Neonatal outcome in twin-to-twin transfusion syndrome not treated with fetoscopic laser surgery

The aim of this study was to describe the neonatal management and outcome in monochorionic twins with twin-to-twin transfusion syndrome (TTTS) not treated with fetoscopic laser surgery. All consecutive live-born neonates with TTTS managed at our center between 2002 and 2021 were included in this retrospective study. Neonatal outcome was assessed in 44 twin pairs with TTTS not treated with laser (nonlaser group) compared to a control group of 88 twin pairs with TTTS successfully treated with laser (laser group), matched for gestational age at birth. Primary outcome was adverse neonatal outcome, a composite outcome including neonatal mortality or severe neonatal morbidity. The incidence of adverse neonatal outcome in the nonlaser group and laser group was 30% (26/88) and 11% (19/176), respectively (relative risk = 3.46, 95% CI [1.79, 6.71]). In the nonlaser group, 11% had necrotizing enterocolitis (vs. 2% in the laser group) and 24% had hypotension (vs. 10% in the laser group). Recipients in the nonlaser group had, compared to recipients in the laser group, significantly more severe cerebral injury (18% vs. 5%) and more polycythemia at birth (21% vs. 1%). Donors in the nonlaser group had, compared to donors in the laser group, more severe growth restriction (71% vs 42%), renal failure (11% vs 1%), and anemia at birth (25% vs. 7%). Thus, the risk for neonatal mortality and/or severe morbidity is three-fold higher in TTTS not treated with laser than in TTTS treated with laser, which highlights the fact that these neonates with TTTS are very sick at birth, requiring accurate and prompt intensive treatment.Research into fetal development and medicin

Reductive dechlorination of hexachlorocyclohexane (HCH) isomers in soil under anaerobic conditions

The biological anaerobic reductive dechlorination of -hexachlorocyclohexane under methanogenic conditions was tested in a number of contaminated soil samples from two locations in the Netherlands. Soils from a heavily polluted location showed rapid dechlorination of -hexachlorocyclohexane to benzene and chlorobenzene with lactate as electron donor. Soils from an adjacent slightly polluted location did not show substantial dechlorination of -hexachlorocyclohexane within 4months. A heavily polluted sample was selected to optimise the dechlorination. All tested hexachlorocyclohexane isomers (-, -, -, and -), either added separately or simultaneously, were dechlorinated in this soil sample. The most rapid dechlorination was observed at a temperature of 30°C. Dechlorination of -hexachlorocyclohexane was observed with acetate, propionate, lactate, methanol, H2, yeast extract and landfill leachate as electron donors. In a soil percolation column, packed with a selected heavily polluted soil sample, the presence of 10mM sulphate in the influent led to simultaneous dechlorination of -hexachlorocyclohexane and sulphate reduction. When the column was fed with 10mM nitrate instead of sulphate, dechlorination ceased immediately. After omitting nitrate from the influent, dechlorination activity recovered in about 1month. Also in a separate column, the addition of nitrate from the start of the experiment did not result in dechlorination of -HCH. The significance of these experiments for in situ bioremediation of polluted soils is discusse

Reductive dechlorination of B-hexachlorocyclohexane (B-HCH) by a Dehalobacter species in coculture with a Sedimentibacter species

An anaerobic coculture was enriched from a hexachlorocyclohexane (HCH) polluted soil. The coculture reductively dechlorinates the ß-HCH isomer to benzene and chlorobenzene in a ratio of 0.5¿2 depending on the amount of ß-HCH degraded. The culture grows with H2 as electron donor and ß-HCH as electron acceptor, indicating that dechlorination is a respiratory process. Phylogenetic analysis indicated that the coculture consists of two bacteria that are both related to gram-positive bacteria with a low G + C content of the DNA. One bacterium was identified as a Dehalobacter sp. This bacterium is responsible for the dechlorination. The other bacterium was isolated and characterized as being a Sedimentibacter sp. This strain is not able to dechlorinate ß-HCH. The Dehalobacter sp. requires the presence of Sedimentibacter for growth and dechlorination, but the function of the latter bacterium is not clear. This is the first report on the metabolic dechlorination of ß-HCH by a defined anaerobic bacterial culture

Explanations for coagulation activation after air travel

Background: It is unknown whether venous thrombosis after long haul air travel is exclusively attributable to immobilization. Objectives: We determined whether the following mechanisms were involved: hypoxia, stress, inflammation or viral infection. Patients/Methods: In a case crossover setting in 71 healthy volunteers who were exposed to an 8-h flight, 8-h movie marathon and 8 h of regular activities, we compared markers for several hypothetical pathways: plasminogen activator inhibitor-1 (PAI-1), stress, plasma factor (F)VIII coagulant activity (FVIIIc), soluble P-selectine (sP-selectine), interleukin-8 (IL-8) and neutrophil elastase. We reported earlier an activated clotting system, as evidenced by thrombin generation, in 17% of volunteers after the flight. Results: PAI-1 increased by 4.2 ng mL-1 (CI95:-49.5 to 6.5) in volunteers with an activated clotting system whereas it decreased in those without (-20.0 ng mL-1, CI95:-33.2 to -14.0). FVIIIc levels rose more in individuals with clotting activation (18.0%, CI95:-1.0 to 33.0) than in those without (2.0%, CI95:-2.0 to 5.0). The increases in FVIIIc were not associated with stress, which appeared unrelated to clotting activation. sP-selectin increased in those with clotting activation (3.5 mu g L-1, CI95: -3.0 to 10.0), but decreased in those without (-0.5 mu g L-1, CI95: -2.0 to 2.0). Changes in levels of neutrophil elastase or IL-8 were not different between the subjects with and without clotting activation. Conclusions: Our results do not support the hypotheses that stress, infection or air pollution are involved in the development of a prothrombotic state in air travellers. After long haul air travel, this state is more pronounced in patients with risk factors and may be caused by hypoxia, triggering systemic inflammation and platelet activation, leading to coagulation induction and degranulation of platelets.Thrombosis and Hemostasi

Economic analysis of fetal fibrinectin testing and/or cervical length measurement in women with threatened preterm labor

Obstetric

The National Immunisation Programme in the Netherlands: surveillance and developments in 2021-2022.

Synopsis The National Immunisation Programme in the Netherlands Surveillance and developments in 2021-2022 RIVM tracks how many people fall ill due to a disease that is included in the National Immunisation Programme (NIP). In 2021, fewer people got such a disease compared to 2020. This is very likely due to COVID-19 control measures such as social distancing and handwashing. There were especially fewer people with invasive pneumococcal disease (about 1,205 people), pertussis (74), and mumps (1). The number of notifications for meningococcal disease caused by serotype W (4) decreased further, after introduction of the vaccine for adolescents into the NIP in 2020. There were no notifications of diphtheria, tetanus, measles, rubella, or polio in 2021. The number of chronic hepatitis B notifications (743) was about the same as in 2020. Between 2014 and 2019 there were many more notifications, with about 1,000 to 1,100 people being made aware they had this disease. The decrease is probably the result of a decrease in doctors’ visits and therefore diagnoses during the COVID-19 pandemic. Only Haemophilus influenzae type b (Hib) occurred more frequently than before the COVID-19 pandemic. In 2020 and 2021 there were 68 notifications per year, compared to 39 in 2019. RIVM currently investigates the cause. The vaccine seems to be as effective as in previous years. In 2021, 1,703,102 children were vaccinated as part of the NIP. They received a total of 2,219,341 vaccinations. Also, 115,886 pregnant women received a vaccination that protects their baby immediately after birth against, amongst others, whooping cough. Vaccination coverage in the Netherlands is slightly lower than last year. This is partly because of the COVID-19 pandemic, which caused some vaccinations to be given later than normally planned. The Health Council of the Netherlands recommended in June 2021 to offer rotavirus vaccination to young babies. In September 2021, the Health Council recommended inviting more risk groups for flu vaccination, including pregnant women. The ministry of Health, Welfare and Sport adopted both recommendations in 2022. Vaccination against COVID-19 works well to prevent severe illness and death, but the protection slowly decreases. Booster vaccinations increase protection again