen, Germany) could be used as a substitute for loupes to create microsurgical vascular anastomoses.

We evaluated microsurgical anastomoses with VITOM® in 10 patients (6 male, 4 female) from January 2019 to December 2019. The created anastomoses were 7 side-to-side, 2 side-to-end and 1 end-to-end.

A valid thrill was always present on palpation. Surgical procedures had an average time of 87.6 min, ranging from 49 to 110 min. Eight patients had AVF maturation; in the remaining 2, one had a thrombosis after 25 days and one couldn't be dialyzed due to low flow in AVF.

The VITOM® system makes it possible to carry out anastomosis in difficult cases. It is both safe and useful for the training of young surgeons.
The VITOM® system makes it possible to carry out anastomosis in difficult cases. It is both safe and useful for the training of young surgeons.
Laparoscopic rectal resection with total mesorectal excision is a technically challenging procedure, and there are limitations in conventional laparoscopy. A surgical robotic system may help to overcome some of the limitations. The aim of our study was to compare long-term oncological outcomes of robotic and laparoscopic sphincter-saving total mesorectal excision in male patients with mid-low rectal cancer.

The study was conducted as a retrospective review of a prospectively maintained database. One-hundred-three robotic and 84 laparoscopic sphincter-saving total mesorectal excisions were performed by a single surgeon between January 2011 and January 2020. Patient characteristics, perioperative recovery, postoperative complications, pathology results, and oncological outcomes were compared between the two groups.

The patients' characteristics did not differ significantly between the two groups. Median operating time was longer in the robotic than in the laparoscopic group (180 minutes versus 140 minutes, p=0.033). Macroscopic grading of the specimen in the robotic group was complete in 96 (93.20%), near complete in four (3.88%) and incomplete in three (2.91%) patients. In the laparoscopic group, grading was complete in 37 (44.04%), near complete in 40 (47.61%) and incomplete in seven (8.33%) patients (p=0.03). The median length of follow up was 48 (9-102) months in the robotic, and 75.6 (11-113) months in the laparoscopic group. Overall, five-year survival was 87% in the robotic and 85.3% in the laparoscopic groups. Local recurrence rates were 3.8% and 7.14%, respectively, in the robotic and laparoscopic groups (p<0.05).

Sphincter-saving robotic total mesorectal excision is a safe and feasible tool, which provides good mesorectal integrity and better local control in male patients with mid-low rectal cancer.
Sphincter-saving robotic total mesorectal excision is a safe and feasible tool, which provides good mesorectal integrity and better local control in male patients with mid-low rectal cancer.Androgen deprivation therapy (ADT) is a libido-inhibiting medication that may be necessary to reduce recidivism in the treatment of paraphilic disorders, especially in those with a pedophilic disorder. However, there is a significant risk to develop osteoporosis while using ADT and thereby an increased risk to develop fractures. These risks and benefits must be carefully weighed in the treatment of these patients. We describe a case in which this dilemma is further explained and clarified. We recommend to request a second opinion and a structured risk assessment. If the risk for recidivism remains increased, despite psychotherapeutic interventions, we advise to suspend further rehabilitation into society, and let the reduction of the risk of recidivism prevail over the wishes of the patient.A 61-year-old woman with suspected schizophrenia has been attending an outpatient geriatrics service for some time, initially with memory complaints and panic attacks. During treatment, the diagnosis schizophrenia was rejected and psychopharmaceuticals were largely phased out, which improved cognitive functions. Eventually, flashbacks of incest experienced in childhood remained together with REM sleep pathology. The flashbacks, nightmares and the REM sleep pathology were responsive to rivastigmine. Rivastigmine use for the treatment of REM sleep pathology is known in the literature, but it has never been described previously that rivastigmine also impacts on flashbacks and nightmares..Although the manifestation of borderline personality disorder (BPD) is situated in adolescence and young adulthood, in clinical practice the diagnosis and treatment often get delayed until adulthood. Preliminary research shows good results for structured treatments in young people with BPD. Early intervention programs for BPD show promising results in improvement of the level of functioning. This case study of a fourteen-year-old girl with BPD illustrates early intervention within the program Helping Young People Early (HYPE). This case illustrates the understanding, recognition and revision of relational patterns in emotional and relational problems. In addition, the case highlights the multidisciplinary integration of psychotherapeutic, systemic theoretical and psychosocial ingredients within a multidisciplinary early intervention program for BPD.Background The annual prevalence of mental disorders is 20% whereas the Dutch mental health care system annually can cater no more than 7%. This suggests a need for public mental health care, parallel to traditional one-on-one treatment services. Multi-expert eCommunities are a novel phenomenon that appear to meet part of the public mental health care need. Aim The current analysis is a case study of PsychoseNet.nl, a multi-expert eCommunity that was launched in 2015 and now has 1.5 million annual visitors. It presents a range of static and dynamic content in the realm of psychoeducation, recovery narratives, self-management, empowerment, building resilience, interactive platforms and online consulting. Methods We describe explorative and descriptive analyses on usage and functionality of PsychoseNet.nl, using the Google Analytics framework. Results PsychoseNet.nl was visited by more than three million users, generating more than 13 million pageviews. Users mainly originated from the Netherlands and Belgium. Popular sections of the website were online counseling, chat, forum and blogs. Conclusion eCommunities such as PsychoseNet.nl appear to fill a gap, and further research is required on health impact and the place of public mental health initiatives in the system of mental health services. An English version of the site was recently started as Psychosisnet.com. Tijdschrift voor Psychiatrie 63(2021)1, 56-63.Background Brexpiprazole has been registered in the Netherlands and Belgium for the treatment of schizophrenia since 2019. It is a third-generation antipsychotic drug with a number of pharmacological similarities to aripiprazole and cariprazine. Aim To critically evaluate the pharmacology, effectiveness and side effects of brexpiprazole in the treatment of schizophrenia using the hitherto available double-blind, placebo-controlled study. Method A clinically oriented study of the literature. Results Brexpiprazole is effective in the treatment of schizophrenia and has few extrapyramidal side effects, metabolic side effects and moderate weight gain, no QTc prolongation, no sedation, and little influence on blood prolactin levels. Limited dose titration is required when initiated on brexpiprazole. Conclusion Brexpiprazole is a treatment option for schizophrenia, with a relatively favorable side effect profile. WZB117 nmr The position of brexpiprazole within the current treatment algorithm should become clear through future research and clinical experience. Tijdschrift voor Psychiatrie 63(2021)1, 48-55.
Quantification of population-level socioeconomic-demographic factors impacting onset and course of health care consumption can help health care commissioning and public health planning.<br/> AIM To analyse associations between mental health care, medical-specialist care and general practitioner (GP) care with regional socioeconomic-demographic factors. Two cost parameters were examined (i) absolute costs; and (ii) relative costs, defined as the proportion of PC3-level costs attributable to outliers (defined as costs above the 80th percentile - as a proxy for care intensity).<br/> METHOD Analysis of Vektis data over the period 2014-2017 in the age range of 18-65 years.<br/> RESULTS Mental health care cost variation was for 28% reducible to (younger) age, urbanicity, PC3-level ethnic density and PC3-level socioeconomic-demographic factors. Variation in medical-specialist care and GP care costs were reducible principally to (older) age. Costs attributable to outliers ranged from 34% for GP care to 55% for mental health care. Socioeconomic-demographic factors explained a substantial part of the variation in the PC3-level proportion of outlier costs for mental health care (31%), medical-specialist care (43%) and GP-care (33%).<br/> CONCLUSION Analysis of the degree and pattern of socioeconomic-demographic factors impacting mental health care can inform both public mental health planning and mental health care commissioning. Tijdschrift voor psychiatrie 63(2021)1, 39-47.
CONCLUSION Analysis of the degree and pattern of socioeconomic-demographic factors impacting mental health care can inform both public mental health planning and mental health care commissioning. Tijdschrift voor psychiatrie 63(2021)1, 39-47.Background Non- compliance with drug regimens has a negative effect on symptomatology and is the largest predictor of relapse in people with Severe Psychiatric Disorder (EPA). When care providers are informed in good time that medication has not been collected and can act on it, compliance can be increased. Aim Assessment of usefulness and feasibility of a system for the Signaling and Reporting by Pharmacists of Uncollected Medication for people with an EPA (Dutch 'SMANOM-EPA') within the current legal context. Method The package of requirements was drawn up on the basis of questionnaires and telephone interviews with psychiatrists and pharmacists and focus group meetings with patients and significant others. Lawyers and ICT professionals were consulted to formulate the legal and technical preconditions. Results All parties involved considered SMANOM-EPA to be useful. The administrative burden was a determining factor for the feasibility and transparency was an important precondition. The exchange of information could take place securely with existing technology, despite the variation in prescribing and issuing systems.
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