Beatrix Kinderziekenhuis

IntroductionInguinal hernia repair is one of the most frequently performed operations in the paediatric population and can be performed according to two approaches: open or laparoscopic. At present, decisive evidence about the best treatment strategy is lacking and consequently, there is an ongoing debate about the most (cost-)effective treatment for the paediatric inguinal hernia. The aim of the Hernia Endoscopic oR opeN repair In chIldren Analysis—trial (HERNIIA2-trial) is to estimate the (cost-)effectiveness of the laparoscopic percutaneous internal ring suturing (PIRS) technique compared with open repair in children aged 0–16 years with a primary unilateral inguinal hernia.Methods and analysisA national multicentre randomised controlled trial will be performed including 464 children aged 0–16 years with a primary unilateral inguinal hernia. Patients will be randomised between the open or PIRS technique. The primary outcome is the number of reoperations within 2 years after primary surgery. Secondary outcome measures are: operative and postoperative complications, total duration of surgery, postoperative pain, length of admission, time to normal daily activities, cosmetic appearance of the scar, social and healthcare costs and health-related quality of life. Furthermore, cost-effectiveness will be assessed from a societal and healthcare perspective.Ethics and disseminationThe protocol was approved by the ethics committee of the Amsterdam University Medical Hospital. Informed consent will be obtained by parents and, if possible, according to age, by patient. The study will be conducted according to the principles of the Declaration of Helsinki (2013) and in accordance with the Medical Research Involving Human Subjects Act (WMO) and Good Clinical Practice. Study findings will be disseminated through scientific publications, conferences and patient-friendly materials. The national study network of participating centres will facilitate rapid dissemination and implementation within the Netherlands and potentially abroad.Trial registration numberClinicalTrials.gov PRS (ID NCT06451432).

Varroa destructor ist ursprünglich ein Parasit der östlichen Honigbiene Apis cerana, der auf die westliche Honigbien Apis melifera übergegangen ist. Varroa destructor ist die Hauptursache für Bienenvölkerverluste in Deutschland. Bewirtschaftete Bienenvölker werden behandelt. Eine Selektion auf Wirtsresistenz und Toleranz der Bienen wird dadurch verhindert. Blacquière et. al. stellen 2019 einen Entwurf für einen natürlichen Selektionsweg vor, Darwinian black box selection [1]. Dieser Ansatz wird in einem von der EU geförderten Projekt (Better-B) in 8 Ländern verfolgt [2]. Eine Population von 25 Bienenvölkern wird in einem abgelegenen Gebiet möglichst ohne genetischen Einfluss von Völkern von außerhalb vermehrt. Die Bienenvölker werden nicht gegen die Varroamilbe behandelt. Die Volksentwicklung und der Varroabefall werden beobachtet. Bienenvölker, die behandelt werden müssen, werden aus dem Projekt entfernt. Ende Mai wurden 100 Ableger gebildet. Circa 70 wurden eingewintert. 17 Völker haben den Winter überlebt und sind die Ausgangspopulation für die weitere Selektion.

An increase in pediatric cases of invasive group A streptococcus (iGAS) disease was noted in the Netherlands starting in early 2022. GAS disease can range from mild to life-threatening invasive infections. Clinical and public health decisions rely on timely and detailed reporting of clinical data. To determine risk factors associated with severe pediatric iGAS, defined as requiring admission to an intensive care unit and/or death, and to analyze pediatric iGAS incidence, presentations, and outcome between pre-COVID-19 pandemic (January 2015 to March 2020), COVID-19 pandemic (April 2020 to December 2021), and post-COVID-19 pandemic (January 2022 to June 2024) periods. This observational, retrospective and prospective cohort study in 20 hospitals (tertiary and nontertiary) in the Netherlands was conducted from January 2015 to June 2024, with real-time reporting of data on the study website since January 2022. Children aged 0 to 17 years with iGAS (positive culture or polymerase chain reaction test and/or clinical presentation) were included. iGAS infection. The primary outcome was risk factors for severe iGAS; secondary outcomes included iGAS incidence rate and clinical phenotypes prior, during, and after the COVID-19 pandemic. Risk factors for severity and mortality were analyzed using univariable and multivariable logistic regression analyses, and incidence rate ratios (IRRs) between pre-COVID-19 and postCOVID-19 pandemic periods were calculated using Poisson regression. Of 617 children included, 351 (56.9%) were aged 0 to 4 years. For the 192 participants with detailed data collection, median (IQR) age was 4.2 (1.7-7.1) years and 91 (47.4%) were male. iGAS cases decreased during the COVID-19 pandemic and increased significantly in the post-COVID-19 period (IRR, 2.93; 95%, 2.46-3.49), as compared with the pre-COVID-19 pandemic period. By late 2023, the incidence of iGAS returned to pre-COVID-19 pandemic levels. Factors associated with increased risk of severe disease included a post-COVID-19 pandemic diagnosis (odds ratio [OR], 3.49; 95% CI, 2.31-6.26), pulmonary involvement (OR, 8.64; 95% CI, 5.50-13.55), streptococcal toxic shock syndrome (STSS; OR, 11.71; 95% CI, 4.39-31.18), and meningitis or encephalitis (OR, 4.38; 95% CI, 4.39-31.18). Clinical factors associated with increased risk of severe disease were reduced consciousness (OR, 7.61; 95% CI, 1.84-34.41), dyspnea (OR, 9.89; 95% CI, 3.04-32.14), abnormal auscultation (OR, 6.32; 95% CI, 2.18-18.32), and elevated C-reactive protein (OR, 6.32; 95% CI, 2.18-18.32), while estimated glomerular filtration rate was associated with a decreased risk (OR, 0.64; 95% CI, 0.49-0.84). Disease severity increased in post-COVID-19-pandemic cases, with higher mortality (13 of 294 cases [4.4%] vs 3 of 218 cases [1.4%]) and intensive care admission rates (113 of 294 cases [38.4%] vs 34 of 218 cases [15.6%]), as compared with pre-COVID-19 pandemic cases. Severity of pulmonary iGAS was similar in both periods. In the post-COVID-19 pandemic period, there was a significant increase in the incidence of pulmonary infections (IRR, 5.04; 95% CI, 3.27-7.97) , STSS (IRR, 10.30; 95% CI, 3.88-35.60), meningitis or encephalitis (IRR, 12.30; 95% CI, 4.14-52.70), and necrotizing fasciitis (IRR, 26.10; 95% CI, 5.14-475.00). In this cohort study, risk factors for a complicated course of iGAS in children included pulmonary or central nervous system involvement, STSS, reduced consciousness or pulmonary clinical signs, elevated CRP, and decreased eGFR. Awareness of these risk factors is important to improve timely recognition of at-risk cases and improve clinical outcomes.

Biological control of seedborne pathogens and soilborne seedling pathogens through antagonists applied on seeds is an alternative to chemical seed treatments. The survival of coated microorganisms during the various seed processing, storage and distribution steps is essential for the use of beneficial fungi or bacteria on seeds. A study was done to gain insight into the survival potential and variability in survival of representatives of different microbial groups during storage of coated seeds of different crops. Survival of inocula on seeds of Brassica, onion, spinach and perennial ryegrass was tested by plating and for a subset of coated seeds by viability qPCR. A close correlation was found for CFU counts per seed and the estimated number of viable conidia based on strain-specific or generic fungal viability qPCR for conidia of Cladosporium cladosporioides H39 coated on various seed lots. For Lysobacter enzymogenes 3.1 T8, viability qPCR showed survival of cells on coated seeds. However, only few colonies were produced on Tryptone soy agar. Generic fungal and bacterial qPCR and viability qPCR assays with non-coated seeds indicated that only a proportion of the seed microbiota, frequently less than 10 %, are viable. Survival of inocula coated on seeds and stored for three to six months differed between applied microbial groups, formulation of inocula and between laboratories conducting the experiments. From the obtained results it can be concluded that there is a promising potential to improve the often envisaged low survival of inocula coated on seeds. Improved strains selection, improved and adapted seed processing technologies, and developing expertise in microbial seed processing will allow the use of a broader range of fungal and bacterial groups. The application of viability qPCR will support this development as a fast and reliable tool to monitor the survival of microbial inocula coated on seeds.

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To estimate the probability of long-term nonprogression (LTNP) in the absence of antiretroviral treatment (ART) in children with perinatally acquired HIV, and the impact of LTNP definitions on these estimates. Analysis of longitudinal routine care data (follow-up to 2016) collected through a collaboration of cohorts of children in routine HIV care across Europe and Thailand. LTNP was defined as reaching age 8 years without disease progression (defined as an AIDS diagnosis or immunosuppression based on WHO immunosuppression-for-age thresholds, age-adjusted CD4 +z -scores or CD4 + counts). ART initiation was treated as a competing risk (children initiating ART before age 8 were not considered to have LTNP). We included children born domestically in six national HIV cohorts ( n = 2481). Additional analyses included domestic-born children enrolled in national cohorts in infancy (aged <12 months, n = 1144, six cohorts), or all domestic-born children in national and nonnational cohorts ( n = 4542, 18 cohorts). Results were stratified by birth year. Among children born domestically in national cohorts in 2004-2007, the probability [95% confidence interval (CI)] of LTNP at age 8 years was 10% (6-15%) based on WHO immunosuppression-for-age criteria. This was lower for children born earlier when ART use was less frequent. Results were similar using other immunosuppression thresholds. Estimates were lower when restricted to domestic-born children in national cohorts enrolled in infancy, and higher when including all domestic-born children. Up to 10% of children born during 2004-2007 had LTNP at age 8. Our findings may help identify participants with LTNP for research into posttreatment control and HIV cure.

Wind energy development is a key component of climate change mitigation. However, birds collide with wind turbines, and this additional mortality may negatively impact populations. Collision risk could be reduced by informed selection of turbine dimensions, but the effects of turbine dimensions are still unknown for many species.As analyses of mortality data have several limitations, we applied a simulation approach based on flight height distributions of six European raptor species. To obtain accurate flight height data, we used high-frequency GPS tracking (GPS tags deployed on 275 individuals). The effects of ground clearance and rotor diameter of wind turbines on collision risk were studied using the Band collision risk model.Five species had a unimodal flight height distribution, with a mode below 25 m above ground level, while Short-toed Eagle showed a more uniform distribution with a weak mode between 120 and 260 m. The proportion of positions within 32–200 m ranged from 11 % in Marsh Harrier to 54 % in Red Kite.With increasing ground clearance (from 20 to 100 m), collision risk decreased in the species with low mode (−56 to −66 %), but increased in Short-toed Eagle (+38 %). With increasing rotor diameter (from 50 to 160 m) at fixed ground clearance, the collision risk per turbine increased in all species (+151 to +558 %), while the collision risk per MW decreased in the species with low mode (−50 % to −57 %).These results underpin that wind turbine dimensions can have substantial effects on the collision risk of raptors. As the effects varied between species, wind energy planning should consider the composition of the local bird community to optimise wind turbine dimensions. For species with a low mode of flight height, the collision risk for a given total power capacity could be reduced by increasing ground clearance, and using fewer turbines with larger diameter.

<bold>Background:</bold> Ethnic minorities have worse health outcomes, but the relationship between ethnicity, disease burden, and gut bacteriome in children with moderate-to-severe asthma/wheezing remains unclear. <bold>Methods:</bold> Pooled analysis was performed using 3 pediatric study populations (U-BIOPRED, SysPharmPediA, and PUFFIN) with moderate-to-severe asthma/wheezing. Self-reported ethnic groups were compared in asthma burden based on exacerbations requiring hospitalizations, ICU/ER visits, and (c)ACT/PA(C)QLQ questionnaire z-scores. Gut bacteriome was analyzed in feces by metagenomics in 2 populations (SysPharmPediA, PUFFIN), comparing ethnic groups in α- and β-diversities, and whether α-diversity has a mediating link between race and disease burden. All analyses were adjusted for potential confounders. <bold>Results:</bold> Non-white children (n=95/420, mean age=9.8±3.7, 55% male) exhibited a higher risk for hospitalizations/ER-visits (adj OR=2.8, 95%CI=1.5-5.2) and lower (c)ACT/PA(C)QLQ z-scores (adj β =-0.40, 95%CI=-0.63,-0.17, and −0.31, 95%CI=-0.54,-0.09, respectively). They (n=37/180) also showed distinct gut bacteriome composition compared to White patients with lower Shannon diversity (adj β=-0.41, 95%CI=-0.68,-0.15) and significantly different β-diversity (R²=0.01, p<0.05). Shannon diversity partially mediated the link between race and hospitalizations/ER-visits (proportion mediated=0.17, 95%CI=0.01, 0.55), but not to asthma control or quality of life. <bold>Conclusion:</bold> Ethnic minorities have a higher asthma burden and lower gut bacterial diversity. However, the gut bacteriome diversity only showed a modest association between race and asthma burden, suggesting that additional factors play a role.