Patient satisfaction and amenorrhea rate after endometrial ablation by ThermaChoice III or NovaSure: a retrospective cohort study

Heavy menstrual bleeding poses an important health problem, which can be managed, besides other treatments, with endometrial ablation. Nowadays, the bipolar radio frequency device (NovaSure) is the most commonly used device for endometrial ablation, followed by the thermal balloon device (ThermaChoice III). Thus far, studies looking at treatment outcomes have mainly been done comparing NovaSure with the older ThermaChoice (I–II) devices. The aim of this study is to compare the effectiveness of the improved ThermaChoice III with NovaSure. Patients treated with ThermaChoice III at the Ziekenhuisgroep Twente hospital and NovaSure at the Medisch Spectrum Twente hospital were included in the study. The primary outcome measure was patient satisfaction after treatment, measured by the condition-specific menorrhagia multi-attribute scale (MMAS). The secondary outcome measure was effectiveness of the treatment, measured by the amenorrhea rate and the hysterectomy rate. Five hundred fourteen patients were included in this study; of these, 216 patients were treated with ThermaChoice III and 289 patients with NovaSure. The score on the condition-specific MMAS was high for both groups, without a significant difference between the groups (88.8 vs 86.5, p = 0.183). The amenorrhea rate was significantly higher in the NovaSure group (45 vs 27 %, p = 0.001). The hysterectomy rate was slightly higher in the ThermaChoice III group, without a significant difference between the groups (19 compared to 13 %, p = 0.066). Patient satisfaction is comparable in patients treated with ThermaChoice III or NovaSure. However, NovaSure endometrial ablation leads to a significantly higher amenorrhea rat

Triplet superconductivity in a one-dimensional ferromagnetic t-J model

In this paper we study the ground state phase diagram of a one-dimensional $t-U-J$ model, at half-filling. In the large-bandwidth limit and for ferromagnetic exchange with easy-plane anisotropy, a phase with gapless charge and massive spin excitations, characterized by the coexistence of triplet superconducting ($TS$) and spin density wave ($SDW^{z}$) instabilities is realized in the ground state. With reduction of the bandwidth, a transition into an insulating phase showing properties of the spin-1/2 XY model takes place. In the case of weakly anisotropic antiferromagnetic exchange the system shows a long range dimerized (Peierls) ordering in the ground state. The complete weak-coupling phase diagram of the model, including effects of the on-site Hubbard interaction, is obtained

Conformally flat spacetimes and Weyl frames

We discuss the concepts of Weyl and Riemann frames in the context of metric theories of gravity and state the fact that they are completely equivalent as far as geodesic motion is concerned. We apply this result to conformally flat spacetimes and show that a new picture arises when a Riemannian spacetime is taken by means of geometrical gauge transformations into a Minkowskian flat spacetime. We find out that in the Weyl frame gravity is described by a scalar field. We give some examples of how conformally flat spacetime configurations look when viewed from the standpoint of a Weyl frame. We show that in the non-relativistic and weak field regime the Weyl scalar field may be identified with the Newtonian gravitational potential. We suggest an equation for the scalar field by varying the Einstein-Hilbert action restricted to the class of conformally-flat spacetimes. We revisit Einstein and Fokker's interpretation of Nordstr\"om scalar gravity theory and draw an analogy between this approach and the Weyl gauge formalism. We briefly take a look at two-dimensional gravity as viewed in the Weyl frame and address the question of quantizing a conformally flat spacetime by going to the Weyl frame.Comment: LATEX - 18 page

Pairing and Density Correlations of Stripe Electrons in a Two-Dimensional Antiferromagnet

We study a one-dimensional electron liquid embedded in a 2D antiferromagnetic insulator, and coupled to it via a weak antiferromagnetic spin exchange interaction. We argue that this model may qualitatively capture the physics of a single charge stripe in the cuprates on length- and time scales shorter than those set by its fluctuation dynamics. Using a local mean-field approach we identify the low-energy effective theory that describes the electronic spin sector of the stripe as that of a sine-Gordon model. We determine its phases via a perturbative renormalization group analysis. For realistic values of the model parameters we obtain a phase characterized by enhanced spin density and composite charge density wave correlations, coexisting with subleading triplet and composite singlet pairing correlations. This result is shown to be independent of the spatial orientation of the stripe on the square lattice. Slow transverse fluctuations of the stripes tend to suppress the density correlations, thus promoting the pairing instabilities. The largest amplitudes for the composite instabilities appear when the stripe forms an antiphase domain wall in the antiferromagnet. For twisted spin alignments the amplitudes decrease and leave room for a new type of composite pairing correlation, breaking parity but preserving time reversal symmetry.Comment: Revtex, 28 pages incl. 5 figure

Evaluation of low-dose aspirin in the prevention of recurrent spontaneous preterm labour (the APRIL study) : A multicentre, randomised, double-blinded, placebo-controlled trial

Funding: MdB, LV, TN, BM, MO and CdG received funding from ZonMw, The Dutch Organisation for Health Research and Development (grant number 836041006). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Low dose aspirin in the prevention of recurrent spontaneous preterm labour - the APRIL study: A multicenter randomized placebo controlled trial

Background: Preterm birth (birth before 37 weeks of gestation) is a major problem in obstetrics and affects an estimated 15 million pregnancies worldwide annually. A history of previous preterm birth is the strongest risk factor for preterm birth, and recurrent spontaneous preterm birth affects more than 2.5 million pregnancies each year. A recent meta-analysis showed possible benefits of the use of low dose aspirin in the prevention of recurrent spontaneous preterm birth. We will assess the (cost-)effectiveness of low dose aspirin in comparison with placebo in the prevention of recurrent spontaneous preterm birth in a randomized clinical trial. Methods/design: Women with a singleton pregnancy and a history of spontaneous preterm birth in a singleton pregnancy (22-37 weeks of gestation) will be asked to participate in a multicenter, randomized, double blinded, placebo controlled trial. Women will be randomized to low dose aspirin (80 mg once daily) or placebo, initiated from 8 to 16 weeks up to maximal 36 weeks of gestation. The primary outcome measure will be preterm birth, defined as birth at a gestational age (GA) < 37 weeks. Secondary outcomes will be a composite of adverse neonatal outcome and maternal outcomes, including subgroups of prematurity, as well as intrauterine growth restriction (IUGR) and costs from a healthcare perspective. Preterm birth will be analyzed as a group, as well as separately for spontaneous or indicated onset. Analysis will be performed by intention to treat. In total, 406 pregnant women have to be randomized to show a reduction of 35% in preterm birth from 36 to 23%. If aspirin is effective in preventing preterm birth, we expect that there will be cost savings, because of the low costs of aspirin. To evaluate this, a cost-effectiveness analysis will be performed comparing preventive treatment with aspirin with placebo. Discussion: This trial will provide evidence as to whether or not low dose aspirin is (cost-) effective in reducing recurrence of spontaneous preterm birth. Trial registration: Clinical trial registration number of the Dutch Trial Register: NTR 5675. EudraCT-registration number: 2015-003220-31

Elevated risk of infection with SARS-CoV-2 Beta, Gamma, and Delta variants compared with Alpha variant in vaccinated individuals

The extent to which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) break through infection- or vaccine-induced immunity is not well understood. We analyzed 28,578 sequenced SARS-CoV-2 samples from individuals with known immune status obtained through national community testing in the Netherlands from March to August 2021. We found evidence of an increased risk of infection by the Beta (B.1.351), Gamma (P.1), or Delta (B.1.617.2) variants compared with the Alpha (B.1.1.7) variant after vaccination. No clear differences were found between vaccines. However, the effect was larger in the first 14 to 59 days after complete vaccination compared with ≥60 days. In contrast to vaccine-induced immunity, there was no increased risk for reinfection with Beta, Gamma, or Delta variants relative to the Alpha variant in individuals with infection-induced immunity.</p

Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with 'refractoriness to treatment': a cohort study

Background: The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage hampers comparative studies and optimization of clinical management. The concept of persistent postpartum haemorrhage, based on refractoriness to initial first-line treatment, was proposed as an alternative to common definitions that are either based on estimations of blood loss or transfused units of packed red blood cells (RBC). We compared characteristics and outcomes of women with severe postpartum haemorrhage captured by these three types of definitions. Methods: In this large retrospective cohort study in 61 hospitals in the Netherlands we included 1391 consecutive women with postpartum haemorrhage who received either ≥4 units of RBC or a multicomponent transfusion. Clinical characteristics and outcomes of women with severe postpartum haemorrhage defined as persistent postpartum haemorrhage were compared to definitions based on estimated blood loss or transfused units of RBC within 24 h following birth. Adverse maternal outcome was a composite of maternal mortality, hysterectomy, arterial embolisation and intensive care unit admission. Results: One thousand two hundred sixty out of 1391 women (90.6%) with postpartum haemorrhage fulfilled the definition of persistent postpartum haemorrhage. The majority, 820/1260 (65.1%), fulfilled this definition within 1 h following birth, compared to 819/1391 (58.7%) applying the definition of ≥1 L blood loss and 37/845 (4.4%) applying the definition of ≥4 units of RBC. The definition persistent postpartum haemorrhage captured 430/471 adverse maternal outcomes (91.3%), compared to 471/471 (100%) for ≥1 L blood loss and 383/471 (81.3%) for ≥4 units of RBC. Persistent postpartum haemorrhage did not capture all adverse outcomes because of missing data on timing of initial, first-line treatment. Conclusion: The definition persistent postpartum haemo