Expertise - ASTARC

Tailored management of subfertile patients will lead to an increased number of couples fulfilling their wish to have a child. Background Infertility is defined as the failure to become pregnant during a twelve months period of regular unprotected sexual intercourse. Infertility and subfertility are affecting 9% of the couples with a desire to have a child. Apart from the obvious reasons for non-conception such as a bilateral tubal block, anovulation, extremely low sperm count or absence of sperm in the ejaculate, severe endometriosis and premature ovarian insufficiency, most couples are suffering from subfertility and this is by far the majority. Subfertile couples have one or more aspects that are under the norm after fertility investigation and these are usually combined with factors such as increasing older age of the women (men), lower sexual intercourse frequency, busy jobs, more planning and lack of time. Although these patients are often categorized as having mild to moderate endometriosis, mild male subfertility or having no obvious reasons for not conceiving (unexplained or idiopathic infertility), this in itself is usually not the explanation for their involuntary childlessness. This subfertility is explained by the fact that reproduction is a matter of chance depending on the subtle balance between success and failure of complex and mostly poorly understood sequential processes that may lead to a pregnancy such as spermatogenesis, oogenesis, ovulation, sexual intercourse, transport of gametes, fertilization, embryogenesis and last but not least implantation. Besides the patient population with a clear indication for treatment all other couples (the majority) are facing subfertility rather than infertility. This poses a tremendous challenge to the treating physician to balance his or her advice between expectant management or active treatment such as intra-uterine insemination (IUI) or IVF/ICSI. The decision for one or the other depends on numerous factors whereby scientific information and patient preferences should lead to the best option for the couple. What we have been underestimating is that in our continuous strive to increase the quality of our treatment, patients may experience the biggest difficulty in “holding on” to the therapy and discontinuation or dropout from fertility treatment is underestimated. Discontinuation is to a large extent explained by the burden of the treatment, both physically as psychological. Objectives The research I want to continue focusses on both improvement of efficacy and safety but also be patient centered by taking into account patient’s preferences to keep our patients “on board”. As part of the research project “How does detection of DNA damage in sperm influence the patient’s chance of conception? “we will investigate the role of sperm DNA fragmentation as a sperm function test with the potential to discriminate and select couples with optimal chances for intra-uterine insemination. A Belgian multicenter study will be started and coordinated by myself to investigate the dropout rate and reasons for drop-out in case of the availability of cryopreserved embryos in a large Belgian ART population. We are conducting a study where we investigate whether a digital pre-conceptional lifestyle assistant in fertility treatment can be a trustworthy toolbox in assisting patients during their treatment and increasing cumulative ongoing pregnancy rates. I am the chief-investigator in an investigator- led KCE sponsored trial in 12 Belgian fertility centers to investigate whether the addition of Lipiodol during tubal patency testing (Hyfosy) will lead to a higher chance of conception which will lead to fewer patients that have to undergo more invasive fertility treatments subsequently

Technique

Measurement of sperm DNA fragmentation Male infertility accounts for nearly 20-70% of diagnoses whilst most of male factor infertility cannot be treated adequately. The current diagnosis of male infertility is based on semen criteria updated by the WHO in 2010. These guidelines would consider a man normal with reference values of greater than 15 million sperm, greater than 4% normal morphology, and 32% progressive motility. Although the WHO classification suggests accuracy through a methodology harmonized across laboratories, the relevance for the choice of treatment and the predictive value for an infertile couple embarking on medically assisted reproduction is questionable. Numerous studies utilizing different techniques for assessing sperm DNA fragmentation support the existence of a significant association between sperm DNA damage and pregnancy outcomes. Moreover, a significant number of subfertile men have abnormal DNA integrity despite normal semen parameters. The level of DNA fragmentation correlates negatively with pregnancy and delivery in both natural and assisted conceptions. We perform direct DNA fragmentation testing with terminal deoxyuridine nick end labeling (TUNEL) assay on fresh sperm samples both on the total and vital fraction, before and after density gradient . (Punjabi U, Van Mulders H, Goovaerts I, Peeters K, Clasen K,Janssens P, Zemtsova O, De Neubourg D. Sperm DNA fragmentation in the total and vital fractions before and after density gradient centrifugation: Significance in male fertility diagnosis. Clin Biochem. 2018 Dec;62:47-54. doi: 10.1016/j.clinbiochem.2018.05.011) We are now testing the hypothesis that DNA fragmentation testing can play a diagnostic and thus pivotal role in selecting the patient who will benefit from intra-uterine insemination therapy leading to a higher clinical pregnancy and live birth rate compared to the standard semen criteria.

Users

Patients Couples with childwish Researchers investigating the impact on the sperm quality. Patient organisations Government Fertility experts

Keywords

Sperm quality, Fertility, Reproduction

Simulation training for laparoscopic urology Varicoceles and pubertal development Porn induced sexual dysfuctions Transition and congenital lifelong urology

Technique

Laparoscopic simulation training: movement analysis and EMG measurements Scrotal duplex ultrasound Erectile testing Survey research uroflow @ home

Users

Centers for skills training in laparoscopic surgery sexologists

Keywords

Laparoscopic urology

Neuropathic pain syndromes result from damage or dysfunction of the somatosensory nervous system. They are very resistant to common pain-killers and patients often suffer from terrible discomfort. Trigeminal neuralgia (“tic douloureux”) is an extreme form of facial neuropathic pain. A rat model was developed where the Infraorbital nerve (IoN), which constitutes almost the entire maxillary branch of the trigeminal nerve, is loosely ligated. Following IoN surgery, rats display increased face grooming behavior directed to the territory of the injured IoN indicative of spontaneous pain. After an initial period of hyporesponsiveness, rats also become hyperresponsive to mechanical (von Frey hair) stimulation of the IoN territory. In addition to its role in tumourigenesis and angiogenesis, evidence is accumulating that ET-1 may be of critical importance in the occurrence of cancer pain. Recently, our lab has been focusing on the effects of application of ET-1 to the infraorbital nerve (IoN) of the rat and of prolonged exposure to ET-1. Video-ECoG, or the simultaneous recording of behaviour and electrocorticography in awake animals, has become a valuable tool in neurophysiological and neuropharmacological studies. In our lab, we have begun to implement the video-ECoG methodology in the IoN-CCI model in order to correlate behavioral (grooming) data with ECoG data in normal and IoN-CCI rats.

Technique

Infraorbital nerve chronic constriction rat model for the study of trigeminal neuropathic pain including analysis of spontaneous pain and mechanical allodynia. Transcranial micro-injections into the trigeminal ganglion in rats. Use of the Operant Orofacial Pain Assessment Device (OPAD) to Measure Changes in Nociceptive Behavior. Video-ECoG, or the simultaneous recording of behaviour and electrocorticography in awake animals.

Users

Research facilities at universities, biotechnical and pharmaceutical companies.

Keywords

Pain, Pain treatment, Rats, Trigeminal neuropathy

The expertise of Prof. Guy Hans is situated in the field of acute, subacute and chronic pain. His research is mostly focused on neuropathic pain conditions as wall as on the utilization of mobile health and e-health applications in nociceptive conditions.

Technique

animal pain models for acute and chronic pain, quantitative sensory testing, pharmacological research and research on e-health and m-health

Users

Pharmacological companies, patient organizations and government agencies.

Keywords

Televigilance, Pain management

Since 1995 I am involved in researchlines of the ASTARC group. This research has focussed on innovative surgical techniques for the treatment of lung metastatic disease, fundamental and clinical in a 2nd stage. With my appointment in 2020 as head of thoracic and vascular surgery, I have created a new researchgroup, together with the new head of pneumology. Research domains are congenital diseases, oncology, transplantation and end-stage lung diseases such as COPD, with ageing and remodelling as a central theme. Next to this, we have also build a strong expertise since 2002 in clinical studies regarding vascular medicine (innovative treatments and medical devices), the diabetic foot and the lymphatic system.

Technique

Felasa C animal care and experiments Expert in lung research (domain oncology, transplantation, COPD): fundamental; translational, clinical Expert in vascular research (domain arterial peripheral): clinical Expert in lymphatic system: clinical

Users

Investigators interested in animal experiments Investigators with research questions regarding lung (congenital, oncology, transplantation, COPD and ILD) Investigators with research questions regarding vessels, their diseases and treatments Investigators with research questions regarding lymphatic system

Keywords

Lung perfusion, Lung, Oncology, Transplantation, Lung cancer

anythig concerning pelvic floor pathology ,myoma, endometriosis, preeclampsia, pregnancy, prenatal ultrasound, maternal health care perinatal mental healh care pelvic organ proalps pop gynaecologic and pelvic surgery laparoscopy pelvic floor ultrasound preterm birth pprom infections in pregnancy

Technique

ultrasound US guided invasive procedures laparoscopy davinci robot surgery hysteroscopy uscom doppler internal fetal ecg external fetal ecg

Users

patients pregnant women women wanting to become pregnant gynecologists midwives any researcher

Keywords

Preeclampsia, Pelvic organ prolaps

Research on coping strategies with pathologies of the spine. The use of BMP's in spinal pathology.

Technique

Basic research and clinical studies

Users

The public. Government and colleges spinal surgeons.

Keywords

Regeneration capacity

Clinical research on the quality of resuscitation. Clinical research on the effects of implementing Rapid Response Teams in hospitals. Clinical research on the effects of triaging patiënts to emergency departments or to general practitioners cooperatives. Clinical research on emergency care for elderly in home care centres. Clinical research on screening methods in emergency departmenst to detect child abuse.

Technique

Translational research Qualitative research Randomised studies Development of guidelines Systematic reviews

Users

Policy Makers Researchers Clinicians Journalists

Keywords

Resuscitation

Topics of research : Women's Health Physiotherapy - Urogynaecology - Perinatal Physiotherapy - Musculoskeletal Disorders - 3D/4D transperineal ultrasound of the pelvic floor - clinical assessment of the pelvic floor - ICF classification of heath problems - Adherence strategies in conservative treatment - prevention - primary health care - teamwork towards secondary & tertiary subspecialized care - Extended expertise in a multidisciplinary team aiming to improve interprofessional cooperation and patient centered care. - A strong national and international network in women's health and pelvic health aiming to implement research findings in improved health care and in a diverse society. - Expertise in Health Education, aiming to raise awareness about prevention and treatment of pelvic floor disorders in women - Expertise in good science communication, also aiming to raise more awareness and to empower women in helpseaking behavior.

Technique

Clinical assesment of the pelvic floor Clinical assesment of musculosceletal health ICF classification 3D/4D transperineal ultrasound Transabdominal ultrasound assesment of the pelvic floor and abdominal wall EMG biofeedback of pelvic floor muscles postnatal women's health assesment uroflowmetry micturition and defecation functional assesment research designs: quantitative and qualitative research observational, prospective and retrospective research intervention studies systhematic reviews RCT Survey studies

Users

Women of all ages Pregnant and postnatal women All medical and paramedical health professionals/practitionners Students in medical health care (nursing and obstetrics, physiotherapy, medicine) Professional organizations (VVOG, AXXON BICAP, VBOV, etc.) Specialized, clinical small pelvis clinics patient associations KCE, WOREL EBP practice network, RISIV, health insurance funds

Keywords

Ultrasound, Women's health physiotherapy, Perinatal physiotherapy, Incontinence, Pelvic floor

Endocarditis: clinical expertise - participation in European registry New techiques in aortic and mitral valve surgery: clinical expertise minimal invasive surgery Assist devices - ECMO/ECLS: clinical expertise treatment cardiogenic shock Aortic pathology

Technique

The Cardiac Surgery Department relies predominantly on clinical expertise. We have common interest with Genetics and Cardiology through peroperative samples (aortic wall or atrial appendix) for experimental research. We are working on a pig model for organ perfusion.

Users

Coworkers, students, other researchers

Keywords

Aortapathy, Cardiac arrest, Cardiac surgery

Experimental and clinical expertise in isolated lung perfusion in vivo (only available as cooperative research project).

Technique

Isolated lung perfusion.

Users

- Industry with a special interest in drug evaluation in a model of isolated lung perfusion (toxicity, pharmacokinetics, efficiency on tumours) - Research groups with a specific interest in locoregional lung perfusion (animal and clinical model)

Keywords

Thoracic and cardiovascular surgery, Toxicity, Thoracic, Pharmacokinetics, Lung cancer, Lung metastasen, Drug efficacy