The Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) Scale: Comprehensive Assessment of Psychopathology in Down Syndrome

People with Down syndrome (DS) are prone to develop Alzheimer’s disease (AD). Behavioral and psychological symptoms of dementia (BPSD) are core features, but have not been comprehensively evaluated in DS. In a European multidisciplinary study, the novel Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) scale was developed to identify frequency and severity of behavioral changes taking account of life-long characteristic behavior. 83 behavioral items in 12 clinically defined sections were evaluated. The central aim was to identify items that change in relation to the dementia status, and thus may differentiate between diagnostic groups. Structured interviews were conducted with informants of persons with DS without dementia (DS, n = 149), with questionable dementia (DS+Q, n = 65), and with diagnosed dementia (DS+AD, n = 67). First exploratory data suggest promising interrater, test-retest, and internal consistency reliability measures. Concerning item relevance, group comparisons revealed pronounced increases in frequency and severity in items of anxiety, sleep disturbances, agitation & stereotypical behavior, aggression, apathy, depressive symptoms, and eating/drinking behavior. The proportion of individuals presenting an increase was highest in DS+AD, intermediate in DS+Q, and lowest in DS. Interestingly, among DS+Q individuals, a substantial proportion already presented increased anxiety, sleep disturbances, apathy, and depressive symptoms, suggesting that these changes occur early in the course of AD. Future efforts should optimize the scale based on current results and clinical experiences, and further study applicability, reliability, and validity. Future application of the scale in daily care may aid caregivers to understand changes, and contribute to timely interventions and adaptation of caregiving.

[The behavioral and psychological symptoms of dementia in down syndrome (BPSD-DS) scale: comprehensive assessment of psychopathology in down syndrome]

Behavioral and psychological symptoms of dementia (BPSD) have not been comprehensively studied in people with Down syndrome, despite their high risk on dementia. A novel evaluation scale was developed to identify the nature, frequency and severity of behavioral changes (83 behavioral items in 12 clinically defined sections). Central aim was to identify items that change in relation to the dementia status. Structured interviews were conducted with informants of people with Down syndrome without dementia (DS, N = 149), with questionable dementia (DS + TD, N = 65) and with diagnosed dementia (DS + AD, N = 67). Group comparisons showed a pronounced increase in frequency and severity of items about anxiety, sleep disturbances, agitation & stereotypical behavior, aggression, apathy, depressive symptoms, and, eating/drinking behavior. The proportion of individuals presenting an increase was highest in the DS + AD group and lowest in the DS group. Interestingly, among DS + TD individuals, a substantial proportion already presented increased anxiety, sleep disturbances, apathy and depressive symptoms, suggesting that these changes may be early alarm signals of dementia. The scale may contribute to a better understanding of the changes, adapting daily care/support, and providing suitable therapies to people with Down syndrome. The scale needs to be optimized based on the results and experiences. The applicability, reliability and validity require further study.

Effect of outer water phase composition on oil droplet size and yield of (w1/o/w2) double emulsions

In this study the effect of various emulsifiers (whey protein isolate (WPI), Na-caseinate, and Tween 20) and thickeners (xanthan and pectin) present in the outer water phase, w₂, on oil droplet size and yield of the inner water phase, w₁, of (w₁/o/w₂) double emulsions was investigated. Double emulsions stabilized by Tween 20 had smaller oil droplet sizes and higher yields in comparison to emulsions stabilized by WPI and Na-caseinate. Gelation of the inner water droplets w₁ increased yield by 20% for all emulsifiers. Upon the addition of thickeners, the increasing viscosity of the outer water phase, w₂, facilitated oil droplet breakup. This resulted in smaller oil droplets and lower yields. When pectin was used as a thickener, in comparison to xanthan, an additional decrease in yield was observed. The yield decreased to values close to zero indicating that all inner water droplets w₁ were lost during emulsification. We conclude that type of hydrophilic emulsifier, properties of inner water droplets, viscosity ratio of continuous and dispersed phase, as well as type of thickener influence oil droplet size and yield of w₁ phase of double emulsions. This work provides a better understanding of how composition influences the properties of double emulsions and how this can be used to design double emulsions as fat replacers in more complex food systems.

Influence of double (w1/o/w2) emulsion composition on lubrication properties

This article focusses on the influence of composition (level of fat reduction, mechanical properties of w₁ droplets) on lubrication properties of double (w₁/o/w₂) emulsions.

Descriptive sensory profiling of double emulsions with gelled and non-gelled inner water phase

The use of double emulsions (w₁/o/w₂) has been acknowledged as a promising strategy to reduce oil content in several food applications. Despite the potential of double emulsions for oil reduction, their sensory properties have not been investigated. In this study, we investigated sensory perception of double emulsions by descriptive sensory profiling using a trained panel (n=11). Two sets of emulsions with either 30 or 50% dispersed phase fraction were studied. Each set differed in composition (gelled and non-gelled inner w₁ phase, gelatin as gelling agent) and fat reduction level (30 to 50%), but was similar in oil droplet size and viscosity. Fat reduction level depended on the amount of water droplets entrapped inside the oil droplets. Emulsions were evaluated on nine attributes describing taste (T), mouth-feel (MF) and after-feel (AF) perception, including thickness (MF), creaminess (MF, AF), fattiness (MF, AF), and cohesiveness (MF). The replacement of oil by small water droplets w₁ did not decrease the intensity of fat-related attributes. When inner w₁ droplets were gelled, 47wt.% of oil could be replaced while increasing the intensity of fat-related attributes. This indicates that the sensory perception of single and double emulsions with gelled and non-gelled w₁ phase is mainly determined by the total oil droplet surface area. The composition of the inner water phase (gelled or not) also influences the sensory perception of double emulsions. We conclude that fat reduction up to 47wt.% can be achieved in double emulsions while maintaining or enhancing fat-related sensory perception.

High amounts of broccoli in pasta-like products: nutritional evaluation and sensory acceptability

Pasta and noodles were enriched with concentrations of broccoli powder (BP) up to 30% (v/v). To ensure the benefits from the broccoli nutrients, their leakage during cooking should be prevented. Such leakage is determined by the microstructure. In a previous study we have shown that the microstructure can change dramatically in such broccoli-enriched products. In this article we investigated the amount of nutrients retained within the product. As a representative of nutrients we have chosen glucosinolates (GLs). Therefore, we have investigated the concentration of these phytochemicals in dried and cooked pasta and noodles. We have found that glucosinolates present in the pasta and noodles increase linearly with the volume fraction of BP up to 20%. At 30% BP the retained amount of GLs was equal to that of 20% BP and did not increase further. Therefore incorporation of 30% BP does not lead to additional health benefits over incorporation of 20% BP. We conclude that the nutritional function of our pasta-like products can be improved by enrichment up to 20% broccoli. This value is much higher than that found in common commercial products (which is a few percent). In this article we also briefly address the sensory acceptability of such products. Up to 20% broccoli the products turned out to remain acceptable. Combining this with our results on texture analysis we conclude that the GLs release, sensory acceptability and textural properties are related via the microstructure.

Experimental orthotopic small bowel transplantation: a revised model

Small bowel transplantation is emerging as an alternative treatment for end-stage intestinal failure. To date, immunological and technical problems are still hampering clinical success. Functional experimental small bowel transplantation models have traditionally been plagued with a high technical complication rate. The purpose of this study was to describe in detail the harvesting and transplantation procedure in rats. In this paper the technical aspects of the one-stage, isogenic orthotopic partial small bowel transplantation model with systemic drainage are illustrated. Because of the achieved acceptable survival rate and the favourable functional outcome, the model is considered reliable and reproducible.

A scale to assess activities of daily living in persons affected by leprosy

The aim of this study was to develop a scale for identifying disability among people in the rural areas of developing countries. The studies were carried out in the Green Pastures Hospital and the leprosy field programme of the Western Region of Nepal. With the help of staff experienced in working with people with disability, a 68-question questionnaire was made, based on the International Classification of Impairments, Activities and Participation (ICIDH-2). A survey was carried out of 269 people affected by leprosy who had impairments, as well as a sample of those who were unimpaired. The survey results were used to develop the questionnaire into a scale, using standard scale development methods. This included checking of criterion validity, discrimination and reliability and stability using weighted kappa statistics. Of the 68 questions, 38 were included in the second draft of the instrument. Eight questions were added to identify difficulty in relationships, about the use of aids and about occupation and employment. The sum score of the scale against the expert score gave a Spearman correlation coefficient of 0.72. Intra- and inter-interviewer reliability coefficients were 0.77 (95% CI 0.73-0.81) and 0.61 (95% CI 0.56-0.67), respectively. The stability test gave an overall kappa of 0.76 (95% CI 0.70-0.82). Four questions with particularly poor results were omitted from the final draft of the instrument. An interview-based instrument was developed for identifying limitations in activities of daily living (disability) in people living in a rural setting in a developing country--the Green Pastures Activity Scale (GPAS). The scale performed well during validity and reliability testing. It consists of 34 activity questions, five relationship questions, and three questions on the use of aids, occupation and employment.

Thauera mechernichensis sp. nov., an aerobic denitrifier from a leachate treatment plant

A heterotrophic bacterial strain TL1T capable of aerobic denitrification was previously enriched in continuous culture from a landfill leachate treatment plant and isolated as a pure culture. The taxonomic position of this isolate within the beta-subclass of the Proteobacteria was determined by 16S rDNA sequence analysis and by conventional taxonomy including substrate spectrum, quinone type (ubiquinone Q-8) and cellular fatty acid composition. Detection of the specific polyamine 2-hydroxyputrescine supports the membership of strain TL1T in the beta-subclass of the Proteobacteria. The results of 16S rDNA sequencing showed that the strain clustered with, but was separate from, Thauera aromatica and Thauera selenatis. DNA-DNA hybridization experiments indicated that the new isolate represents a new species of the genus, for which the name Thauera mechernichensis is proposed; the type strain is DSM 12266T.

[Liposuction]

Liposuction is a frequently applied technique in aesthetic plastic surgery, with which subcutaneous adipose tissue can be removed. In recent decades new techniques of liposuction were developed. This led to better results and fewer complications. Liposuction is indicated as symptomatic treatment of obesity and (or) lipomas. Liposuction is not without risks; patients have to be informed of practical consequences and possible complications of the technique.

[Iatrogenic cicatricial endometriosis]

A woman aged 36, who two years previously had undergone a caesarean section, developed a painful swelling of the scar attributed to cicatricial endometriosis. This is a rare disorder brought about by peroperative displacement of normally or ectopically situated uterine mucous membrane to the surgical wound. There, it may proliferate and cause characteristic signs and symptoms that are simple to diagnose: cyclic pain, swellings and sometimes, bleedings. Pharmaceutical, possible hormonal treatment is of limited value, because cessation of the medication is frequently followed by recurrences. Consequently, ample surgical excision in endometriosis is to be preferred; this is to be regarded as a curative therapy.

Look-back of anti-HCV ELISA-positive, HCV-RNA PCR-negative donors and recipients of their blood products

BACKGROUND AND OBJECTIVES

To establish the infectivity of anti-HCV ELISA-positive, but cDNA-PCR-negative blood components transfused before the introduction of routine anti-HCV blood donor screening, we enrolled recipients of such blood products in a look-back programme.

MATERIALS AND METHODS

The blood components were donated by (A) RIBA-2-indeterminate and cDNA-PCR-negative donors, and (B) RIBA-2 and cDNA-PCR-negative donors. The look-back comprised 214 blood products from group A donors and 278 from group B.

RESULTS

Of 211 recipients of group A components, 66 (31.3%) were available for testing. All other recipients could not be traced, had died, or refused collaboration. Of these 66, 3 patients had independent risk factors for HCV infection and were excluded. All remaining 63 recipients were anti-HCV ELISA-negative. Of 274 recipients of group B components, 84 (30.7%) were available for testing. All others could not be traced, had died, or refused collaboration. Of these 84, six patients had an independent risk factor for HCV infection and were excluded. All remaining 78 recipients were anti-HCV ELISA-negative. None of the recipients of blood products from previous donations of anti-HCV ELISA-positive, cDNA-PCR-negative, and RIBA-2-indeterminate or negative donors were HCV-infected.

CONCLUSIONS

Donors and patients with such reactivities in anti-HCV ELISA, RIBA-2, and cDNA-PCR can be assured that they are not infected with HCV. The donors involved can re-enter the donor pool, provided that future donations are anti-HCV ELISA-negative.

Preputial necrosis as an unusual cutaneous manifestation of cholesterol crystal embolization

We report a case of the cholesterol crystal embolization syndrome concomitant with an unusual cutaneous localization. Extensive embolization of cholesterol crystals caused severe necrosis of the prepuce. Circumcision was performed and histopathological examination confirmed the diagnosis.

Look-back study of infectivity of anti-HCV ELISA-positive blood components

The infectivity of blood components from donors who were later found to be anti-HCV ELISA-positive was investigated in recipients who were enrolled in a look-back programme. Recipients received ELISA-positive blood components from donors who were PCR-positive and/or RIBA-2-positive (n = 22, group A) or PCR-negative and indeterminate or negative on RIBA-2 (n = 105, group B). 26 of 32 (81%) recipients of group A donors and none of 140 of group B were HCV-infected. All stored serum samples of previous donations (n = 172) of group A donors were anti-HCV-positive in RIBA-3, indicating a chronic carrier state of HCV in these donors.

Electrohydraulic-clamshell heart with energy converter inside the compliance reservoir

Two new ideas on the electrohydraulic actuation of blood pumps have been combined. The first idea was to put the energy converters that propel the hydraulic fluid inside the compliance reservoir instead of having them separate. Compactness of the device and better cooling of the energy converter by the surrounding fluid are two major advantages of this approach. Secondly, we put the pumping membrane inside a clamshell that fits over a soft ventricle (1). The ventricle can be implanted first, after which the shell is slid over it. These two ideas have resulted in devices described in this paper. Preliminary in vitro and in vivo data are presented.