Introduction: There are two surgical approaches to reconstruct a pressure ulcer (PU): one-stage reconstruction or two-stage reconstruction. One stage reconstruction consists of surgical debridement and flap reconstruction during one operation. Two-stage surgery consist of a surgical debridement and a final reconstruction in two different sessions, with approximately six weeks between both sessions. Objective: The aim of this study was to compare the results of single stage surgery and two-stage surgery on the PU recurrence rate and other important post operative complications. Method: A retrospective, comparative study in Spinal Cord Injured (SCI) individuals with a single- or two stage surgical reconstruction between 2005 and 2016 was designed. A total of 81 records were included for analysis. Results: The primary outcome, the difference in occurrence of a recurrent PU in the reconstructed area (33.3% versus 31.6%), is not statistically significant between one-and two-stages reconstruction. Also, the mean duration to develop a recurrent PU between both surgical reconstructions is not statistically significant. Other surgical complications in the reconstructed area like wound hematoma, hemorrhage, seroma or (partial) flap failure did not differ significantly between both groups, apart and in total. We calculated the additional costs in case of a two-stage approach compared with a single-stage reconstruction at EUR 16,362. Conclusions: There are no statistical significant differences in PU recurrence rate or other post operative complications between SCI patients who have undergone one- or two stage PU reconstructive surgery. The most obvious choice for a one-stage approach in case of PU reconstructive surgery has great positive implications for the patient, family, health care providers and the health care system.
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Many organizations have undergone substantial reorganization in the last decade. They re-engineered their business processes and exchanged proprietary, not integrated applications for more standard solutions. Integration of structured data in relational data bases has improved documentation of business transactions and increased data quality. But almost 90% of the information that organizations manage is unstructured, can not easily be integrated into a traditional database. Just like structured data, unstructured information in organizations are records, meant and used as evidence for organizational actions and transactions. Governments, courts and other stakeholders are making increasing demands for the trustworthiness of records. This is part of a long-term trend toward defining what accountability means in a digital era. An analysis of literature of information science, organization science and archival science illustrates that for accountability, reconstruction of the past is essential. Hypothesis of this paper is that for the reconstruction of the past each organization needs (at least) a combination of three mechanisms: enterprise records management, organizational memory and records auditing. Enterprise records management ensures that records meet the for accountability necessary quality requirements: integrity, authenticity, controllability and historicity. These requirements ensure records that can be trusted. Trusted records enhance the possibility of reconstructing the past. The organizational memory ensures that trusted records are preserved for as long as is necessary to comply to accountability regulations. It provides an information and communication technology infrastructure to (indefinitely) store those records and to keep them accessible. Records auditing audits enterprise records management and organizational memory to assess the possibility to reconstruct past organizational actions and transactions. These mechanisms ensure that organizations have a documented understanding of: the processing of actions and transactions within business processes; the dissemination of trusted records; the way the organization accounts for the actions and transactions within its business processes; and the reconstruction of actions and transactions from business processes over time. This understanding is important for the reconstruction of the past in digitized organizations and improve organizational accountability.
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Breast cancer is the most prevalent form of cancer that affects women worldwide, posing a significant burden on public health. While advancements in early detection and improved treatments have led to a remarkable 90% five-year survival rate and an 83% ten-year survival rate, this has also resulted in more prophylactic mastectomies being performed. Despite advancements in breast-conserving techniques, immunotherapy, and hormone therapy, many women still undergo mastectomies as part of their cancer treatment. In all cases, this results in scarring, and additional side effects from treatment modalities may arise. The loss of a breast can profoundly impact health-related quality of life (HRQoL). Although HRQoL has improved greatly during the recent years, systematic and local therapy having side effects is not uncommon, and this needs more attention.
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Structural Biology plays a crucial role in understanding the Chemistry of Life by providing detailed information about the three-dimensional structures of biological macromolecules such as proteins, DNA, RNA and complexes thereof. This knowledge allows researchers to understand how these molecules function and interact with each other, which forms the basis for a molecular understanding of disease and the development of targeted therapies. For decades, X-ray crystallography has been the dominant technique to determine these 3D structures. Only a decade ago, advances in technology and data processing resulted in a dramatic improvement of the resolution at which structures of biomolecular assemblies can be determined using another technique: cryo-electron microscopy (cryo-EM). This has been referred to as “the resolution revolution”. Since then, an ever increasing group of structural biologists are using cryo-EM. They employ a technique named Single Particle Analysis (SPA), in which thousands of individual macromolecules are imaged. These images are then computationally iteratively aligned and averaged to generate a three-dimensional reconstruction of the macromolecule. SPA works best if a very pure and concentrated macromolecule of interest can be captured in random orientations within a thin layer (10-50nm) of vitreous ice. Maastricht University has been the inventor of the machine that is found in most labs worldwide used for this: the VitroBot. We have been the inventor of succeeding technologies that allow for much better control of this process: the VitroJet. In here, we will develop a novel chemical way to expand our arsenal for preparing SPA samples of defined thickness. We will design, produce and test chemical spacers to allow for a controlled sample thickness. If successful, this will provide an easy, affordable solution for the ~1000 laboratories worldwide using SPA, and help them with their in vitro studies necessary for an improved molecular understanding of the Chemistry of Life.
