Health-related quality of life of X-linked hypophosphatemia in Spain

BACKGROUND

Health-related quality of life (HRQoL) of patients with X-linked hypophosphatemia (XLH) is lower than that of both the general population and the patients with other chronic diseases, mainly due to diagnostic delay, treatment difficulties, poor psychosocial support, and problems with social integration. Early diagnosis and optimal treatment are paramount to control the disease in patients with XLH, avoid complications, and maintain or improve their HRQoL. We, therefore, analyzed the HRQoL of pediatric and adult patients with XLH treated with conventional therapy in Spain.

RESULTS

We used several versions of the EuroQol-5 dimensions (EQ-5D) instrument according to the age of patients with XLH. Then we compared the HRQoL of patients to that of the general Spanish population. Children with XLH (n = 21) had moderate problems in walking about (61.9%), washing or dressing themselves (9.52%), and performing their usual activities (33.33%). They also felt moderate pain or discomfort (61.9%) and were moderately anxious or depressed (23.81%). Adults with XLH (n = 29) had lower HRQoL, with problems in walking (93%, with 3.45% unable to walk independently), some level of pain (86%, with 3.45% experiencing extreme pain), problems with their usual activities (80%) and self-care (> 50%), and reported symptoms of anxiety and/or depression (65%). There were important differences with the general Spanish population.

CONCLUSIONS

XLH impacts negatively on physical functioning and HRQoL of patients. In Spanish patients with XLH, the HRQoL was reduced despite conventional treatment, clearly indicating the need to improve the therapeutic approach to this disorder.

Acute recurrent pancreatitis complicated by pancreatic-portal venous fistulisation, secondary chronic portal vein thrombosis, multiple hepatic abscesses and newly diagnosed cirrhosis

Pancreatic-portal vein fistula, portal vein thrombosis and liver abscesses are rare complications of acute pancreatitis which occur in the setting of localised inflammation of the pancreatic tissues and surrounding structures. We discuss a 34-year-old woman with a medical history of intermittently controlled HIV and alcohol use disorder who presents with severe epigastric pain diagnosed with acute pancreatitis. Concerning CT findings showing hypoattenuating liver lesions likely to be abscesses and multiple pancreatic pseudocysts led us to order an MRI which showed thrombosis of the portal vein, porto-pancreatic pseudocyst fistulation and cirrhotic changes. Patient was treated conservatively in the hospital and ultimately given a course of antibiotics for hepatic abscesses. Workup for new diagnosis of cirrhosis revealed positive antimitochondrial antibodies, raising suspicion for autoimmune hepatitis possibly triggered by immune reconstitution in the setting of HIV infection. Patient was discharged on oral antibiotic therapy and home antiretroviral therapy.

Non-reproducible signals of adaptation to elevation between open and understorey microhabitats in snapdragon plants

Experimental studies on local adaptation rarely investigate how different environmental variables might modify signals of adaptation or maladaptation. In plant common garden experiments, signals of adaptation or maladaptation to elevation are usually investigated in open habitats under full light. However, most plants inhabit heterogeneous habitats where environmental conditions differ. Understorey microhabitats are common and differ in terms of tree shade, temperature, water availability, microbiota, allelochemicals etc. Germination is a fitness-related trait of major importance for the adaptation of plants to contrasted climate conditions. It is affected by shade in snapdragon plants (Antirrhinum majus) and many other plant species. Here, we tested for the reproducibility of signals extrapolated from germination results between open and understorey microhabitats in two parapatric snapdragon plant subspecies (A. m. striatum and A. m. pseudomajus) characterized by a similar elevation range by using common garden experiments at different elevations. Signals observed under one microhabitat systematically differed in the other. Most scenarios could be inferred, with signals either shifting, appearing or disappearing between different environments. Our findings imply that caution should be taken when extrapolating the evolutionary significance of these types of experimental signals because they are not stable from one local environmental condition to the next. Forecasting the ability of plants to adapt to environmental changes based on common garden and reciprocal transplant experiments must account for the multivariate nature of the environment.

Angular Momentum Removal by Neutron and γ-Ray Emissions during Fission Fragment Decays

We investigate the angular momentum removal from fission fragments (FFs) through neutron and γ-ray emission, finding that about half the neutrons are emitted with angular momenta ≥1.5ℏ and that the change in angular momentum after the emission of neutrons and statistical γ rays is significant, contradicting usual assumptions. Per fission event, in our simulations, the neutron and statistical γ-ray emissions change the spin of the fragment by 3.5-5ℏ, with a large standard deviation comparable to the average value. Such wide angular momentum removal distributions can hide any underlying correlations in the fission fragment initial spin values. Within our model, we reproduce data on spin measurements from discrete transitions after neutron emissions, especially in the case of light FFs. The agreement further improves for the heavy fragments if one removes from the analysis the events that would produce isomeric states. Finally, we show that while in our model the initial FF spins do not follow a sawtoothlike behavior observed in recent measurements, the average FF spin computed after neutron and statistical γ emissions exhibits a shape that resembles a sawtooth. This suggests that the average FF spin measured after statistical emissions is not necessarily connected with the scission mechanism as previously implied.

[Metastatic Crohn's disease of the umbilicus: An exceptional location]

INTRODUCTION

Cutaneous manifestations of Crohn's disease are frequent and include metastatic lesions. These are separated from the digestive tract and affect particularly the limbs and major folds. Umbilical involvement is exceptional.

CASE REPORT

A 93-year-old woman followed for 6 years for Crohn's disease, in remission on infliximab, 5mg/kg every 8 weeks, consulted for a fissured and painful omphalitis. Histology revealed epithelioid granulomas without necrosis in the dermis, leading to the diagnosis of umbilical cutaneous metastasis of Crohn's disease. Infliximab intensification every 6 weeks led to a positive outcome.

CONCLUSION

We report a unique case of umbilical metastatic localization of Crohn's disease occurring during treatment with anti-TNF alpha. The diagnosis was based on skin biopsy and histology which found epithelioid granulomas without caseous necrosis.

Phenotypic Response to Light Versus Shade Associated with DNA Methylation Changes in Snapdragon Plants (Antirrhinum majus)

The phenotypic plasticity of plants in response to change in their light environment, and in particularly, to shade is a schoolbook example of ecologically relevant phenotypic plasticity with evolutionary adaptive implications. Epigenetic variation is known to potentially underlie plant phenotypic plasticity. Yet, little is known about its role in ecologically and evolutionary relevant mechanisms shaping the diversity of plant populations in nature. Here we used a reference-free reduced representation bisulfite sequencing method for non-model organisms (epiGBS) to investigate changes in DNA methylation patterns across the genome in snapdragon plants (Antirrhinum majus L.). We exposed plants to sunlight versus artificially induced shade in four highly inbred lines to exclude genetic confounding effects. Our results showed that phenotypic plasticity in response to light versus shade shaped vegetative traits. They also showed that DNA methylation patterns were modified under light versus shade, with a trend towards global effects over the genome but with large effects found on a restricted portion. We also detected the existence of a correlation between phenotypic and epigenetic variation that neither supported nor rejected its potential role in plasticity. While our findings imply epigenetic changes in response to light versus shade environments in snapdragon plants, whether these changes are directly involved in the phenotypic plastic response of plants remains to be investigated. Our approach contributed to this new finding but illustrates the limits in terms of sample size and statistical power of population epigenetic approaches in non-model organisms. Pushing this boundary will be necessary before the relationship between environmentally induced epigenetic changes and phenotypic plasticity is clarified for ecologically relevant mechanisms with evolutionary implications.

Potential adaptive divergence between subspecies and populations of snapdragon plants inferred from QST -FST comparisons

Phenotypic divergence among natural populations can be explained by natural selection or by neutral processes such as drift. Many examples in the literature compare putatively neutral (F_ST ) and quantitative genetic (Q_ST ) differentiation in multiple populations to assess their evolutionary signature and identify candidate traits involved with local adaptation. Investigating these signatures in closely related or recently diversified species has the potential to shed light on the divergence processes acting at the interspecific level. Here, we conducted this comparison in two subspecies of snapdragon plants (eight populations of Antirrhinum majus pseudomajus and five populations of A. m. striatum) in a common garden experiment. We also tested whether altitude was involved with population phenotypic divergence. Our results identified candidate phenological and morphological traits involved with local adaptation. Most of these traits were identified in one subspecies but not the other. Phenotypic divergence increased with altitude for a few biomass-related traits, but only in A. m. striatum. These traits therefore potentially reflect A. m. striatum adaptation to altitude. Our findings imply that adaptive processes potentially differ at the scale of A. majus subspecies.

Hyaluronic acid treatment outcome on the post-extraction wound healing in patients with poorly controlled type 2 diabetes: A randomized controlled split-mouth study

Background

Hyaluronic acid is widely used in the medical field. However, there is a lack of research about its effect on patients with certain risks, such as compromised wound healing commonly found in patients with poorly controlled type 2 diabetes. The aim of this study is to investigate the efficacy of hyaluronic acid on the post-extraction wound healing and pain in patients with poorly controlled type 2 diabetes.

Material and Methods

The randomized controlled split-mouth study was designed, which included 30 patients with poorly controlled type 2 diabetes with a bilaterally same teeth in the lower jaw for extraction. The sockets treated with 0.8% hyaluronic acid represented the study group, while the sockets where hyaluronic acid was not applied represented the control group. Wound closure rate (WCR), clinical scores in wound healing scale (WHS) and pain intensity in Visual analogue scale (VAS) were recorded. Patients were followed up on 5th, 10th, 15th, 20th, 25th day after tooth extraction.

Results

The results showed a higher WCR at the extraction site where hyaluronic acid was applied. Also, statistically significant difference was found (p< 0.001). In regards to WHS, the sockets treated with hyaluronic acid showed better healing, especially on day 10 (p=0.006) and day 15 (p=0.021). However, there were no statistically significant differences in VAS scores between groups.

Conclusions

Hyaluronic acid placed in post-extraction socket in patients with poorly controlled diabetes may improve wound healing, especially in the first days after application.

Key words:Hyaluronic acid, type 2 diabetes mellitus, post-extraction wound healing, wound closure measurement.

Vulvar endometriosis in the setting of a traumatic neuroma

Endometriosis is a rare documented source of vulvar pain. Extra-pelvic endometriosis and traumatic neuromas have been reported in individual cases as a source of pain in procedure-related scars following gynecologic surgery. However, the presence of vulvar endometriosis within a traumatic neuroma has not been documented before. We describe a case of a 42-year-old woman who presented with a chronic vulvar nodule that became swollen, painful, and pruritic 10 years following a Bartholin’s gland excision. Excision of the lesion was performed, and histological analysis revealed a traumatic neuroma with an embedded focus of endometriosis. The patient had complete resolution of her symptoms following excision. Endometriosis within a traumatic neuroma should be considered as a possible diagnosis in a post-operative scar that becomes painful, swollen, or pruritic in a cyclic nature. Surgical excision with routine and immunohistochemical pathologic analysis aids in the successful diagnosis and treatment.

The effectiveness of decompression as initial treatment for jaw cysts: A 10-year retrospective study

Background

Decompression is an approved alternative to cystectomy in the treatment of jaw cysts. This study aimed to evaluate its effectiveness as an initial procedure, as well as factors with potential to influence outcome.

Material and Methods

The frequency of decompression was analysed, whether completed in one session or followed by enucleation at the Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, from 2005 to 2015. Further analysis focussed on factors potentially influencing outcome: cyst location, histopathology, means of preserving the cyst opening, cyst size, patient age.

Results

In all, 53 patients with 55 jaw cysts (mean age of 35.1) were treated by initial decompression in the ten-year period. In the majority of cases, histopathological analysis revealed a follicular cyst (43.6%), followed by odontogenic keratocysts (23.7%), radicular cysts (21.8%), residual cysts (7.3%) and nasopalatine cysts (3.6%) Treatment was completed with a single decompression in 45.5% of the cases. Among those, 72.0% were follicular cysts and 8.0% odontogenic keratocysts. Subsequent enucleation was needed in 54.5% of all cases, with a majority in the keratocystic group (36.7%). Histological findings, means of keeping the cyst open, and patient age were found to influence the effectiveness of decompression.

Conclusions

Decompression could be performed as a procedure completed in one session or combined with subsequent enucleation, mainly dependent on histopathological findings. Subsequent enucleation of odontogenic keratocysts is highly recommended.

Key words:Jaw cysts, decompression, enucleation, histopathology, obturator.

Successful desensitization to cloxacillin in a patient with sepsis, with infective endocarditis and clinical suspicion of hypersensitivity to penicillins, a case report

WHAT IS KNOWN AND OBJECTIVE

Beta-lactam antibiotic (BLA) therapy is frequently needed to treat infective endocarditis (IE). Hypersensitive reactions to BLA restrict BLA therapy in allergic patients. In the current case, we aim to describe the utility of desensitization (DS) in this context. Although the evidence is limited, DS is recommended.

CASE DESCRIPTION

This case report deals with a 79-year-old woman with a clinical suspicion of allergy to BLA and a methicillin-sensitive Staphylococcus aureus (MSSA) IE. A cloxacillin DS protocol was developed to enable treatment with cloxacillin.

WHAT IS NEW AND CONCLUSION

Alternative antibiotic treatments may be less effective or not available in MSSA IE. In this case report, DS allowed optimal cloxacillin treatment.

Modelling the effect of pH and water activity in the growth of Aspergillus fumigatus isolated from corn silage

AIMS

The aim of this work was to use mathematical kinetic modelling to assess the combined effects of a_W, pH, O₂ availability and temperature on the growth rate and time to growth of Aspergillus fumigatus strains isolated from corn silage.

METHODS AND RESULTS

A full factorial design was used in which two factors were assayed: pH and a_W . The a_W levels assayed were 0·80, 0·85, 0·90, 0·92, 0·94, 0·96, 0·98 and 0·99. The levels of pH assayed were 3·5, 4, 4·5, 5, 6, 7, 7·5 and 8. The assay was performed at normal oxygen tension at 25 and 37°C, and at reduced oxygen tension at 25°C. Two strains of A. fumigatus isolated from corn silage were used. Kinetic models were built to predict growth of the strain under the assayed conditions. The cardinal models gave a good quality fit for radial growth rate data. The results indicate that the environmental conditions which take place during silage production, while limiting the growth of most micro-organisms, would not be able to control A. fumigatus. Moreover, pH levels in silage, far from limiting its growth, are also close to its optimum. Carbon dioxide at 5% in the environment did not significantly affect its growth.

CONCLUSIONS

A need for a further and controlled acidification of the silage exists, as no growth of A. fumigatus was observed at pH 3·5, as long as the organoleptic characteristics of the silage are not much compromised.

SIGNIFICANCE AND IMPACT OF THE STUDY

Aspergillus fumigatus is one of the major opportunistic pathogens able to cause illness such as allergic bronchopulmonary aspergillosis, aspergilloma and invasive aspergillosis to rural workers. Exposure of animals to A. fumigatus spores can result in infections, particularly in those organs exposed to external invasion, such as the airways, mammary gland and uterus at birth.

Occurrence of Ochratoxigenic Fungi and Ochratoxin A in Green Coffee from Different Origins

Fungal infection and ochratoxin A (OTA) contamination were determined in green coffee samples from different origins, in which OTA-producing fungi were also identified. About 72% of the beans analysed by direct plating presented fungal infection, including species of Aspergillus, Penicillium and Rhizopus. The genus Aspergillus was presented in more than 90% of infected coffee beans. Aspergillus ochraceus and Aspergillus section Nigri isolates represented 2.8 and 65.4%, respectively from the total number of isolates from the coffee beans. The capacity to produce OTA was determined in 260 isolates of A. section Nigri and 19 of A. ochraceus by the agar plug method, giving positive results for 6% of the A. section Nigri isolates and 16% of the A. ochraceus. OTA production was analysed by high performance liquid chromatography. OTA contamination of green coffee beans was analysed by enzyme immunoassay. OTA levels in all samples analysed were above the limit of detection (0.6 mg/kg), with a mean OTA concentration of 6.7 mg/kg.

Bioaccessibility of ochratoxin A from red wine in an in vitro dynamic gastrointestinal model

Ochratoxin A (OTA) is a mycotoxin produced by Aspergillus and Penicillium species with immunosuppressive, teratogenic, and carcinogenic properties. It has been determined that wine is the second largest source of OTA (10% of total OTA intake) in the European diet and that its presence, even in small doses, can be a problem in terms of long-term toxicity. In this paper, we evaluated the bioaccessibility of OTA in a spiked red wine sample under human fasting conditions using an in vitro dynamic digestion model that includes a continuous-flow dialysis system to simulate intestinal passage. To the best of our knowledge, this report is the first examining the bioaccessibility of OTA in wine. A liquid-liquid method was used to extract the OTA and ochratoxin alpha (OTα) from gastrointestinal juices, and the extracts were analysed by HPLC with a fluorescence detector. The bioaccessibility of OTA from the spiked red wine (1.0, 2.0 and 4 μg/l) was high in the gastric compartment (102.8, 128.3 and 122.3%, respectively), whereas in the simulated intestine, it did not exceed 26%, and the amount of OTA that crossed the dialysis membrane was very low (<3.3%). The amount of OTα in gastric chyme ranged from 5.1 to 19.1% of the spiked OTA, whereas in the intestinal compartment it did not exceed 5%. In conclusion, in the in vitro system assayed, OTA exhibited a high bioaccessibility in the simulated stomach, but it decreased after the intestinal digestion and passage through the dialysis membrane.

A Bayesian methodology to improve prediction of early graft loss after liver transplantation derived from the liver match study

BACKGROUND

To generate a robust predictive model of Early (3 months) Graft Loss after liver transplantation, we used a Bayesian approach to combine evidence from a prospective European cohort (Liver-Match) and the United Network for Organ Sharing registry.

METHODS

Liver-Match included 1480 consecutive primary liver transplants performed from 2007 to 2009 and the United Network for Organ Sharing a time-matched series of 9740 transplants. There were 173 and 706 Early Graft Loss, respectively. Multivariate analysis identified as significant predictors of Early Graft Loss: donor age, donation after cardiac death, cold ischaemia time, donor body mass index and height, recipient creatinine, bilirubin, disease aetiology, prior upper abdominal surgery and portal thrombosis.

RESULTS

A Bayesian Cox model was fitted to Liver-Match data using the United Network for Organ Sharing findings as prior information, allowing to generate an Early Graft Loss-Donor Risk Index and an Early Graft Loss-Recipient Risk Index. A Donor-Recipient Allocation Model, obtained by adding Early Graft Loss-Donor Risk Index to Early Graft Loss-Recipient Risk Index, was then validated in a distinct United Network for Organ Sharing (year 2010) cohort including 2964 transplants. Donor-Recipient Allocation Model updating using the independent Turin Transplant Centre dataset, allowed to predict Early Graft Loss with good accuracy (c-statistic: 0.76).

CONCLUSION

Donor-Recipient Allocation Model allows a reliable donor and recipient-based Early Graft Loss prediction. The Bayesian approach permits to adapt the original Donor-Recipient Allocation Model by incorporating evidence from other cohorts, resulting in significantly improved predictive capability.

Mycotoxins: occurrence, toxicology, and exposure assessment

Mycotoxins are abiotic hazards produced by certain fungi that can grow on a variety of crops. Consequently, their prevalence in plant raw materials may be relatively high. The concentration of mycotoxins in finished products is usually lower than in raw materials. In this review, occurrence and toxicology of the main mycotoxins are summarised. Furthermore, methodological approaches for exposure assessment are described. Existing exposure assessments, both through contamination and consumption data and biomarkers of exposure, for the main mycotoxins are also discussed.

Bleeding risk in warfarinized patients with a therapeutic international normalized ratio: the effect of low factor IX levels

OBJECTIVE

Bleeding is the main complication of warfarin therapy, even patients with an international normalized ratio (INR) in the target range can suffer bleeding, suggesting that INR does not perfectly reflect the therapeutic effect of warfarin. We hypothesized the INR might underestimate the level of anticoagulation in a subject with a lower factor (F) IX level than average.

METHODS AND RESULTS

We modeled warfarin anticoagulation in our in vitro thrombin generation (TG) model by adjusting the levels of vitamin K-dependent factors to those of patients with an INR of 2-3. Variation in FIX had a marked effect on TG but had no effect on the prothrombin time (PT)-INR. A prospective observational, cross-sectional clinical study including 341 consecutive patients admitted to the emergency department with an INR between 2 and 3, showed a statistically lower FIX activity in bleeders (P = 0.004) compared with others. No correlation was found between TG capacity and PT-INR results (P = 0.36). However, in patients, presenting with a warfarin-related hemorrhage, TG was significantly lower (P < 0.001) than others. A correlation on the boundary of significance was observed between TG capacity and FIX levels (P = 0.09).

CONCLUSION

These data demonstrates that patients who bleed when their PT-INR is in the target range 2-3 might have defective TG related to a lower level of FIX than expected.

Analyse rétrospective de l'adaptation à la sécheresse chez le douglas

For a number of years in certain regions of France the Douglas-fir trees (Pseudotsuga menziesii [Mirb.] Franco) have presented symptoms of withering which have been attributed to drought. Our results show that the hydraulic function of the wood plays a part in the resistance of the Douglas-fir to dry conditions. Narrower cellular conduits, and therefore a greater wood density, contribute to the survival of trees confronted with a period of a marked water deficit. This idea is confirmed by the existence of significant relationships between wood density and hydraulic properties of wood in which the raw sap circulates, and also by the relationships found between the ecological preferences of specimens in their area of origin and the density of their wood in regions of France where they have been introduced. Those coming from dry regions have a tendency to develop wood with characteristics similar to that of trees which have survived drought. While the relationship between wood density and survival has been demonstrated, the differences in the nature of this relationship between different sites show that the mechanisms involved are complex and to a large extent still not understood.

[The use of allografts in the surgical treatment of enlarged hiatal hernias]

The use of allografts in the surgical treatment of enenlarged hiatal hernias is a current hot topic of discussion. Using meshes in order to strengthen the hiatus of the esophagus is an efficient procedure which reduces the risk of reoccurences. In order to consolidate the initial surgical treatment of the enlarged hiatal hernias, polypropylene, polytetrafluoroethylene and biomaterial meshes are mainly used. There are ongoing discussions with regards to the use of meshes, their type and positioning. Although mesh usage is associated with a low recurrence rate, numerous authors have described complications such as: meshes migrating into the esophagus (caused by the alloplastic material used in the hiatoplasty), strictures, dysphagia, ulcers or perforations. From experience, the mesh used in the surgical treatment of hiatal hernia should preferably be non-biological and must be placed circumferentially, while fermly grounded at the pillar of the diaphragm. The correct placing of the mesh lowers the risk of strictures and degradation. Further prospective studies are needed in order to clarify the best method of surgically treating enlarged hiatal hernias.

In vitro effect of some fungicides on growth and aflatoxins production by Aspergillus flavus isolated from Capsicum powder

The aim of this study was to determine the effect of some pre-harvest fungicides on growth and aflatoxin (AF) production of three Aspergillus flavus strains found in Capsicum powder. Each isolate, previously isolated from paprika, chilli and smoked paprika, was inoculated on yeast extract sucrose agar and on a 3% paprika extract agar medium supplemented with different fungicides and incubated at 20 and 30°C during 7 days. Growth measurements were obtained on days 3, 5 and 7, and the AF production was determined on day 7. The significance of the effects of the factors (strain, medium, temperature, time and fungicides) and their interaction over colony diameter and AF production was determined. Temperature constrained the effectiveness of fungicides in reducing growth, the fungicides being most effective at 20°C. The efficacy of the fungicides over AF production depended on the medium used and temperature. The most effective fungicides in inhibiting growth and AF production, regardless of the strain tested or applied conditions, were tebuconazole 25% and mancozeb 80% applied at a concentration of 0.75 and 3.5 g l(-1), respectively. Care should thus be taken in the choice of a suitable fungicide because their effectiveness may depend on intra-specific variation and temperature. Moreover, it is necessary to take into account that the most efficient fungicide in reducing growth is not always the best choice for pre-harvest treatments because it may promote AF production. Thus, the best fungicide is the one that can simultaneous prevent growth and AF production.

Congener profile, occurrence and estimated dietary intake of dioxins and dioxin-like PCBs in foods marketed in the Region of Valencia (Spain)

During 2006-2008, a monitoring program was conducted on 29 target compounds, including PCDD/Fs and dl-PCBs, comprising 150 randomly collected individual food samples marketed in the Region of Valencia, Spain, grouped into 8 categories (vegetables, cereals, fats and oils, eggs, milk and dairy products, fish products, meat and meat products and fish oil). For PCDD/Fs, the highest frequency of detection corresponds to 1,2,3,4,6,7,8-HpCDD, OCDD, 2,3,4,7,8-PeCDF; and PCBs 118, 105 and 156 were the more frequent dl-PCBs. The food groups presenting higher contamination, expressed as toxic equivalents (WHO-TEQs), were fish oil (6.38 pg WHO-TEQ g(-1)fat), fish (1.21 pg WHO-TEQ g(-1)w.w.) and milk and dairy products (0.90 pg WHO-TEQ g(-1)fat). Of all analysed samples, only two fish oils presented levels higher than the EU limits for total WHO-TEQ. The average PCDD/Fs and dl-PCBs intakes were estimated as 2.86 pg WHO-TEQ kg(-1)b.w.d(-1) and 4.58 pg WHO-TEQ kg(-1)b.w.d(-1), for adults and children, respectively, using the deterministic method for chronic exposure. The main contributors to total intake for adults were fish (59%), milk and dairy products (19%), and fat and oils (9%). The average daily intake for adults (2.86 pg WHO-TEQ kg(-1)b.w.d(-1)) is within range of TDI recommended by the WHO (1-4 pg WHO-TEQ kg(-1)b.w.d(-1)), and slightly above the TWI and PTMI adopted by SCF and JECFA respectively.

Biomonitoring of Fusarium spp. Mycotoxins: Perspectives for an Individual Exposure Assessment Tool

Fusarium species are probably the most prevalent toxin-producing fungi of the northern temperate regions and are commonly found on cereals grown in the temperate regions of America, Europe and Asia. Among the toxins formed by Fusarium we find trichothecenes of the A-type or B-type, zearalenone, fumonisins or nivalenol. The current exposure assessment consists of the qualitative and/or quantitative evaluation based on the knowledge of the mycotoxin occurrence in the food and the dietary habits of the population. This process permits quantifying the mycotoxin dietary intake through deterministic or probabilistic methods. Although these methods are suitable to assess the exposure of populations to contaminants and to identify risk groups, they are not recommended to evaluate the individual exposition, due to a low accuracy and sensitivity. On the contrary, the use of biochemical indicators has been proposed as a suitable method to assess individual exposure to contaminants. In this work, several techniques to biomonitor the exposure to fumonisins, deoxynivalenol, zearalenone or T-2 toxin have been reviewed.

Predictors of low bone mineral density in elderly males with chronic obstructive pulmonary disease: the role of body mass index

OBJECTIVE

The aim of this study was to investigate the relationships between nutritional indices (Body mass index (BMI), serum albumin), sarcopenia, bone mineral density (BMD) and the severity of their pulmonary obstruction in elderly patients with chronic obstructive pulmonary disease (COPD).

METHODS

The method involved was a prospective transversal study; 82 males >65 years old, 41 stable patients with COPD and 41 healthy elderly individuals (controls). All subjects underwent spirometry, biochemical analyses and dual energy X-ray absorptiometry. The significance of the differences between mean values and prevalence rates was tested. The relationships between BMD and independent predictors were analysed by multiple linear regressions. Logistic regression models were applied on dichotomised variables.

RESULTS

In patients with COPD, the prevalence of osteoporosis was higher in subjects with sarcopenia (46% vs. 0%; p < 0.05) and with BMI < 25.1 kg/m(2) (58% vs. 15%; p < 0.02). Multiple regression analysis indicated that BMI, appendicular skeletal muscle mass (ASMM), albumin, and forced expiration volume after 1 s (FEV1) explained the 70% of BMD variability at the hip and 56% at the spine. Logistic regression showed that a BMI < 25.1 kg/m(2) was independently associated with osteoporosis risk (OR = 10.0; 95%CI 1.3-76); no independent effect emerged for FEV1% (<and 50%).

CONCLUSION

In elderly males with COPD, the BMI values < or =25 kg/m(2) are more strongly related to low BMD levels than albumin values. Among those patients, BMI values within the normal range for younger adults might point out a higher risk of osteoporosis.

Review. Ochratoxin A: Presence in Human Plasma and Intake Estimation

Ochratoxin A (OTA) is a fungal toxic secondary metabolite that can be found in several foodstuffs and thereby ingested by humans. One way to assess exposure of humans to OTA is the determination of the levels of this mycotoxin in blood plasma from a certain population. Such studies have been done in many countries, both in healthy people and nephropathy patients. Relationships with individual characteristics were investigated in several cases. Thus, most studies found no correlation with age, either with gender. However, the few studies that found correlation between OTA plasma levels and gender showed that men presented the highest values. When sampling was done over more than one season, the highest OTA plasma levels were found mostly in summer. Differences within regions of a country were related to dietary habits of each area. OTA levels of group populations showed variations from year to year, whereas intraindividual repetitions showed no specific trend. Daily intake of the toxin can be estimated from OTA plasma concentrations by the Klaassen equation. OTA toxicokinetics are considered in this review. Calculated daily intake of OTA by different studies did not overpass the proposed tolerable daily intakes of OTA.

Brief in vitro study on Botrytis cinerea and Aspergillus carbonarius regarding growth and ochratoxin A

AIMS

To evaluate the effect of Botrytis cinerea growth on ochratoxin A (OTA) production by Aspergillus carbonarius and degradation.

METHODS AND RESULTS

OTA-producing A. carbonarius and B. cinerea were grown on grape-like medium at 20 degrees C for 7 days. Radii of colonies were daily recorded and OTA was analysed. In addition, each B. cinerea isolate was inoculated on grape-like synthetic nutrient medium (SNM) paired with each A. carbonarius isolate at a distance of 45 mm. Botrytis cinerea isolates were also grown in OTA-spiked SNM. Growth rates of B. cinerea and A. carbonarius were 20 and 75 mm day(-1), respectively. The growth of the colonies of each species stopped when they contacted each other in paired cultures. OTA production by A. carbonarius in the contact area was affected by B. cinerea, but no clear trend was observed. All B. cinerea isolates showed to degrade between 24.2% and 267% of OTA from spiked SNM.

CONCLUSIONS

The ecological advantage of B. cinerea, in terms of growth rate, vs. OTA-producing Aspergillus in some wine-growing regions and its ability to degrade OTA may explain the low levels of this toxin in noble wines.

SIGNIFICANCE AND IMPACT OF THE STUDY

At determinate conditions, the presence of B. cinerea in grapes with A. carbonarius may help in reducing OTA accumulation.

Comparison of the capacities of two prothrombin complex concentrates to restore thrombin generation in plasma from orally anticoagulated patients: an in vitro study

BACKGROUND

Human prothrombin complex concentrates (PCCs) are used for prevention and treatment of bleeding episodes in patients under warfarin therapy. PCCs contain human factor (F) II, FVII, FIX, FX, protein C and protein S. The concentrations of these coagulation factors contained in PCCs are variable and do not reflect entirely the capacity of these drugs to correct hemostasis. Furthermore, commercially available PCCs do not have exactly the same composition, though they are all labelled and prescribed in units per kg of FIX (10-40 IU of FIX/kg). As the final product generated by PCCs is thrombin, a thrombin generation (TG) test could theoretically be used for monitoring the hemostatic correction.

METHODS

TG was measured in platelet free plasma in the presence of tissue factor 5 pm and phospholipids 4 microM with a final concentration of PCC of 0-0.1-0.2-0.3-0.4-0.5-0.75-1 IU ml(-1). The activity of vitamin K-dependent coagulation factors (i.e. FII, FVII, FIX, FX, protein C and protein S) were determined for each concentration of two different PCCs available on the French market.

RESULTS AND DISCUSSION

Our results showed that the addition of two different PCCs dose-dependently increased the TG capacity in patients with INR of 2-2.5-3-4 and >7 (n = 15 subjects) that reached the normal values. We also found a significant correlation between endogenous thrombin potential (ETP) and INR (Pearson test, P < 0.0001). The two PCCs improved the TG parameters differently with increasing concentrations. The difference in the correction of TG capacity observed between the two drugs could be explained by a variable increase in FX, FVII and protein C with similar doses. These results strongly suggest that TG assay could be used for monitoring the clinical efficacy of PCC and for optimizing the therapeutic regimen towards a more individualized therapy involving the type of the bleeding complications, the level of inhibition of the coagulation system and the molecule content of the PCC.