[Diagnostics and therapy of achalasia]

The low incidence (1:100,000) makes primary idiopathic achalasia a problem of special importance. Patients often have a long medical history of suffering before the diagnosis is established and adequate therapy provided. Surgeons who perform antireflux surgery must be certain of detecting achalasia patients within their collective of gastroesophageal reflux disease (GERD) patients to avoid contraindicated fundoplication. The current gold standard for establishing the diagnosis of achalasia is manometry. Especially in early stages, symptom evaluation, endoscopy and barium swallow lack adequate sensitivity. High-resolution manometry (HRM) is increasingly used and allows characterization of different achalasia types (i.e. type I classical achalasia, type II panesophageal pressurization and type III spasmodic achalasia) and differentiation from other motility disorders (e.g. distal esophageal spasm, jackhammer esophagus and nutcracker esophagus). For patients over 45 years of age additional endoscopic ultrasound and computed tomography are recommended to exclude pseudoachalasia. A curative treatment restoring normal esophageal function does not exist; however, there are good options for symptom control. Therapy aims are abolishment of dysphagia, improvement of esophageal clearance, prevention of reflux and abolishment of chest pain. The current standard treatment is cardiomyotomy, which was first described 100 years ago by the German surgeon Ernst Heller and has been shown to be clearly superior when compared to endoscopic treatment (e.g. botox injection and balloon dilatation). Heller's myotomy procedure is preferentially performed via the laparoscopic route and combined with partial fundoplication. Currently, an alternative to performing Heller's myotomy via the endoscopic route is under intensive investigation in several centers worldwide. The peroral endoscopic myotomy (POEM) procedure has shown very promising initial results and warrants further clinical evaluation.

Does the exposure mode to ENPs influence their toxicity to aquatic species? A case study with TiO2 nanoparticles and Daphnia magna

Recent studies suggest that the ecotoxicity of engineered nanoparticles (ENPs) is dependent upon the treatment of ENPs in suspensions (e.g. sonication or use of solvents) and on the mode of exposure to test organisms. We conducted several bioassays with Daphnia magna in order to determine how adverse effects of TiO2 nanoparticles (n-TiO2) are influenced by experimental set-up. Several treatments were applied, including three test media, several treatments of n-TiO2 suspensions (stirring, sonication) and different exposure modes (exposure duration and volume of test suspension). No adverse effects were observed when D. magna were exposed to 50 mL of suspension, regardless of TiO2 concentration (up to 250 mg/L) and exposure duration. Conversely, adverse effects were observed when D. magna were exposed to 2 mL of suspension for 96 h with a 50 % effect concentration EC50 values ranging from 32 mg/L to 82 mg/L. Test media had no significant influence on the outcome of all treatments. For a better mechanistic understanding of the experimental set-up at which adverse effects were observed, the particle size of n-TiO2 in the test media was characterized throughout the test duration. These measurements revealed a fast and strong agglomeration with a secondary particle size in the order of magnitude of micrometers. Our study describes how the effects of n-TiO2 on D .magna are influenced by the duration of exposure and volume of media, highlighting the need for standardization of experimental methods.

[Peroral endoscopic myotomy for treatment of achalasia. Literature review and own initial experience]

Peroral endoscopic myotomy (POEM) is a new, purely endoscopic procedure for treatment of achalasia. Due to the lack of incisions POEM can be regarded as a true NOTES procedure. With POEM a myotomy is created in a similar fashion to the previous standard treatment, laparoscopic Heller myotomy (LHM). The relatively free choice of length and localization of the myotomy may be regarded as advantages of POEM. The procedure starts with a mucosal incision (mucosal entry) followed by preparation of a submucosal tunnel crossing the esophagogastric junction and creation of a myotomy in an antegrade direction before the mucosal access is closed with endoscopic clip placement. Since the first description of the application of POEM in humans in 2010 by the pioneer Haruhiro Inoue, Yokohama, Japan, it has been used increasingly and investigated in some centers in Asia, the U.S.A. and also Europe. The results are very promising. Although the procedure is technically demanding it can be performed safely with low complication rates. The POEM procedure achieves very good control of dysphagia and gastroesophageal reflux witch is only a rare side-effect witch is well-controllable with proton pump inhibitors (PPI). We review the currently available data from the literature and present our own initial series of  14 patients treated with POEM.

The coating makes the difference: acute effects of iron oxide nanoparticles on Daphnia magna

The surface of nanoparticles (NP) is often functionalized with a capping agent to increase their colloidal stability. Having a strong effect on the characteristics of NP, the coating might already determine the risk from NP to organisms and the environment. In this study identical iron oxide nanoparticles (IONP; Ø 5-6nm) were functionalized with four different coatings: ascorbate (ASC-IONP), citrate (CIT-IONP), dextran (DEX-IONP), and polyvinylpyrrolidone (PVP-IONP). Ascorbate and citrate stabilize NP via electrostatic repulsion whereas dextran and polyvinylpyrrolidone are steric stabilizers. All IONP were colloidally stable over several weeks. Their acute effects on neonates of the waterflea Daphnia magna were investigated over 96h. The highest immobilizing effect was found for ASC- and DEX-IONP. In the presence of neonates, both agglomerated or flocculated and adsorbed to the carapace and filtering apparatuses, inducing high immobilization. Lower immobilization was found for CIT-IONP. Their effect was hypothesized to partly originate from an increased release of dissolved iron and the ability to form reactive oxygen species (ROS). Furthermore, incomplete ecdysis occurred at high concentrations of ASC-, DEX-, and CIT-IONP. PVP-IONP did not induce any negative effect, although high quantities were visibly ingested by the daphnids. PVP-IONP had the highest colloidal stability without any occurring agglomeration, adsorption, or dissolution. Only strong swelling of the PVP coating was observed in medium, highly increasing the hydrodynamic diameter. Each coating caused individual effects. Toxicity cannot be correlated to hydrodynamic diameter or the kind of stabilizing forces. Effects are rather linked to decreasing colloidal stability, the release of ions from the core material or the ability to form ROS, respectively.

A miniaturized solid contact test with Arthrobacter globiformis for the assessment of the environmental impact of silver nanoparticles

Silver nanoparticles (AgNPs) are widely applied for their antibacterial activity. Their increasing use in consumer products implies that they will find their way into the environment via wastewater-treatment plants. The aim of the present study was to compare the ecotoxicological impact of 2 differently designed AgNPs using the solid contact test for the bacterial strain Arthrobacter globiformis. In addition, a miniaturized version of this test system was established, which requires only small-sized samples because AgNPs are produced in small quantities during the design level. The results demonstrate that the solid contact test can be performed in 24-well microplates and that the miniaturized test system fulfills the validity criterion. Soils spiked with AgNPs showed a concentration-dependent reduction of Arthrobacter dehydrogenase activity for both AgNPs and Ag ions (Ag(+)). The toxic effect of the investigated AgNPs on the bacterial viability differed by 1 order of magnitude and can be related to the release of dissolved Ag(+). The release of dissolved Ag(+) can be attributed to particle size and surface area or to the fact that AgNPs are in either metallic or oxide form. Environ

Adaptation of the Daphnia sp. acute toxicity test: miniaturization and prolongation for the testing of nanomaterials

Manufacturing of nanomaterials (NMs) is often complex and expensive, and their environmental risks are poorly understood or even unknown. An economization of testing NMs is therefore desirable, which can be achieved by miniaturizing test systems. However, the downsizing of test vessels and volumes can enlarge the surface/volume ratio (SVR) which in turn can affect the bioavailable concentration of adsorbing substances like NMs. The present study focused on the miniaturization of the acute toxicity test with Daphnia magna. The adaptations were verified with three reference substances, the non-adsorbing potassium dichromate (K2Cr2O7) and as potentially highly-adsorbing substances silver nanoparticles (AgNPs) and silver nitrate (AgNO3). The miniaturized test was conducted in 24-well microtiter plates (MT) and simultaneously compared to the OECD standard test (ST). Furthermore, the test duration was prolonged from 48 to 96 h since NMs tend to show effects only after extended exposure. The toxicity of K2Cr2O7 and AgNPs continued to increase within the prolonged test span. The test comparisons with K2Cr2O7 did not reveal any significant differences between ST and MT. AgNO3 toxicity was significantly decreased in MT compared to ST due to the enlarged SVR. The toxicity of AgNPs in MT after 24 h was equal to ST. Contrary to our expectations an exposure longer than 24 h resulted in an increase of AgNP toxicity in MT, possibly due to enhanced dissolution of silver. Microtiter plates are appropriate alternative test vessels for the Daphnia sp. acute toxicity test; thus, its miniaturization is feasible. The enlarged SVR has to be taken into account since it can affect the toxicity of potentially adsorbing substances. Furthermore, the standard test duration of 48 h might underestimate the toxicity of many substances, especially of NMs.

Intrinsically green iron oxide nanoparticles? From synthesis via (eco-)toxicology to scenario modelling

Iron oxide nanoparticles (IONP) are currently being studied as green magnet resonance imaging (MRI) contrast agents. They are also used in huge quantities for environmental remediation and water treatment purposes, although very little is known on the consequences of such applications for organisms and ecosystems. In order to address these questions, we synthesised polyvinylpyrrolidone-coated IONP, characterised the particle dispersion in various media and investigated the consequences of an IONP exposure using an array of biochemical and biological assays. Several theoretical approaches complemented the measurements. In aqueous dispersion IONP had an average hydrodynamic diameter of 25 nm and were stable over six days in most test media, which could also be predicted by stability modelling. The particles were tested in concentrations of up to 100 mg Fe per L. The activity of the enzymes glutathione reductase and acetylcholine esterase was not affected, nor were proliferation, morphology or vitality of mammalian OLN-93 cells although exposure of the cells to 100 mg Fe per L increased the cellular iron content substantially. Only at this concentration, acute toxicity tests with the freshwater flea Daphnia magna revealed slightly, yet insignificantly increased mortality. Two fundamentally different bacterial assays, anaerobic activated sludge bacteria inhibition and a modified sediment contact test with Arthrobacter globiformis, both rendered results contrary to the other assays: at the lowest test concentration (1 mg Fe per L), IONP caused a pronounced inhibition whereas higher concentrations were not effective or even stimulating. Preliminary and prospective risk assessment was exemplified by comparing the application of IONP with gadolinium-based nanoparticles as MRI contrast agents. Predicted environmental concentrations were modelled in two different scenarios, showing that IONP could reduce the environmental exposure of toxic Gd-based particles by more than 50%. Application of the Swiss "Precautionary Matrix for Synthetic Nanomaterials" rendered a low precautionary need for using our IONP as MRI agents and a higher one when using them for remediation or water treatment. Since IONP and (considerably more reactive) zerovalent iron nanoparticles are being used in huge quantities for environmental remediation purposes, it has to be ascertained that these particles pose no risk to either human health or to the environment.

Composition of body storage compounds influences egg quality and reproductive investment in the land snail Cornu aspersum

In invertebrates, resources available for growth and reproduction might influence the composition of body stores and subsequently nutrient allocation to eggs, thereby adjusting energy investment in reproduction. We investigated in the land snail Cornu aspersum (Müller, 1774) the efficiency of growth and the main storage compounds in the body and in eggs with respect to lipid content in food (5.5% versus 2.5%). The high body dry mass density of snails fed on lipid-rich diet underlined the high storage capacity of neutral lipids acquired during growth (high growth efficiency) without changing energy content because of the prevailing carbohydrate storage compounds. Reproductive investment was lower in these snails, and maternal effects decreased clutch size. Triglyceride allocation to eggs might enhance survival probability of offspring and therefore compensate for smaller clutch size. Snails fed on lipid-poor diet maximized their investment in clutch size whatever the amount of body stores, and allocated a higher amount of cholesterol to eggs. Cholesterol could be essential for embryo growth, as it ensures membrane functioning. In conclusion, the availability of resources can differentially affect nutrient allocation and energy investment in reproduction. Thus, the investigation of physiological processes becomes essential to understand population dynamics in fluctuating or changing habitats.

[Newly recognized side-effects of proton pump inhibitors. Arguments in favour of fundoplication for GERD?]

Among other indications proton pump inhibitors (PPIs) are used as medical treatment of gastroesophageal reflux disease (GERD) and are the most frequently prescribed and most frequently used drugs in gastroenterology. Until recently PPIs were regarded as very safe and associated with very few side-effects. However, during recent years study results have revealed many severe adverse events associated especially with long-term PPI use. We review the currently available evidence, regarding the side-effects of PPIs and discuss the potential impact on treatment strategies for GERD (conservative treatment vs. antireflux surgery). Currently available data suggest that PPIs are associated with osteoporosis-related fractures, Clostridium difficile associated diarrhea (CDAD), community and hospital-acquired pneumonia, pharmacologic interaction with clopidogrel and acetylsalicylic acid with subsequent increased rate of cardiovascular events, refractory hypomagnesemia and rebound reflux symptoms etc. The risk-benefit ratio of PPIs is increasingly recognized as being less favourable. This leads to a more critical viewpoint and raises the question whether the side-effects of PPIs may outweigh the benefits, especially with long-term use. The side-effects of PPIs seem to make a strong argument in favour of laparoscopic fundoplication in the treatment of GERD.

Adjustment of metabolite composition in the haemolymph to seasonal variations in the land snail Helix pomatia

In temperate regions, land snails are subjected to subzero temperatures in winter and hot temperatures often associated to drought in summer. The response to these environmental factors is usually a state of inactivity, hibernation and aestivation, respectively, in a temperature and humidity buffered refuge, accompanied by physiological adjustments to resist cold or heat stress. We investigated how environmental factors in the microhabitat and body condition influence the metabolite composition of haemolymph of the endangered species Helix pomatia. We used UPLC and GC-MS techniques and analyzed annual biochemical variations in a multivariate model. Hibernation and activity months differed in metabolite composition. Snails used photoperiod as cue for seasonal climatic variations to initiate a physiological state and were also highly sensitive to temperature variations, therefore constantly adjusting their physiological processes. Galactose levels gave evidence for the persistence of metabolic activity with energy expenditure during hibernation and for high reproductive activity in June. Triglycerides accumulated prior to hibernation might act as cryoprotectants or energy reserves. During the last month of hibernation snails activated physiological processes related to arousal. During activity, protein metabolism was reflected by high amino acid level. An exceptional aestivation period was observed in April giving evidence for heat stress responses, like the protection of cells from dehydration by polyols and saccharides, the membrane stabilization by cholesterol and enhanced metabolism using the anaerobic succinic acid pathway to sustain costly stress responses. In conclusion, physiological adjustments to environmental variations in Helix pomatia involve water loss regulation, cryoprotectant or heatprotectant accumulation.

Seasonally contrasting life-history strategies in the land snail Cornu aspersum: physiological and ecological implications

When a life history is characterized by both seasonality in reproduction and seasonality in offspring fitness, trade-offs in reproductive traits might be adjustments to seasonal time constraints to optimize reproductive success. Therefore, we compared in the laboratory the trade-offs in reproductive traits between early (after maturity) and delayed (after dormancy) reproduction in young land snails Cornu aspersum (Müller, 1774) (syn. Helix aspersa ), depending on food energy content. We also investigated the maternal investment in reproductive output in both breeding periods. After attaining maturity, snails produced single clutches with many small eggs, which resulted, in contrast to previous studies, in large offspring with a low hatching rate owing to high within-clutch cannibalism. The young cannibals may have a higher survival probability in the following hibernation. Snails starting to reproduce after hibernation had smaller clutches of larger eggs, resulting in high quantity of lighter offspring. The clutch mass was positively correlated with maternal mass in snails reproducing after having attained maturity and negatively correlated in snails reproducing after hibernation. Multiple oviposition occurred only after hibernation, thereby enhancing reproductive success. An energy-rich diet did not affect reproductive strategies. Further studies should focus on seasonal plasticity of reproductive strategies in natural populations of C. aspersum and investigate survival probabilities of breeders and juveniles in an evolutionary context.

An indispensable asset at risk: merits and needs of chemicals-related environmental sciences

BACKGROUND

Modern societies depend on environmental sustainability and on new generations of individuals well-trained by environmental research and teaching institutions. In the past, significant contributions to the identification, assessment, and management of chemical stressors with legal consequences have been made.

MAIN FEATURES

Within this article, we intend to elucidate the merits and the emerging challenges of chemicals-related environmental sciences. The manuscript is supported by more than 70 professors and university academics of leading institutions in Germany, Switzerland, Austria, and other countries in Europe, but addresses topics of global concern.

RESULTS AND DISCUSSION

Many environmental problems of pollutants remain to be addresses, since new chemical compounds or classes of new compounds are continuously developed and brought to the market and sooner or later "emerge" in the environment. Further issues are the inclusion of transformation products and chemical mixtures in environmental risk assessment, the long-term presence of xenobiotics bound to soils and sediments, as well as an understanding of the ecological relevance of ecotoxicological end points.

CONCLUSION AND PERSPECTIVES

We point out the need for a strong academic research and education system in chemicals-related environmental sciences to ministries, politicians, and research funding institutions and we propose to create specific units in the national funding bodies that address basic and interdisciplinary research in this field.

Ionic liquids in soils: effects of different anion species of imidazolium based ionic liquids on wheat (Triticum aestivum) as affected by different clay minerals and clay concentrations

This study contributes to a prospective hazard assessment of ionic liquids, focusing on the terrestrial environment. The influence of differently composed soils-varying contents of the clay minerals smectite and kaolinite-on the toxicity of different anion species of imidazolium based ionic liquids was studied for growth inhibition of wheat (Triticum aestivum). IM14 (CF(3)SO(2))(2)N appeared the most toxic, independently of the investigated soil type. The toxicity of IM14 Cl, IM14 BF(4) and IM14 HSO(4) was mainly dominated by the cationic moiety. The observed effects varied in dependence of the added clay type and clay concentration. An increase of clay content resulted in less pronounced effects of these substances. In contrast, for IM14 (CF(3)SO(2))(2)N the addition of clay minerals caused higher toxic effects in comparison to the reference soil. Our results give first hints for the assumption, that ionic liquids whose toxic action is based on the anionic moiety are especially hazardous for soils, particular for soils with high clay contents.

Sorption and desorption of imidazolium based ionic liquids in different soil types

This study investigates the influence of the two different clay minerals kaolinite and smectite as well as of organic matter on the cation sorption and desorption behaviour of three imidazolium based ionic liquids -1-butyl-3-methyl-imidazolium tetrafluoroborate (IM14 BF(4)), 1-methyl-3-octyl-imidazolium tetrafluoroborate (IM18 BF(4)) and 1-butyl-3-methyl-imidazolium bis[(trifluoromethyl)sulfonyl]imide (IM14 (CF(3)SO(2))(2)N) - in soil. The German standard soil Lufa 2.2 - a natural soil classified as a loamy sand - was the basis substrate for the different soil compositions and also served as a reference soil. The addition of organic matter and clays increases the sorption of the substances and in particular smectite had striking effects on the sorption capacity for all three ionic liquids indicating that ionic interactions play an important role for sorption and desorption processes of ionic liquids in soil. One exception was for kaolinite-containing soils and the IM14 cation: with (CF(3)SO(2))(2)N(-) as an anion the sorption was identical at either 10 wt% or 15 wt% clay content, and with BF(4)(-) sorption was even lower at 15 wt% kaolinite than at 10 wt%. Desorption was weak for IM18 BF(4), presumably owing to the longer alkyl side chain. With regard to the influence of kaolinite on desorption, the same pattern was observed as it was found for the sorption of IM14 BF(4) and IM14 (CF(3)SO(2))(2)N.

Environmental behavior and ecotoxicity of engineered nanoparticles to algae, plants, and fungi

Developments in nanotechnology are leading to a rapid proliferation of new materials that are likely to become a source of engineered nanoparticles (ENPs) to the environment, where their possible ecotoxicological impacts remain unknown. The surface properties of ENPs are of essential importance for their aggregation behavior, and thus for their mobility in aquatic and terrestrial systems and for their interactions with algae, plants and, fungi. Interactions of ENPs with natural organic matter have to be considered as well, as those will alter the ENPs aggregation behavior in surface waters or in soils. Cells of plants, algae, and fungi possess cell walls that constitute a primary site for interaction and a barrier for the entrance of ENPs. Mechanisms allowing ENPs to pass through cell walls and membranes are as yet poorly understood. Inside cells, ENPs might directly provoke alterations of membranes and other cell structures and molecules, as well as protective mechanisms. Indirect effects of ENPs depend on their chemical and physical properties and may include physical restraints (clogging effects), solubilization of toxic ENP compounds, or production of reactive oxygen species. Many questions regarding the bioavailability of ENPs, their uptake by algae, plants, and fungi and the toxicity mechanisms remain to be elucidated.

Effects of nickel chloride and oxygen depletion on behaviour and vitality of zebrafish (Danio rerio, Hamilton, 1822) (Pisces, Cypriniformes) embryos and larvae

We examined acute (2 h exposure of 5-day-old larvae) and subchronic (exposure from fertilization up to an age of 11 days) effects of NiCl(2).6H2O on embryos and larvae of zebrafish (Danio rerio), both alone and in combination with oxygen depletion. The following endpoints were recorded: acute exposure: locomotory activity and survival; subchronic exposure: hatching rate, deformations, locomotory activity (at 5, 8 and 11 days) and mortality. In acute exposures nickel chloride (7.5-15 mg Ni/L) caused decreasing locomotory activity. Oxygen depletion (<or=2.45+/-0.16 mg O2/L) also resulted in significantly reduced locomotory activity. In the subchronic test, exposure to >or=10 mg Ni/L resulted in delayed hatching at an age of 96 h, in decreased locomotory activity at an age of 5 days, and increased mortality at an age of 11 days (LC20=9.5 mg Ni/L). The observed LOEC for locomotory activity (7.5 mg Ni/L) is in the range of environmentally relevant concentrations. Since locomotory activity was already affected by acute exposure, this parameter is recommended to supplement commonly recorded endpoints of toxicity.

Biological effects of imidazolium ionic liquids with varying chain lengths in acute Vibrio fischeri and WST-1 cell viability assays

Detailed biological studies of methyl- and some ethylimidazolium ionic liquids in luminescent bacteria as well as in the IPC-81 (leukemia cells) and C6 (glioma cells) rat cell lines are presented. Effective concentrations in these test systems are generally some orders of magnitude lower than effective concentrations [corrected] of the conventional solvents acetone, acetonitrile, methanol, and methyl t-butyl ether. No general influence of the anionic compound in the ionic liquids on toxicity could be found, although they seem to modulate toxicity in some cases. The clear influence of the alkyl chain length on toxicity was quantified by linear regression analysis. Alkyl chain length of the longer alkyl chain was varied from 3 to 10 carbon atoms. Consequences for a design of sustainable alternative solvents are briefly sketched.