The water in the canals and some recreational lakes in Amsterdam is microbiologically contaminated through the discharge of raw sewage from houseboats, sewage effluent, and dog and bird feces. ...Exposure to these waters may have negative health effects. During two successive 1-year study periods, the water quality in two canals (2003 to 2004) and five recreational lakes (2004 to 2005) in Amsterdam was tested with regard to the presence of fecal indicators and waterborne pathogens. According to Bathing Water Directive 2006/7/EC, based on Escherichia coli and intestinal enterococcus counts, water quality in the canals was poor but was classified as excellent in the recreational lakes. Campylobacter, Salmonella, Cryptosporidium, and Giardia were detected in the canals, as was rotavirus, norovirus, and enterovirus RNA. Low numbers of Cryptosporidium oocysts and Giardia cysts were detected in the recreational lakes, despite compliance with European bathing water legislation. The estimated risk of infection with Cryptosporidium and Giardia per exposure event ranged from 0.0002 to 0.007% and 0.04 to 0.2%, respectively, for occupational divers professionally exposed to canal water. The estimated risk of infection at exposure to incidental peak concentrations of Cryptosporidium and Giardia may be up to 0.01% and 1%, respectively, for people who accidentally swallow larger volumes of the canal water than the divers. Low levels of viable waterborne pathogens, such as Cryptosporidium and Giardia, pose a possible health risk from occupational, accidental, and recreational exposure to surface waters in Amsterdam.
Abstract Objective Mismatch negativity (MMN) is an automatic event related brain response, well investigated in the acute phase after severe brain injury: the presence of a MMN is often found to ...predict the emergence from coma, and the exclusion of shifting into a vegetative state (VS). In the present study MMN was examined during recovery from VS. Methods Ten vegetative patients were repeatedly examined every 2 weeks for an average period of 3.5 months. Amplitudes and latencies were related to the patients’ recovery from VS to consciousness, and to a healthy norm group. In addition, MMN was examined on its prognostic value in VS patients, in predicting recovery to consciousness and long-term functional outcome. Results With recovery to consciousness MMN-amplitudes increased. A sudden increase was seen in MMN amplitude when patients started to show inconsistent behavioural responses to simple commands. At this level MMN resembled the MMN response as was seen in the norm group. In addition, the MMN-amplitude and latency during the first measurement predicted the patients’ outcome on recovery to consciousness. Conclusions With recovery from VS to consciousness the ability to process auditory stimulus deviance increases. A sudden enhancement in MMN-amplitude preceded overt communication with the environment. This might be indicative of the consolidation of neural networks underlying overt communication. Moreover, MMN can be helpful in identifying the ability to recover from VS. Significance MMN can be used to track recovery from the vegetative state in the post-acute phase after severe brain injury. In addition, MMN can be used to predict the ability to recover from the vegetative state.
Pre-operative anxiety in children is very common and is associated with adverse outcomes.
The aim of this study was to investigate if virtual reality exposure (VRE) as a preparation tool for elective ...day care surgery in children is associated with lower levels of anxiety, pain and emergence delirium compared with a control group receiving care as usual (CAU).
A randomised controlled single-blind trial.
A single university children's hospital in the Netherlands from March 2017 to October 2018.
Two-hundred children, 4 to 12 years old, undergoing elective day care surgery under general anaesthesia.
On the day of surgery, children receiving VRE were exposed to a realistic child-friendly immersive virtual version of the operating theatre, so that they could get accustomed to the environment and general anaesthesia procedures.
The primary outcome was anxiety during induction of anaesthesia (modified Yale Preoperative Anxiety Scale, mYPAS). Secondary outcomes were self-reported anxiety, self-reported and observed pain, emergence delirium, need for rescue analgesia (morphine) and parental anxiety.
A total of 191 children were included in the analysis. During induction of anaesthesia, mYPAS levels (median IQR were similar in VRE, 40.0 28.3 to 58.3 and CAU, 38.3 28.3 to 53.3; P = 0.862). No differences between groups were found in self-reported anxiety, pain, emergence delirium or parental anxiety. However, after adenoidectomy/tonsillectomy, children in the VRE condition needed rescue analgesia significantly less often (55.0%) than in the CAU condition (95.7%) (P = 0.002).
In children undergoing elective day care surgery, VRE did not have a beneficial effect on anxiety, pain, emergence delirium or parental anxiety. However, after more painful surgery, children in the VRE group needed rescue analgesia significantly less often, a clinically important finding because of the side effects associated with analgesic drugs. Options for future research are to include children with higher levels of anxiety and pain and to examine the timing and duration of VRE.
Netherlands Trial Registry: NTR6116.
Purpose
Olaparib is a poly (ADP-ribose) polymerase (PARP) inhibitor indicated for ovarian and metastatic breast cancer. Increased serum creatinine levels have been observed in patients taking ...olaparib, but the underlying mechanism is unknown. This study aimed to investigate if patients receiving olaparib have increased creatinine levels during olaparib treatment and whether this actually relates to a declined glomerular filtration rate (GFR).
Methods
We retrospectively identified patients using olaparib at the Netherlands Cancer Institute – Antoni van Leeuwenhoek (NKI-AVL) from 2012 until 2020. Patients with at least one plasma or serum sample available at baseline/off treatment and during olaparib treatment were included. Cystatin C levels were measured, creatinine levels were available and renal function was determined by calculating the estimated glomerular filtration rate (eGFR) using the Creatinine Equation (CKD-EPI 2009) and the Cystatin C Equation (CKD-EPI 2012).
Results
In total, 66 patients were included. Olaparib treatment was associated with a 14% increase in median creatinine from 72 (inter quartile range (IQR): 22) μmol/L before/off treatment to 82 (IQR: 20) μmol/L during treatment (
p
< 0.001) and a 13% decrease in median creatinine-derived eGFR from 86 (IQR: 26) mL/min/1.73 m
2
before/off treatment to 75 (IQR: 29) mL/min/1.73 m
2
during treatment (
p
< 0.001). Olaparib treatment had no significant effect on median cystatin C levels (
p
= 0.520) and the median cystatin C–derived eGFR (
p
= 0.918).
Conclusions
This study demonstrates that olaparib likely causes inhibition of renal transporters leading to a reversible and dose-dependent increase in creatinine and does not affect GFR, since the median cystatin C–derived eGFR was comparable before/off treatment and during treatment of olaparib. Using the creatinine-derived eGFR can give an underestimation of GFR in patients taking olaparib. Therefore, an alternative renal marker such as cystatin C should be used to accurately calculate eGFR in patients taking olaparib.
Early life experiences are known to be of great importance for later life. For instance, exposure to stress during early life can increase fearfulness at later age. In broilers, delayed feeding after ...hatch may cause metabolic stress. Besides, delayed feeding after hatch may affect neonatal broiler development and thermogenesis and consequently preferred ambient temperature. Moreover, these effects of feeding strategy may be dependent on late incubation temperature. To study this, eggs (n = 1,338) from a 54-wk-old Ross broiler breeder flock were incubated at 37.8°C (control) or 36.7°C (lower) eggshell temperature (EST) during late incubation (≥ embryonic d 17). At hatch, two feeding strategies were applied (direct access (early feeding) or 51 to 54 h delayed access (delayed feeding)). Broilers (n = 960) were equally divided over 32 pens and grown for 3 wk. Stress was assessed by determination of corticosterone in blood at 0 h, 48 h, 96 h and d 21 after hatch. Fearfulness was assessed by tonic immobility at d 13. Temperature preference was assessed at d 2 and d 12. Broiler development was determined at 0 h, 48 h, and 96 h after hatch. There was no EST × feeding strategy interaction for any parameter (P ≥ 0.07). Early feeding resulted in a 2.5× lower plasma corticosterone concentration at 48 h (P < 0.01) and a 2.2°C and 2.0°C lower preference temperature for d 2 and d 12 respectively (P = 0.01) compared to delayed feeding. Tonic immobility was not affected. In conclusion, early feeding reduces exposure to stress in the short term and stimulates thermoregulatory ability of broilers in the longer term.
OBJECTIVES: To evaluate the effectiveness of Tai Chi Chuan in fall prevention in elderly people living at home with a high risk of falling.
DESIGN: Randomized controlled trial.
SETTING: Two ...industrial towns in the western part of the Netherlands.
PARTICIPANTS: Two hundred sixty‐nine elderly people (average age 77) living at home with a high risk of falling.
INTERVENTIONS: The intervention group received Tai Chi Chuan training for 1 hour twice a week for 13 weeks; the control group received usual care. Both groups received a brochure containing general information on how to prevent fall incidents.
MEASUREMENTS: Primary outcome was the number of falls over 12 months. Secondary outcomes were balance, fear of falling, blood pressure, heart rate at rest, forced expiratory volume during the first second, peak expiratory flow, physical activity, and functional status.
RESULTS: After 12 months, no lower fall risk in the Tai Chi Chuan group was observed than in the control group (adjusted hazard ratio=1.16; 95% confidence interval=0.84–1.60), and there were no significant intervention effects on the secondary outcome measures.
CONCLUSION: These results suggest that Tai Chi Chuan may not be effective in elderly people at a high risk of falling who live at home.
During incubation, development of embryos is affected by eggshell temperature (EST). A constant EST of 37.8°C has been considered so far to result in most optimal embryo development. However, it can ...be hypothesized that a higher EST in week 2 in combination with a lower EST in week 3 stimulates embryo development and subsequent grow-out performance. In this study, 468 eggs of a 44-week-old Ross 308 breeder flock were incubated at different incubation temperature patterns in a 2 × 2 factorial arrangement. In week 2, EST was either 37.8°C or 38.9°C, and in week 3, EST was either 37.8°C or 36.7°C. At hatch, chick quality was determined. Thereafter, 320 broilers were grown in 32 pens (8 replicates/treatment) for 6 wk. Weekly BW and ADFI were determined, and at day 40, slaughter yield from 128 broilers (4 per pen) was determined. Results showed that EST in week 2 did not interact with EST in week 3 for any variable. An EST of 38.9°C in week 2 resulted in a 1 mm longer chick length (P < 0.001) and 0.4 mmol/L lower blood glucose level (P = 0.04) at hatch than an EST of 37.8°C. Grow-out performance was not affected by EST in week 2 of incubation. An EST of 36.7°C in week 3 resulted in a 1 mm shorter chick length (P = 0.02), 1.0 mmol/L higher blood glucose level (P < 0.001), and higher relative heart (P = 0.01) and stomach weights (P = 0.03) at hatch than an EST of 37.8°C. Additionally, an EST of 36.7°C in week 3 resulted in lower BW, ADG, and ADFI on slaughter age (all P < 0.03) than an EST of 37.8°C. In conclusion, no interaction between EST in week 2 and 3 of incubation was found for any variable. A higher EST in week 2 had minor effects at hatching and during rearing, whereas a lower EST in week 3 seemed to result in better organ development, but resulted in lower grow-out performance.
Ecosystem-service indicators and related accounting units are crucial for the development of decision frameworks for sustainable land management systems. With a management concept using ecosystem ...services, land-use expectations can be linked to quantifiable soil features in a defendable and transparent way. A method to define a set of site-specific ecosystem services and indication system for quantification was set-up and run. First, we interviewed a wide group of land users profiting from ecosystem services of the soil at four arable farms in the polder Hoeksche Waard (S–SE of Rotterdam, the Netherlands). Subsequently, site-specific ecosystem services were defined and weighted according to land use expectations at different spatial and temporal scales. Second, a practical set of indicators was taken from ’Best Professional Judgment’ and used to quantify the performance of the ecosystem services for these four farms. The indicators were derived from biotic and abiotic soil parameters. The performance of ecosystem services was related to a reference situation (MEP: maximum ecological potential) with the same land use and soil type combination (i.e., arable fields on silt loam) taken from the database of our national soil survey. In many cases, the performance of ecosystem services was relatively poor if compared to MEP. However, the performances of natural attenuation and/or climate-related services were better. In addition, the different management of these farms (i.e. conventional, intensive and organic farming) was reflected in the performance of the ecosystem services of their soils. Third, land management measures to improve the targeted ecosystem services were incorporated in the outlined method, but not worked out with illustrative field data in this study. Together with concordant data, we show opportunities for a quantification of ecosystem services to improve land-users’ awareness and to assess management sustainability.
► We developed a methodology to valuate, quantify and assess land-based ecosystem services. ► As an example, we applied the method at four arable farms in the Netherlands. ► Stakeholders produced a set of weighted site-specific ecosystem services. ► The performance of ecosystem services at the farms was related to the farm management.
Eggshell temperature (EST) during incubation greatly affects embryo development, chick quality at hatch, and subsequently various broiler physiological systems. Until now, a constant EST of 37.8°C ...seems optimal. Data on effects of EST patterns on immune organ development and subsequent broiler immune response are, however, scarce. A higher EST of 38.9°C in week 2 and/or a lower EST of 36.7°C in week 3 of incubation potentially positively affect embryo immune organ development and broiler immune response post hatch. Broiler eggs (n = 468) were incubated at 4 different EST patterns (n = 117 eggs/treatment) from week 2 of incubation onward. Week 1 (embryonic age (E)0 < E7) EST was 37.8°C for all eggs. Week 2 (E7 < E14) EST was either 37.8°C (Control) or 38.9°C (Higher), and week 3 (E14 - /hatch) EST was either Control or 36.7°C (Lower). At hatch, histology of bursal follicles and jejunum villi and crypts were determined as well as heterophil to lymphocyte ratio (H:L) (n = 49). Posthatch, both sexes were grown in 8 pens/treatment for 6 wk (n = 320). Natural antibodies (NAb) were determined at day 14, 22, and slaughter (day 41 or 42) as an indicator of immunocompetence and response to a Newcastle disease (NCD) vaccination was determined by antibody levels at day 22 and slaughter (n = 128). Results showed no interaction EST week 2 × EST week 3, except for jejunum histology. Higher EST in week 2 resulted in lower cell density within bursal follicles (P = 0.02) and a tendency for lower H:L (P = 0.07) at hatch, and higher NCD titers at slaughter (P = 0.02) than Control EST. Lower EST in week 3 resulted at hatch in higher cell density within bursal follicles, higher H:L (both P < 0.05), and a tendency for a higher posthatch mortality rate than control EST (P = 0.10). In conclusion, higher EST in week 2 during incubation may benefit embryonic immune organ development and posthatch broiler immunocompetence, while lower EST in week 3 showed opposite indications.
In-transit metastases (ITM) are defined as metastatic lymph nodes or deposits occurring between the primary tumor and proximal draining lymph node basin. In extremity rhabdomyosarcoma (RMS), they ...have rarely been reported. This study evaluates the frequency, staging and survival of patients with ITM in distal extremity RMS.
Patients with extremity RMS distal to the elbow or knee, enrolled in the EpSSG RMS 2005 trial between 2005 and 2016 were eligible for this study.
One hundred and nine distal extremity RMS patients, with a median age of 6.2 years (range 0–21 years) were included. Thirty seven of 109 (34%) had lymph node metastases at diagnosis, 19 of them (51%) had ITM, especially in lower extremity RMS. 18F-FDG-PET/CT detected involved lymph nodes in 47% of patients. In patients not undergoing 18F-FDG-PET/CT lymph node involvement was detected in 22%. The 5-yr EFS of patients with ITM vs proximal lymph nodes vs combined proximal and ITM was 88.9% vs 21.4% vs 20%, respectively (p = 0.01) and 5-yr OS was 100% vs 25.2% vs 15%, respectively (p = 0.003).
Our study showed that in-transit metastases constituted more than 50% of all lymph node metastases in distal extremity RMS. 18F-FDG-PET/CT improved nodal staging by detecting more regional and in-transit metastases. Popliteal and epitrochlear nodes should be considered as true (distal) regional nodes, instead of in-transit metastases. Biopsy of these nodes is recommended especially in distal extremity RMS of the lower limb. Patients with proximal (axillary or inguinal) lymph node involvement have a worse prognosis.
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