Monitoring/detectie van Pythium in tomaat

Op bedrijven worden regelmatig tomatenplanten gevonden die zonder aanwijsbare redenen slap gaan en /of vaatverbruining hebben. Verticillium, pepinomozaïekvirus en Pythium en alle combinaties van deze pathogenen lijken hierbij een rol te kunnen spelen. Daarom zijn een aantal bedrijven waar deze verschijnselen voorkwamen over een periode van drie teeltseizoenen inclusief de teeltwisselingen gemonitord. Op de bedrijven zijn in wortels van tomatenplanten Pythium diclinum Tokunga, Pythium sp. “group F (alleen filamenteuze sporangia) en Pythium aphanidermatum (Edson) Fitzpatrick gevonden. De verspreiding van Pythium op deze bedrijven was zeer grillig en het optreden van Pythium-aantasting onvoorspelbaar. Het lijkt er wel op dat de kans op Pythium-aantasting het grootst is na een periode van zeer zware plantbelasting, een periode van donker of extreem warm weer, na geven van erg koud water, een erg droog of nat teeltsubstraat en/of als latere symptomen van pepinomozaïekvirus worden waargenomen. Er wordt daarom geadviseerd op een flink aantal plaatsen vroegtijdig wortelmonsters te nemen, te laten onderzoeken op de aanwezigheid van Pythium en als Pythium is gevonden een behandeling met chemische gewasbeschermingsmiddelen uit te voeren op het moment dat aantasting kan worden verwacht. Nog beter is uiteraard om aantasting te voorkomen door het geven van erg koud water en een erg droog of nat teeltsubstraat te vermijden. Er is geen relatie tussen het watergehalte van de matten, de aanwezigheid van Pythium in de wortels en zichtbare Pythium-aantasting in de vorm van wortelrot gevonden. Alle isolaten waren gevoelig voor zowel Previcur N als AAterra , maar het meest gevoelig voor AAterra

Monitoring tomatenbedrijven op Verticillium

In de teelt van tomaat is Verticillium-aantasting op veel bedrijven een jaarlijks terugkerend probleem omdat de ziekte ondanks vergaande bedrijfshygiënische maatregelen niet volledig wordt geëlimineerd. In het afgelopen jaar zijn door GAC op bedrijven Verticillium-soorten aangetoond waarvan de isolaten morfologisch en wat betreft pathogeniteit van elkaar verschillen. Doel van de monitoring was; - Duidelijkheid te verkrijgen welke pathogene Verticillium-soorten waar op de bedrijven voorkomen opdat de juiste opsporingsmethode (detectietechniek) wordt gebruikt. - Duidelijkheid te verkrijgen waar op bedrijven de pathogene soorten voorkomen om inzicht verkrijgen in verspreiding en overdracht van Verticillium opdat monsters worden genomen op plaatsen waar de kans het grootst is de plantenziekteverwekker op te sporen. - De opsporingsmethoden die worden ontwikkeld in de praktijk op hun bruikbaarheid testen. - Duidelijkheid verkrijgen in hoeverre naast miljoenpoten, bodeminsecten een rol spelen bij verspreiding van en aantasting door Verticillium. - Bezien of aanvullingen/veranderingen nodig zijn in het hygiëneprotocol tomaat dat in 2000 is gepubliceerd

Cost-effectiveness of medically assisted reproduction or expectant management for unexplained subfertility: when to start treatment?

STUDY QUESTION Over a time period of 3 years, which order of expectant management (EM), IUI with ovarian stimulation (IUI-OS) and IVF is the most cost-effective for couples with unexplained subfertility with the female age below 38 years? SUMMARY ANSWER If a live birth is considered worth €32 000 or less, 2 years of EM followed by IVF was the most cost-effective, whereas above €32 000 this was 1 year of EM, 1 year of IUI-OS and then 1 year of IVF. WHAT IS KNOWN ALREADY IUI-OS and IVF are commonly used fertility treatments for unexplained subfertility although many couples can conceive naturally, as no identifiable barrier to conception could be found by definition. Few countries have guidelines on when to proceed with medically assisted reproduction (MAR), mostly based on the expected probability of live birth after treatment, but there is a lack of evidence to support the strategies proposed by these guidelines. The increased uptake of IUI-OS and IVF over the past decades and costs related to reimbursement of these treatments are pressing concerns to health service providers. For MAR to remain affordable, sustainable and a responsible use of public funds, guidance is needed on the cost-effectiveness of treatment strategies for unexplained subfertility, including EM. STUDY DESIGN, SIZE, DURATION We developed a decision analytic Markov model that follows couples with unexplained subfertility of which the woman is under 38 years of age for a time period of 3 years from completion of the fertility workup onwards. We divided the time axis of 3 years into three separate periods, each comprising 1 year. The model was based on contemporary evidence, most notably the dynamic prediction model for natural conception, which was combined with MAR treatment effects from a network meta-analysis on randomized controlled trials. We changed the order of options for managing unexplained subfertility for the 1 year periods to yield five different treatment policies in total: IVF-EM-EM (immediate IVF), EM-IVF-EM (delayed IVF), EM-EM-IVF (postponed IVF), IUIOS-IVF-EM (immediate IUI-OS) and EM-IUIOS-IVF (delayed IUI-OS). PARTICIPANTS/MATERIALS, SETTING, METHODS The main outcomes per policy over the 3-year period were the probability of live birth, the average treatment and delivery costs, the probability of multiple pregnancy, the incremental cost-effectiveness ratio (ICER) and finally, which policy yields the highest net benefit in which costs for a policy were deducted from the health effects, i.e. live births gained. We chose the Dutch societal perspective, but the model can be easily modified for other locations or other perspectives. The probability of live birth after EM was taken from the dynamic prediction model for natural conception and updated for Years 2 and 3. The relative effects of IUI-OS and IVF in terms of odds ratios, taken from the network meta-analysis, were applied to the probability of live birth after EM. We applied standard discounting procedures for economic analyses for Years 2 and 3. The uncertainty around effectiveness, costs and other parameters was assessed by probabilistic sensitivity analysis in which we drew values from distributions and repeated this procedure 20 000 times. In addition, we changed model assumptions to assess their influence on our results. MAIN RESULTS AND THE ROLE OF CHANCE From IVF-EM-EM to EM-IUIOS-IVF, the probability of live birth varied from approximately 54–64% and the average costs from approximately €4000 to €9000. The policies IVF-EM-EM and EM-IVF-EM were dominated by EM-EM-IVF as the latter yielded a higher cumulative probability of live birth at a lower cost. The policy IUIOS-IVF-EM was dominated by EM-IUIOS-IVF as the latter yielded a higher cumulative probability of live birth at a lower cost. After removal of policies that were dominated, the ICER for EM-IUIOS-IVF was approximately €31 000 compared to EM-EM-IVF. The range of ICER values between the lowest 25% and highest 75% of simulation replications was broad. The net benefit curve showed that when we assume a live birth to be worth approximately €20 000 or less, the policy EM-EM-IVF had the highest probability to achieve the highest net benefit. Between €20 000 and €50 000 monetary value per live birth, it was uncertain whether EM-EM-IVF was better than EM-IUIOS-IVF, with the turning point of €32 000. When we assume a monetary value per live birth over €50 000, the policy with the highest probability to achieve the highest net benefit was EM-IUIOS-IVF. Results for subgroups with different baseline prognoses showed the same policies dominated and the same two policies that were the most likely to achieve the highest net benefit but at different threshold values for the assumed monetary value per live birth. LIMITATIONS, REASONS FOR CAUTION Our model focused on population level and was thus based on average costs for the average number of cycles conducted. We also based the model on a number of key assumptions. We changed model assumptions to assess the influence of these assumptions on our results. The change in relative effectiveness of IVF over time was found to be highly influential on results and their interpretation. WIDER IMPLICATIONS OF THE FINDINGS EM-EM-IVF and EM-IUIOS-IVF followed by IVF were the most cost-effective policies. The choice depends on the monetary value assigned to a live birth. The results of our study can be used in discussions between clinicians, couples and policy makers to decide on a sustainable treatment protocol based on the probability of live birth, the costs and the limitations of MAR treatment. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the ZonMw Doelmatigheidsonderzoek (80-85200-98-91072). The funder had no role in the design, conduct or reporting of this work. B.W.M. is supported by a NHMRC Practitioner Fellowship (GNT1082548). B.W.M. reports consultancy for ObsEva, Merck KGaA and Guerbet and travel and research support from ObsEva, Merck and Guerbet. TRIAL REGISTRATION NUMBER N/A.R van Eekelen, M J Eijkemans, M Mochtar, F Mol, B W Mol, H Groen, M van Wel

Correction: Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia between 34 and 37 weeks' gestation (HYPITAT-II): a multicentre, open-label randomised controlled trial

Kim Broekhuijsen, Josje Langenveld, Gert-Jan van Baaren, Mariëlle G van Pampus, Anton H van Kaam, Henk Groen, Martina Porath, Maureen TM Franssen, Ben W Mol, and HYPITAT-II study grou

Liever inleiden dan afwachten bij aterme zwangerschapshypertensie en milde preeclampsie: HYPITAT-studie

OBJECTIVE: To investigate what would benefit women with mild full-term pregnancy-related hypertension most: induction of labour or expectant monitoring, from the perspective of clinical effectiveness, maternal quality of life, and costs. DESIGN: Randomised clinical trial. Trial registration number ISRCTN08132825. METHODS: We undertook a multicentre randomised controlled trial in 38 hospitals in the Netherlands between October 2005 and March 2008. We enrolled patients with a singleton pregnancy in cephalic presentation at 36-41 weeks' gestation, who had gestational hypertension or mild preeclampsia. Participants were randomly allocated to receive either induction of labour or expectant monitoring. The primary outcome was a composite measure of poor maternal outcome, defined as maternal mortality, maternal morbidity (eclampsia, 'haemolysis, elevated liver enzymes, low platelets' (HELLP) syndrome, pulmonary oedema, thrombo-embolic disease and abruptio placentae), progression to severe hypertension or proteinuria, and major postpartum haemorrhage. Secondary outcomes were mode of delivery, neonatal outcome, maternal quality of life and costs. Analysis was by intention to treat. RESULTS: A total of 756 patients were allocated to receive induction of labour (n = 377 patients) or expectant monitoring (n = 379). No cases of maternal or neonatal death or eclampsia were recorded. Development of poor maternal outcome was significantly lower in the induction of labour group (117 women) than the expectant monitoring group (166 women) (31% versus 44%; relative risk 0.71 (95% CI: 0.59-0.86); p < 0.001). The caesarean section rate was lower among women in the induction of labour group (n = 54) compared to women in the expectant monitoring group (n = 72) (14% versus 19%; relative risk 0.75 (95% CI: 0.55-1.04)< p = 0.085). Neonatal outcomes and quality of life were comparable between both groups. Induction of labour is a cost saving strategy (difference euro 831). CONCLUSION: For women with full-term gestational hypertension and pre-eclampsia, induction of labour is associated with improved maternal outcome and lower costs, without the additional risk of a caesarean section being necessary

Protein-contg. fraction from mussel feet

Abstract of NL 1000732 (C1) A protein-contg. fraction suitable for use as an adhesive that can provide an adhesive bond with a strength of more than 15 N/cm2 is claimed. The fraction comprises one or more proteins contg. 3,4-dihydroxyphenylalanine (Dopa) and is obtd. by a process comprising treating mussel feet with a buffer soln. with a pH of \- 7, washing the feet at a pH of 3 or less, subjecting the purified mass to a high pressure drop and shearing stress, separating solids, and recovering an aq. soln. of the protein-contg. fraction

Identification of Topaquinone, as Illustrated for Pig-Kidney Diamine Oxidase and Escherichia-Coli Amine Oxidase

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