Een natuurlijkere toekomst voor Nederland in 2120

Nederland staat voor grote opgaven: de energietransitie, verduurzaming van de landbouw, herstel van de biodiversiteit, verstedelijking en klimaatadaptatie. Al deze opgaven hebben gevolgen voor de ruimtelijke inrichting van ons land. Het is onvermijdelijk dat Nederland er over honderd jaar anders uit zal zien. Grote veranderingen zijn nodig om opgewassen te zijn tegen een stijgende zeespiegel, perioden van extreem weer, een toenemende vraag naar voedselproductie en een noodzaak om de uitstoot van broeikasgassen terug te dringen.Deze opgaven vragen om een nieuw verhaal voor Nederland. Een verhaal waarin dit dichtbevolkte land zich ontwikkelt tot een gidsland waar natuur, duurzame economie, leefbaarheid en veiligheid voorop staan. Een verhaal gebaseerd op ‘nature based solutions’ waarin opgaven voor klimaat en biodiversiteit hand in hand gaan.Wageningen University & Research heeft dit verhaal geschreven gebaseerd op expertkennis: een toekomstvisie voor Nederland in 2120, waarin natuur en natuurlijke processen een hoofdrol spelen. Een visie die bedoeld is om te inspireren. Het schetst een toekomst waarin economische ontwikkeling en een natuur-inclusieve samenleving hand in hand gaan. De toekomstvisie houdt rekening met de bijzondere kenmerken van verschillende deelgebieden in Nederland. Door middel van kaarten en doorsnedes laten we op hoofdlijnen zien wat er per gebied mogelijk is op het gebied van ruimtelijke inrichting. Dit toekomstbeeld schetst een denkrichting gebaseerd op de uitkomsten van diverse ontwerp- en discussiesessies met onderzoekers. Er is behoefte aan nadere uitwerking en onderbouwing. Samen met stakeholders gaan we deze visie verder ontwikkelen, onderbouwen en vertalen naar handelingsperspectief voor het hier en nu

Accelerated menopausal changes as human disease model 'FOCUM' for the development of osteoarthritis and other degenerative disorders:protocol for a prospective cohort study

INTRODUCTION: The incidence of degenerative disorders, including osteoarthritis (OA), increases rapidly in women after menopause. However, the influence of the menopause is still insufficiently investigated due to the slowness of menopausal transition. In this study, a novel human model is used in which it is expected that menopausal-related changes will occur faster. This is the Females discontinuing Oral Contraceptives Use at Menopausal age model. The ultimate aim is to link these changes to OA and other degenerative disorders, including cardiovascular diseases, diabetes, osteoporosis and tendinopathies. METHODS AND ANALYSIS: This is a pilot observational prospective cohort study with 2 years of follow-up. Fifty women aged 50–60 who use oral contraceptive (OC) and have the intention to stop are included. Measurements are performed once before stopping OC, and four times thereafter at 6 weeks, 6 months, 1 year and 2 years. At every time point, a questionnaire is filled in and a sample of blood is drawn. At the first and final time points, a physical examination, hand radiographs and a MRI scan of one knee are performed. The primary OA outcome is progression of the MRI Osteoarthritis Knee Score. Secondary OA outcomes are the development of clinical knee and hand OA, development of knee OA according to the MRI definition, and progression of radiographic features for hand OA. Principal component analysis will be used to assess which changes occur after stopping OC. Univariate and multivariate generalised estimating equation models will be used to test for associations between these components and OA. ETHICS AND DISSEMINATION: The study has been approved by the Medical Ethics Committee of the Erasmus MC University Medical Center Rotterdam (MEC-2019-0592). All participants must give informed consent before data collection. Results will be disseminated in national and international journals. TRIAL REGISTRATION NUMBER: NL70796.078.19

Occupational exposure to gases/fumes and mineral dust affect DNA methylation levels of genes regulating expression

Many workers are daily exposed to occupational agents like gases/fumes, mineral dust or biological dust, which could induce adverse health effects. Epigenetic mechanisms, such as DNA methylation, have been suggested to play a role. We therefore aimed to identify differentially methylated regions (DMRs) upon occupational exposures in never-smokers and investigated if these DMRs associated with gene expression levels. To determine the effects of occupational exposures independent of smoking, 903 never-smokers of the LifeLines cohort study were included. We performed three genome-wide methylation analyses (Illumina 450 K), one per occupational exposure being gases/fumes, mineral dust and biological dust, using robust linear regression adjusted for appropriate confounders. DMRs were identified using comb-p in Python. Results were validated in the Rotterdam Study (233 never-smokers) and methylation-expression associations were assessed using Biobank-based Integrative Omics Study data (n = 2802). Of the total 21 significant DMRs, 14 DMRs were associated with gases/fumes and 7 with mineral dust. Three of these DMRs were associated with both exposures (RPLP1 and LINC02169 (2x)) and 11 DMRs were located within transcript start sites of gene expression regulating genes. We replicated two DMRs with gases/fumes (VTRNA2-1 and GNAS) and one with mineral dust (CCDC144NL). In addition, nine gases/fumes DMRs and six mineral dust DMRs significantly associated with gene expression levels. Our data suggest that occupational exposures may induce differential methylation of gene expression regulating genes and thereby may induce adverse health effects. Given the millions of workers that are exposed daily to occupational exposures, further studies on this epigenetic mechanism and health outcomes are warranted

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Patiëntgerapporteerde uitkomsten van transgender mannen na genitale genderbevestigende chirurgie met versus zonder plasbuisverlenging

In this study, patient-reported outcomes (PROs) in transgender men after genital gender-affirming surgery (gGAS) with versus without urethral lengthening were compared. Additionally, predictors of post-operative satisfaction were identified. Transgender men ≥ 1 year after gGAS who were willing to participate filled in a patient-reported outcome measure. Answers were compared between groups. Predictors of post-operative satisfaction were analysed using linear regression analysis. No significant differences were found in PROs. Most participants were (very) satisfied with life (75%), the appearance of the neophallus (66%), voiding (59%), the effect on masculinity (82%), and confirmed that the end surgical result matched their expectations (61%). Satisfaction with the appearance (p < 0.001) and voiding (p = 0.02) were positively associated with patient satisfaction at follow-up. No significant differences were found in PROs after gGAS with versus without urethral lengthening. Satisfaction with the appearance of the neophallus and voiding were positively associated with post-operative patient satisfaction

Surgical outcomes of testicular prostheses implantation in transgender men with a history of prosthesis extrusion or infection

Background: Testicular prostheses implantation may be used for neoscrotal augmentation in transgender men. In current literature, explantation rates range from 0.6% to 30% and most are a result of infection or extrusion. Information on the surgical path of individuals after prosthesis explantation is scarce. Aim: To assess the frequency and success rate of testicular prosthesis implantation after previous explantation due to infection or extrusion. Methods: All transgender men who underwent testicular prosthesis explantation between January 1991 and December 2018 were retrospectively identified from a departmental database. A retrospective chart study was conducted, recording demographics, surgical and prosthesis characteristics, reoperations, and outcomes. Results: A total of 41 transgender men were included who underwent testicular prosthesis explantation in the study time period. Of these, 28 (68%) opted for new prosthesis implantation. Most explanted prosthesis had a volume ≥30cc and were replaced with an equally sized one. The postoperative course was uneventful in 19 out of 28 (68%) individuals. Explantation of one or both prostheses occurred in 7 out of 28 (25%) individuals, because of infection (n = 3, 11%) or extrusion (n = 4, 14%). Patients that experienced complications had more often a history of smoking (p = 0.049). The explantation rate was lower if a smaller or lighter prosthesis was reimplanted (p = 0.020). Discussion: Most patients opt for testicular prosthesis implantation after previous explantation due to extrusion or infection. Explantation rates are higher than after the primary implantation procedure. Results of current study can be used to inform individuals on postoperative outcomes