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.

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.

Collagen-Carboxymethylcellulose Biocomposite Wound-Dressings with Antimicrobial Activity

Microbial infections associated with skin diseases are frequently investigated since they impact on the progress of pathology and healing. The present work proposes the development of freeze-dried, glutaraldehyde cross-linked, and non-cross-linked biocomposite dressings with a porous structure, which may assist the reepithelization process through the presence of collagen and carboxymethylcellulose, along with a therapeutic antimicrobial effect, due to silver nanoparticles (AgNPs) addition. Phisyco-chemical characterization revealed the porous morphology of the obtained freeze-dried composites, the presence of high crystalline silver nanoparticles with truncated triangular and polyhedral morphologies, as well as the characteristic absorption bands of collagen, silver, and carboxymethylcellulose. In vitro tests also assessed the stability, functionality, and the degradability rate of the obtained wound-dressings. Antimicrobial assay performed on Gram-negative (Escherichia coli), Gram-positive (Staphyloccocus aureus) bacteria, and yeast (Candida albicans) models demonstrated that composite wound dressings based on collagen, carboxymethylcellulose, and AgNPs are suitable for skin lesions because they prevent the risk of infection and have prospective wound healing capacity. Moreover, the cell toxicity studies proved that the obtained materials can be used in long time treatments, with no cytotoxic effects.

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.

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.

The difficulty of articulatory complexity

In our commentary, we offer some support for the view that frequency rather than a language-independent definition of complexity is a main factor determining speech production in healthy adults. We further discuss the limits of defining articulatory complexity based on transcription data. If we want to gauge the impact of substantive constraints on speech production, context-specific production dynamics should be considered, as has been underscored by articulatory-acoustic work on speech errors.

Hybrid Collagen-NaCMC Matrices Loaded with Mefenamic Acid for Wound Healing

Fire and burns represent the fourth cause of death in the world. Numerous options for dressings exist, but their selection should be based on several factors such as burn severity, wound location and water retention. Collagen (COLL) is the most common protein in the human body and, due to its biocompatibility, is the main component in biomaterials development. Mefenamic acid (MA) is a non-steroidal anti-inflammatory drug with analgesic properties, and carboxymethylcellulose (NaCMC) is a biocompatible and biodegradable polymer that is commonly used in biomedical field. Collagen - carboxymethylcellulose - mefenamic acid hydrogels, developed in order to be used in burn treatments were lyophilized and the corresponding spongious matrices were investigated by optical microscopy, FT-IR spectroscopy, water absorption, enzymatic degradation and drug release kinetics studies. All tests revealed proper morphological structure, favourable release patterns, convenient swelling capacity and degradation profiles, indicating the possibility of their use for medical applications.

Mixed modeling for irregularly sampled and correlated functional data: Speech science applications

The speech sciences often employ complex experimental designs requiring models with multiple covariates and crossed random effects. For curve-like data such as time-varying signals, single-time-point feature extraction is commonly used as data reduction technique to make the data amenable to statistical hypothesis testing, thereby discarding a wealth of information. The present paper discusses the application of functional linear mixed models, a functional analogue to linear mixed models. This type of model allows for the holistic evaluation of curve dynamics for data with complex correlation structures due to repeated measures on subjects and stimulus items. The nonparametric, spline-based estimation technique allows for correlated functional data to be observed irregularly, or even sparsely. This means that information on variation in the temporal domain is preserved. Functional principal component analysis is used for parsimonious data representation and variance decomposition. The basic functionality and usage of the model is illustrated based on several case studies with different data types and experimental designs. The statistical method is broadly applicable to any types of data that consist of groups of curves, whether they are articulatory or acoustic time series data, or generally any types of data suitably modeled based on penalized splines.

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.

Applications and toxicity of silver nanoparticles: a recent review

Silver nanoparticles (AgNPs) exhibit a consistent amount of flexible properties which endorse them for a larger spectrum of applications in biomedicine and related fields. Over the years, silver nanoparticles have been subjected to numerous in vitro and in vivo tests to provide information about their toxic behavior towards living tissues and organisms. Researchers showed that AgNPs have high antimicrobial efficacy against many bacteria species including Escherichia coli, Neisseria gonorrhea, Chlamydia trachomatis and also viruses. Due to their novel properties, the incorporation of silver nanoparticles into different materials like textile fibers and wound dressings can extend their utility on the biomedical field while inhibiting infections and biofilm development. Among the noble metal nanoparticles, AgNPs present a series of features like simple synthesis routes, adequate and tunable morphology, and high surface to volume ratio, intracellular delivery system, a large plasmon field area recommending them as ideal biosensors, catalysts or photo-controlled delivery systems. In bioengineering, silver nanoparticles are considered potentially ideal gene delivery systems for tissue regeneration. The remote triggered detection and release of bioactive compounds of silver nanoparticles has proved their relevance also in forensic sciences. The authors report an up to date review related to the toxicity of AgNPs and their applications in antimicrobial activity and biosensors for gene therapy.

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.

Voice onset time in consonant cluster errors: can phonetic accommodation differentiate cognitive from motor errors?

PURPOSE

Phonetic accommodation in speech errors has traditionally been used to identify the processing level at which an error has occurred. Recent studies have challenged the view that noncanonical productions may solely be due to phonetic, not phonological, processing irregularities, as previously assumed. The authors of the present study investigated the relationship between phonological and phonetic planning processes on the basis of voice onset time (VOT) behavior in consonant cluster errors.

METHOD

Acoustic data from 22 German speakers were recorded while eliciting errors on sibilant-stop clusters. Analyses consider VOT duration as well as intensity and spectral properties of the sibilant.

RESULTS

Of all incorrect responses, 28% failed to show accommodation. Sibilant intensity and spectral properties differed from correct responses irrespective of whether VOT was accommodated.

CONCLUSIONS

The data overall do not allow using (a lack of) accommodation as a diagnostic as to the processing level at which an error has occurred. The data support speech production models that allow for an integrated view of phonological and phonetic processing.

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.

[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.

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.

Acoustic consequences of articulatory variability during productions of /t/ and /k/ and its implications for speech error research

An increasing number of studies has linked certain types of articulatory or acoustic variability with speech errors, but no study has yet examined the relationship between such articulatory variability and acoustics. The present study aims to evaluate the acoustic properties of articulatorily errorful /k/ and /t/ stimuli to determine whether these errors are consistently reflected in the acoustics. The most frequent error observed in the articulatory data is the production of /k/ and /t/ with simultaneous tongue tip and tongue dorsum constrictions. Spectral analysis of these stimuli's bursts shows that /k/ and /t/ are differently affected by such co-production errors: co-production of tongue tip and tongue dorsum during intended /k/ results in typical /k/ spectra (and hence in tokens robustly classified as /k/), while co-productions during intended /t/ result in spectra with roughly equal prominence at both the mid-frequency (/k/-like) and high-frequency (/t/-like) ranges (and hence in tokens ambiguous between /k/ and /t/). This outcome is not due to an articulatory timing difference, but to tongue dorsum constriction having an overall greater effect on the acoustic than a tongue tip constriction when the two are co-produced.

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.

Mapping of Aspergillus Section Nigri in Southern Europe and Israel based on geostatistical analysis

Geostatistical analysis was applied to the incidence of Aspergillus Section Nigri and A. carbonarius in Southern Europe and Israel for the 3-year period 2001-2003 to facilitate identification of regions of high risk from contamination with these fungi and production of ochratoxin. The highest incidence of black aspergilli was normally observed at harvesting. At this grape growth stage, spatial variability of black aspergilli was significantly related to latitude and longitude, showing a positive West-East and North-South gradient. Predictive maps of infected berries incidence were drawn and showed the same trend in the 3 years, but incidence was highest in 2003, followed by 2001 and 2002. The highest incidence was always observed in Israel, Greece and Southern France, associated with the highest incidence of A. carbonarius. Southern Spain and Southern Italy also had relevant incidence of black aspergilli. The thermo-wetness maps for the 3 years showed a trend similar to the incidence of black aspergilli. The coldest and wettest year was 2002, while 2003 was the hottest and driest, particularly during August, with Israel being the hottest and driest country, followed by Greece and Southern Italy. This indicates that meteorological conditions can contribute to explain spatial distribution variation of black aspergilli within the Mediterranean basin.

Role of visceral proteins in detecting malnutrition in the elderly

OBJECTIVE

In the clinical practice, visceral proteins are used as indirect markers of protein energy malnutrition (PEM), but their reliability could be reduced with advancing age. The aim of this work is to investigate the reliability of albumin, prealbumin, retinol-binding protein (RBP) and transferrin in evaluating nutritional status in old patients and their relationship with fat-free mass (FFM).

DESIGN

Cross-sectional study.

SETTING

Padua, Italy.

SUBJECTS

In 44 underweight (body mass index < 20 kg/m(2)) (66-97 years) and 69 normal weight or overweight elderly subjects (62-98 years), albumin, prealbumin, transferrin and RBP were determined in the plasma. Body composition and particularly FFM was obtained by dual X-ray absorptiometry. FFM was also expressed as FFM index (FFMI) calculated as FFM divided by height squared. Subjects affected by acute illnesses and inflammatory states were excluded.

RESULTS

Albumin, prealbumin and RBP mean values were significantly lower in underweight subjects. No differences between two groups were found for transferrin. Albumin prealbumin and RBP resulted under the normal range in 55, 25 and 54% of underweight subjects, respectively. Transferrin's values were low in about 40% of underweight and normal weight subjects, respectively. In all subjects, FFMI shows a significant correlation with albumin (r: 0.52), prealbumin (r: 0.64) and RBP (r: 0.57). No correlation between FFMI and transferrin was found.

CONCLUSIONS

Visceral proteins, except for transferrin, seem to be useful indexes in detecting malnutrition in the elderly; low values still in the normal range should also be carefully evaluated because they could suggest a poor nutritional status.