Analyse van klachten na sterilisatie met Essure® in Nederland : Gezondheidsproblemen na een niet chirurgische sterilisatie-ingreep bij vrouwen

alleen digitaal verschenenHet RIVM heeft klachten geanalyseerd van vrouwen die zijn gesteriliseerd met Essure®. Dit zijn metalen veertjes die via de baarmoeder in beide eileiders worden gebracht waardoor deze na ongeveer 3 maanden dichtgroeien. Het voordeel van deze sterilisatiemethode is, in vergelijking met de traditionele afsluiting van de eileiders, dat er geen chirurgische ingreep voor nodig is. Het aantal gemelde klachten komt van ruim 1,5 procent van de circa 30.000 vrouwen die in Nederland met Essure® zijn behandeld. De meest genoemde klachten zijn pijn en vermoeidheid. Bij de pijnklachten gaat het vooral om de buik, de rug en het hoofd. Daarnaast worden hevige bloedingen tijdens en tussen de menstruatie, stemmingswisselingen, geheugenverlies en concentratieproblemen gemeld. Het werkelijke aantal vrouwen met klachten is onbekend. Veel vrouwen geven aan dat deze klachten hun dagelijks leven negatief beïnvloeden. Ze voelen de veertjes zitten of ervaren beperkingen bij het bewegen. Verder kunnen ze de dagelijkse taken en de zorg voor kinderen vaak minder goed uitvoeren. Er zijn ook vrouwen die aangeven dat hun relatie lijdt onder de ontstane problemen. Bij 16 procent van de vrouwen die klachten gemeld hebben, is Essure® verwijderd naar aanleiding van de klachten. 38 procent van de vrouwen in dit onderzoek heeft een afspraak gemaakt om dat te laten doen. De klachten zijn gemeld nadat hieraan via diverse kanalen aandacht is besteed. De Nederlandse Vereniging voor Obstetrie en Gynaecologie (NVOG) heeft de resultaten van de analyse medisch geduid. Sommige klachten zijn mogelijk toe te wijzen aan de plaatsing van Essure®, zoals bepaalde pijnklachten. Bij andere klachten is het moeilijker om een direct verband te leggen omdat er ook andere zaken van invloed kunnen zijn, zoals stoppen met de pil waardoor menstruatieklachten kunnen verergeren. Daarnaast komen verschillende klachten, bijvoorbeeld gewichtsschommelingen en urinewegproblemen, ook met enige regelmaat voor bij vrouwen die geen Essure® hebben. De gemelde klachten komen van vrouwen die tussen 2001 en 2016 het implantaat hebben gekregen. Hun gemiddelde leeftijd was 37 jaar op het moment van de sterilisatie.The RIVM has analyzed the complaints reported by women sterilized using Essure®. Essure® is a sterilization method where two metal coils are placed into both fallopian tubes through the cervix and uterus, provoking those to become blocked after approximately 3 months. In comparison with the traditional sterilization methods, the advantage of the Essure® method is that no surgical procedure is required. The complaints that were received came from more than1,5 percent of the 30.000 women who are estimated to have been sterilized using Essure® in the Netherlands. Probably not all women with health problems have submitted a complaint; therefore, the actual number of women with health problems is unknown. The most frequently mentioned health problems are pain and tiredness. The pain is reported to be located mainly in the abdomen, back, and head. In addition, heavy bleeding during and between menstruations, mood swings, memory loss and concentration problems are also reported frequently. Many women indicated that these health problems negatively affect their daily life. They feel the coils in their body and often experience limitations when moving. They are often less able to adequately perform their daily tasks and take care of their children.There are also women that indicated that their relationship was negatively affected by the health problems. In 16 percent of the women in this study, Essure® has been removed because of the health problems and 38 percent of the women have made an appointment to have Essure® removed. The complaints were submitted, among other reasons, because the media attention on problems experienced by women following sterilization using Essure®. The Dutch Society of Obstetrics and Gyneacology (NVOG) contributed to the interpretation of the results from this study. Some health problems can be directly related to Essure®, for instance some kinds of pain. For other health problems it is more difficult to establish a direct link, because other factors may influence the health problems as well. For instance, heavier menstruation may also be explained by the fact that women stopped taking oral contraceptives following sterilization using Essure®.Furthermore, there are other health problems such as weight changes and urinary tract problems that are also regularly experienced by women not sterilized with Essure®. Women that submitted a complaint were sterilized using Essure between 2001 and 2016. Their mean age at implantation was 37 years.Dutch Health Care Inspectorat

Women Writers and the Dutch Stage: Public Femininity in the Plays of Verwers and Questiers

Book chapter on the plays of two of the earliest Dutch female playwrights

Fatal disseminated Toxoplasma gondii infection in a captive harbour porpoise (Phocoena phocoena)

A 7-year-old female harbour porpoise (Phocoena phocoena), born and held in captivity, suffered from reduced consciousness, imprecise and circling swimming movements and long phases of immobility over a period of 3 weeks. The animal died during treatment in a Danish open sea facility. Pathological examination revealed multifocal pyogranulomatous to necrotizing meningoencephalomyelitis, ganglioneuritis, plexus chorioiditis, myocarditis, hepatitis and adrenalitis with few intralesional protozoal tachyzoites and bradyzoites within cysts. Immunohistochemistry was positive for Toxoplasma gondii antigen within the lesions. Using polymerase chain reaction (PCR), the presence of T. gondii-specific genome fragments was confirmed. A multilocus PCR-restriction fragment length polymorphism analysis using nine unlinked marker regions (nSAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1 and Apico) resulted in the identification of T. gondii type II (variant Apico Type I), which is the T. gondii genotype dominating in Germany. This is the first description of disseminated fatal toxoplasmosis in a captive harbour porpoise that lived in an open sea basin. Surface water contaminated with toxoplasma oocysts is regarded as the most likely source of infection

Conceptual knowledge for understanding other’s actions is organized primarily around action goals

Semantic knowledge about objects entails both knowing how to grasp an object (grip-related knowledge) and what to do with an object (goal-related knowledge). Considerable evidence suggests a hierarchical organization in which specific hand-grips in action execution are most often selected to accomplish a remote action goal. The present study aimed to investigate whether a comparable hierarchical organization of semantic knowledge applies to the recognition of other’s object-directed actions as well. Correctness of either the Grip (hand grip applied to the object) or the Goal (end-location at which an object was directed) were manipulated independently in two experiments. In Experiment 1, subjects were required to attend selectively to either the correctness of the grip or the goal of the observed action. Subjects were faster when attending to the goal of the action and a strong interference of goal-violations was observed when subjects attended to the grip of the action. Importantly, observation of irrelevant goal- or grip-related violations interfered with making decisions about the correctness of the relevant dimension only when the relevant dimension was correct. In contrast, in Experiment 2, when subjects attended to an action-irrelevant stimulus dimension (i.e. orientation of the object), no interference of goal- or grip-related violations was found, ruling out the possibility that interference-effects result from perceptual differences between stimuli. These findings suggest that understanding the correctness of an action selectively recruits specialized, but interacting networks, processing the correctness of goal- and grip-specific information during action observation

Fluorescence-guided detection of pituitary neuroendocrine tumor (PitNET) tissue during endoscopic transsphenoidal surgery available agents, their potential, and technical aspects

Differentiation of pituitary neuroendocrine tumor (PitNET) tissue from surrounding normal tissue during surgery is challenging. A number of fluorescent agents is available for visualization of tissue discrepancy, with the potential of improving total tumor resection. This review evaluates the availability, clinical and technical applicability of the various fluorescent agents within the field of pituitary surgery. According to PRISMA guidelines, a systematic review was performed to identify reports describing results of in vivo application of fluorescent agents. In this review, 15 publications were included. Sodium Fluorescein (FNa) was considered in two studies. The first study reported noticeable fluorescence in adenoma tissue, the second demonstrated the strongest fluorescence in non-functioning pituitary adenomas. 5-Aminolevulinic acid (5-ALA) was investigated in three studies. One study compared laser-based optical biopsy system (OBS) with photo-diagnostic filter (PD) and found that the OBS was able to detect all microadenomas, even when MRI was negative. The second study retrospectively analyzed twelve pituitary adenomas and found only one positive for fluorescence. The third investigated fifteen pituitary adenomas of which one displayed vague fluorescence. Indocyanine green (ICG) was researched in four studies with variable results. Second-Window ICG yielded no significant difference between functioning and non-functioning adenomas in one study, while a second study displayed 4 times higher fluorescence in tumor tissue than in normal tissue. In three studies, OTL38 showed potential in non-functioning pituitary adenomas. At present, evidence for fluorescent agents to benefit total resection of PitNETs is lacking. OTL38 can potentially serve as a selective fluorescent agent in non-functioning pituitary adenomas in the near future

Manipulable Objects Facilitate Cross-Modal Integration in Peripersonal Space

Previous studies have shown that tool use often modifies one's peripersonal space – i.e. the space directly surrounding our body. Given our profound experience with manipulable objects (e.g. a toothbrush, a comb or a teapot) in the present study we hypothesized that the observation of pictures representing manipulable objects would result in a remapping of peripersonal space as well. Subjects were required to report the location of vibrotactile stimuli delivered to the right hand, while ignoring visual distractors superimposed on pictures representing everyday objects. Pictures could represent objects that were of high manipulability (e.g. a cell phone), medium manipulability (e.g. a soap dispenser) and low manipulability (e.g. a computer screen). In the first experiment, when subjects attended to the action associated with the objects, a strong cross-modal congruency effect (CCE) was observed for pictures representing medium and high manipulability objects, reflected in faster reaction times if the vibrotactile stimulus and the visual distractor were in the same location, whereas no CCE was observed for low manipulability objects. This finding was replicated in a second experiment in which subjects attended to the visual properties of the objects. These findings suggest that the observation of manipulable objects facilitates cross-modal integration in peripersonal space

Overwintered <i>Drosophila suzukii</i> are the main source for infestations of the first fruit crops of the season

The mechanisms allowing the widespread invasive pest Drosophila suzukii to survive from early spring until the availability of the first fruit crops are still unclear. Seasonal biology and population dynamics of D. suzukii were investigated in order to better understand the contribution of the early spring hosts to the infestation of the first fruit crops of the season. We identified hosts available to D. suzukii in early spring and assessed their suitability for the pest oviposition and reproductive success under field and laboratory conditions. The natural infestation rate of one of these hosts, Aucuba japonica, was assessed over springtime and the morphology of the flies that emerged from infested A. japonica fruits was characterized under field conditions. Then, these findings were correlated with long-term monitoring data on seasonal reproductive biology and morphology of the pest, using a cumulative degree-days (DD) analysis. Field sampling revealed that overwintered D. suzukii females were physiologically able to lay eggs at 87 DD which coincided with the detection of the first infested early spring hosts. The latter were continuously and increasingly infested by D. suzukii eggs in nature from early spring until the end of May, in particular Aucuba japonica. Individuals emerged from most of these hosts were characterized by a poor fitness and a rather low success of emergence. In the field, only few summer morphs emerged from naturally infested A. japonica fruits around the end of May-beginning of June. However, field monitoring in orchards revealed that D. suzukii individuals consisted solely of winter morphs until mid-June. These observations indicate that overwintered D. suzukii females are the predominant source for the infestations in the first available fruit crops of the season. We discuss these findings in the context of possible pest control strategies

Imitation of hand and tool actions is effector-independent

Following the theoretical notion that tools often extend one’s body, in the present study, we investigated whether imitation of hand or tool actions is modulated by effector-specific information. Subjects performed grasping actions toward an object with either a handheld tool or their right hand. Actions were initiated in response to pictures representing a grip at an object that could be congruent or incongruent with the required action (grip-type congruency). Importantly, actions could be cued by means of a tool cue, a hand cue, and a symbolic cue (effector-type congruency). For both hand and tool actions, an action congruency effect was observed, reflected in faster reaction times if the observed grip type was congruent with the required movement. However, neither hand actions nor tool actions were differentially affected by the effector represented in the picture (i.e., when performing a tool action, the action congruency effect was similar for tool cues and hand cues). This finding suggests that imitation of hand and tool actions is effector-independent and thereby supports generalist rather than specialist theories of imitation