Aflatoxin M1 in Brazilian goat milk and health risk assessment.

Contamination of goat milk with aflatoxin M1 (AFM1) is a public health concern. This study investigated filamentous fungi in goat feed and quantified AFM1 in milk samples (n = 108) from goat fed forage and concentrate. Based on the detected AFM1 concentration, risk assessment analyses were performed concerning the Estimated Daily Intake (EDI) for one-year-old children and adults. Filamentous fungi were found in goat feed samples in a range of 3.1 ± 1.9 to 4.2 ± 0.2 log CFU/g. Five genera were identified, to cite Aspergillus, Penicillium, Fusarium, Rhizopus and Acremonium. Aspergillus species comprised A. flavus, A. niger, and A. ochraceus. All goat milk samples were contaminated with AFM1 (5.60-48.20 ng/L; mean 21.90 ± 10.28 ng/L) in amounts below the limits imposed by regulatory agencies. However, EDI values for AFM1 through goat milk estimated for one-year-old children were above the Tolerable Daily Intake. The calculated Hazard Index for one-year-old children indicated potential risk of liver cancer due to goat milk consumption. The Margin of Exposure values to AFM1 in one-year-old children and adults consuming goat milk as the unique milk source indicated increased health risk. Therefore, contamination of goat milk with AFM1 should be considered a high priority for Brazil's risk management actions.

Derivation of genetic biomarkers for cancer risk stratification in Barrett's oesophagus: a prospective cohort study.

OBJECTIVE: The risk of developing adenocarcinoma in non-dysplastic Barrett's oesophagus is low and difficult to predict. Accurate tools for risk stratification are needed to increase the efficiency of surveillance. We aimed to develop a prediction model for progression using clinical variables and genetic markers. METHODS: In a prospective cohort of patients with non-dysplastic Barrett's oesophagus, we evaluated six molecular markers: p16, p53, Her-2/neu, 20q, MYC and aneusomy by DNA fluorescence in situ hybridisation on brush cytology specimens. Primary study outcomes were the development of high-grade dysplasia or oesophageal adenocarcinoma. The most predictive clinical variables and markers were determined using Cox proportional-hazards models, receiver operating characteristic curves and a leave-one-out analysis. RESULTS: A total of 428 patients participated (345 men; median age 60 years) with a cumulative follow-up of 2019 patient-years (median 45 months per patient). Of these patients, 22 progressed; nine developed high-grade dysplasia and 13 oesophageal adenocarcinoma. The clinical variables, age and circumferential Barrett's length, and the markers, p16 loss, MYC gain and aneusomy, were significantly associated with progression on univariate analysis. We defined an 'Abnormal Marker Count' that counted abnormalities in p16, MYC and aneusomy, which significantly improved risk prediction beyond using just age and Barrett's length. In multivariate analysis, these three factors identified a high-risk group with an 8.7-fold (95% CI 2.6 to 29.8) increased HR when compared with the low-risk group, with an area under the curve of 0.76 (95% CI 0.66 to 0.86). CONCLUSIONS: A prediction model based on age, Barrett's length and the markers p16, MYC and aneusomy determines progression risk in non-dysplastic Barrett's oesophagus.

Stability of ablation flows in inertial confinement fusion: Nonmodal effects.

Fast transient growth of hydrodynamic perturbations due to nonmodal effects is shown to be possible in an ablation flow relevant to inertial confinement fusion (ICF). Likely to arise in capsule ablators with material inhomogeneities, such growths appear to be too fast to be detected by existing measurement techniques, cannot be predicted by any of the methods previously used for studying hydrodynamic instabilities in ICF, yet could cause early transitions to nonlinear regimes. These findings call for reconsidering the stability of ICF flows within the framework of nonmodal stability theory.

Barrett's esophagus surveillance in a prospective Dutch multi-center community-based cohort of 985 patients demonstrates low risk of neoplastic progression.

BACKGROUND AND AIMS: Barrett's esophagus (BE) is accompanied by an increased risk of developing esophageal cancer. Accurate risk-stratification is warranted to improve endoscopic surveillance. Most data available on risk factors is derived from tertiary care centers or from cohorts with limited surveillance time or surveillance quality. The aim of this study was to assess endoscopic and clinical risk factors for progression to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in a large prospective cohort of BE patients from community hospitals supported by an overarching infrastructure to ensure optimal surveillance quality. METHODS: A well-defined prospective multicenter cohort study was initiated in six community hospitals in the Amsterdam region in 2003. BE patients were identified by PALGA search and included in a prospective surveillance program with a single endoscopist performing all endoscopies at each hospital. Planning and data collection was performed by experienced research nurses who attended all endoscopies. Endpoint was progression to HGD/EAC. RESULTS: Nine hundred eighty-five patients were included for analysis. During median follow-up of 7.9 years (IQR 4.1-12.5) 67 patients were diagnosed with HGD (n = 28) or EAC (n = 39), progression rate 0.78% per patient-year. As a clinical risk factor age at time of endoscopy was associated with neoplastic progression (HR 1.05; 95% CI 1.03-1.08). Maximum Barrett length and low-grade dysplasia (LGD) at baseline were endoscopic predictors of progression (HR 1.15; 95% CI 1.09-1.21 and HR 2.36; 95% CI 1.29-4.33). CONCLUSION: Risk of progression to HGD/EAC in a large, prospective, community-based Barrett's cohort was low. Barrett's length, LGD and age were important risk factors for progression. (www.trialregister.nl NTR1789).

Investigation of supersonic heat-conductivity hyperbolic waves in radiative ablation flows.

We carry out a numerical investigation of three-dimensional linear perturbations in a self-similar ablation wave in slab symmetry, representative of the shock transit phase of a pellet implosion in inertial confinement fusion (ICF). The physics of ablation is modeled by the equation of gas dynamics with a nonlinear heat conduction as an approximation for radiation transport. Linear perturbation responses of the flow, its external surface, and shock-wave front, when excited by external pressure or heat-flux perturbation pulses, are computed by fully taking into account the flow compressibility, nonuniformity, and unsteadiness. These responses show the effective propagation, at supersonic speeds, of perturbations from the flow external surface through the whole conduction region of the ablation wave, beyond its Chapman-Jouguet point, and up to the ablation front, after the birth of the ablation wave. This supersonic forward propagation of perturbations is evidenced by means of a set of appropriate pseudocharacteristic variables and is analyzed to be associated to the "heat-conductivity" waves previously identified by Clarisse et al. [J. Fluid Mech. 848, 219 (2018)JFLSA70022-112010.1017/jfm.2018.343]. Such heat-conductivity linear waves are found to prevail over heat diffusion as a feedthrough mechanism [Aglitskiy et al., Philos. Trans. R. Soc. A 368, 1739 (2010)PTRMAD1364-503X10.1098/rsta.2009.0131] for perturbations of longitudinal characteristic lengths of the order of-or larger than-the conduction region size, and long transverse wavelengths with respect to this region size, and over time scales shorter to much shorter than the shock transit phase duration. This mechanism, which results from the dependency of the heat conductivity on temperature and density in conjunction with a flow temperature stratification, is expected to occur for other types of nonlinear heat conductions-e.g., electron heat conduction-as well as to be efficient at transmitting large scale perturbations from the surrounding of an ICF pellet to its inner compressed core at later times of its implosion. Besides, the proposed set of pseudocharacteristic variables are recommended for analyzing perturbation dynamics in an ablation flow as it furnishes additional propagation information over the fundamental linear modes of fluid dynamics [Kovásznay, J. Aeronautic. Sci. 20, 657 (1953)1936-995610.2514/8.2793], especially in the flow conduction region.

Combining autofluorescence imaging and narrow-band imaging for the differentiation of adenomas from non-neoplastic colonic polyps among experienced and non-experienced endoscopists.

OBJECTIVES: Endoscopic tri-modal imaging incorporates high-resolution white-light endoscopy (HR-WLE), narrow-band imaging (NBI), and autofluorescence imaging (AFI). Combining these advanced techniques may improve endoscopic differentiation between adenomas and non-neoplastic polyps. In this study, we aimed to assess the interobserver variability and accuracy of HR-WLE, NBI, and AFI for polyp differentiation and to evaluate the combined use of AFI and NBI. METHODS: First, still images of 50 polyps (22 adenomas; median 3 mm) were randomly displayed to three experienced and four non-experienced endoscopists. All HR-WLE and NBI images were scored for Kudo classification and AFI images for color. Second, the combined AFI and NBI images were assessed using a newly developed algorithm by six additional non-experienced endoscopists. RESULTS: The outcomes measured were interobserver agreement and diagnostic accuracy using histopathology as reference standard. Experienced endoscopists had better interobserver agreement for NBI (kappa=0.77) than for AFI (kappa=0.33), whereas non-experienced endoscopists had better agreement for AFI (kappa=0.58) than for NBI (kappa=0.33). The accuracies of HR-WLE, NBI, and AFI among experienced endoscopists were 65, 70, and 74, respectively. Figures among non-experienced endoscopists were 57, 63, and 77. The algorithm was associated with a significantly higher accuracy of 85% among all observers (P<0.023). These figures were confirmed in the second evaluation study. CONCLUSIONS: Non-experienced endoscopists have better interobserver agreement and accuracy for AFI than for HR-WLE or NBI, indicating that AFI is easier to use for polyp differentiation in non-experienced setting. The newly developed algorithm, combining information of AFI and NBI together, had the highest accuracy and obtained equal results between experienced and non-experienced endoscopists.

Symptoms of gastroesophageal reflux disease in severely mentally retarded people: a systematic review.

BACKGROUND: Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently backs up (or refluxes) into the gullet (or esophagus), and it has serious consequences for the quality of life. Usually this is felt as heartburn. Because severely mentally retarded people usually do not utter complaints of heartburn, it requires a high index of suspicion to discover possible GERD. Therefore it is relevant for care professionals such as nurses to have knowledge of those with a higher risk of GERD and of the possible manifestations of GERD. METHODS: Using a predefined search method, electronic databases were searched for studies relating the presence of symptoms to the presence of GERD. Relevant data were extracted and the methodological quality of the studies assessed. The results of the included studies were synthesized and conclusions about the level of evidence were drawn. RESULTS: Nineteen studies were found relating symptoms to the presence of GERD. Only four were of good methodological quality. The studies were very diverse concerning the studied population, the study method, and the kind of symptoms examined. This makes it difficult to synthesize the results of the studies. There is evidence that patients with cerebral palsy, patients using anticonvulsive drugs, and those with an IQ lower than 35 more frequently have GERD. There is also evidence that vomiting, rumination and hematemesis are associated with a higher risk of the presence of GERD, whereas there is no clear scientific evidence that particular behavior symptoms are indicative for GERD. CONCLUSION: The possible manifestations of GERD are many and varied. A guideline will be made for care professionals to aid systematic observation of possible manifestations of GERD.

Dynamic clonal equilibrium and predetermined cancer risk in Barrett's oesophagus.

Surveillance of Barrett's oesophagus allows us to study the evolutionary dynamics of a human neoplasm over time. Here we use multicolour fluorescence in situ hybridization on brush cytology specimens, from two time points with a median interval of 37 months in 195 non-dysplastic Barrett's patients, and a third time point in a subset of 90 patients at a median interval of 36 months, to study clonal evolution at single-cell resolution. Baseline genetic diversity predicts progression and remains in a stable dynamic equilibrium over time. Clonal expansions are rare, being detected once every 36.8 patient years, and growing at an average rate of 1.58 cm(2) (95% CI: 0.09-4.06) per year, often involving the p16 locus. This suggests a lack of strong clonal selection in Barrett's and that the malignant potential of 'benign' Barrett's lesions is predetermined, with important implications for surveillance programs.

Cervical myelopathy secondary to Hunter syndrome in an adult.

We present a case of type II mucopolysaccharidosis in which the diagnosis was delayed until the onset of cervical myelopathy in adulthood. Radiographic features were characteristic, with striking dural thickening shown on CT and MR imaging.

Preoperative percutaneous injection of methyl methacrylate and N-butyl cyanoacrylate in vertebral hemangiomas.

PURPOSE: To investigate the usefulness of preoperative percutaneous injections in vertebral hemangiomas. METHODS: Four patients presented with complicated vertebral hemangioma (spinal cord compression in three cases, intermittent spinal claudiction in one case). A three-part treatment was performed: initially, arterial embolization in three cases; 1 day later, percutaneous injections of methyl methacrylate into the vertebral body to strengthen it and of N-butyl cyanoacrylate into the posterior arch to optimize hemostasis during surgery; finally, the day after percutaneous injections, decompressive laminectomy and epidural hemangioma excision (when present). RESULTS: Laminectomy was performed with minimal blood loss. The epidural component present in three cases was excised without any difficulty. The follow-up (average, 20 months) showed no evidence of vertebral collapse. CONCLUSION: Percutaneous injections of methyl methacrylate and N-butyl cyanoacrylate might be useful before surgery for vertebral hemangiomas.

The incidence of adenocarcinoma in Barrett's esophagus in an institutionalized population.

OBJECTIVE: To ascertain the incidence rate of adenocarcinoma in Barrett's esophagus (ACE) in a stable population of 28,000 institutionalized intellectually disabled individuals (IDI) in whom the prevalence rate of Barrett's esophagus (BE) was previously estimated in a representative sample by 24 h pH monitoring and endoscopy, and in which all cases of ACE were ascertained over a 6-year period. These IDI do not smoke or drink alcohol and are known to have exceptionally high prevalence rates of gastro-esophageal reflux disease, and consequently of BE. METHODS: A population comprising 52,038 person-years was observed and all cases of ACE were ascertained. On the basis of the representative sample, the percentage of this population with BE was estimated to be 10.8%. ACE incidence rates could then be estimated and compared with those found in a free-living BE cohort after correction for age and gender differences. RESULTS: In IDI an incidence rate of ACE of 2.5/1000 person-years was found against 6.3/1000 person-years in the free-living BE cohort. However, the age distributions of the IDI and of the free-living BE cohort were very different, and after correction for this factor there was no significantly lower incidence rate of ACE in the IDI (relative risk, 0.79; P = 0.61). CONCLUSIONS: This is the first reported incidence study of ACE in a stable, well-defined population. In contrast to squamous cell carcinoma, our findings suggest only a minor role for smoking and alcohol in the etiology of ACE.

Pituitary microadenomas: experience with Gd-DOTA-enhanced MR imaging at 0.5 Telsa.

PURPOSE: We report our experience with magnetic resonance imaging at 0.5 Tesla in the radiological diagnosis of pituitary adenomas. METHODS: Over 2 years we performed a prospective study in 38 patients with pituitary microadenomas to assess the potential additional benefit of gadolinium in the detection of small intrasellar lesions. The protocol included three coronal T1-weighted sequences: precontrast, early postcontrast (obtained less than 2 min after injection) and late postcontrast (obtained 5 min after injection). For each sequence lesions were classified according to their visibility into three categories: definite lesion, probable lesion or absent lesion. RESULTS: Lesions were classified as well-defined in 55% of patients on the precontrast study, 89.5% on the early postcontrast study and 60.5% on the late postcontrast study. Of nine microadenomas not detected on the precontrast scans, all were clearly seen on the early post contrast scans; only four were well-defined on the late postcontrast study. Only one lesion was not seen on the early postcontrast study but was well-defined on precontrast study as a spontaneous high-intensity focal area: it was a hemorrhagic microadenoma. CONCLUSION: Our results suggest that the early postcontrast study is the most useful sequence for the detection of microadenomas. Precontrast image is necessary to detect hemorrhagic lesions; the late postcontrast sequence has a low additional diagnostic yield and seems unnecessary unless the other sequences are inconclusive.

Parkinson's disease and basal ganglia calcifications: prevalence and clinico-radiological correlations.

We reviewed computerized tomograms (CT) for basal ganglia and dentate nucleus calcifications in 79 patients with Parkinson's disease (PD), 54 patients with Alzheimer's disease (AD) and 109 controls aged 50 or more. When it was determined, no patient had disturbances in calcium metabolism. We found: (1) 30 subjects out of 242 (12.3%) with calcification located within the lenticular nucleus in 28. (2) Calcifications were unilateral in 11 and asymmetric in 11. (3) The prevalence of calcifications was 21.5% in PD, 9.2% in AD and 7.3% in controls and were significantly more severe in PD than in C and AD (P less than 0.02). (4) PD patients with calcifications were clinically indistinguishable from those without calcification. (5) Calcifications within the basal ganglia were not associated with a levodopa-resistance. We suggest the basal ganglia calcifications are more frequent in PD, but we cannot explain why, since post-synaptic lesions have never been showed in PD.

Causes of dislocation of total hip arthroplasty. CT study of component alignment.

We reviewed radiographs and CT scans of 38 total hip arthroplasties which had dislocated (36 posteriorly; 2 anteriorly) and compared the alignment of the prosthetic components with those of 14 uncomplicated arthroplasties. No difference was found between the alignment of the prosthetic components in the two groups. In the seven patients who had reoperations, the cause of dislocation diagnosed by CT was confirmed in only two cases (one retroversion of the cup and one protruding osteophyte). Muscular imbalance rather than malposition of the components was the major factor determining dislocation. CT allows accurate measurement of cup and neck anteversion but contributes little to preoperative planning.

Results of surgical treatment of radiculomyelopathy caused by cervical arthrosis based on 1000 operations.

Wide experience over a 20-year period with 1000 interventions for radiculomyelopathy caused by cervical arthrosis is reported. The results are analyzed according to clinical signs, surgical methods, timing of operation, influence of pathogenic phenomena, age, and preexisting illness. Intra- and postoperative problems and accidents are covered.

Cervical intradiskal injection of aprotinin. Technical note and preliminary report.

Chemonucleolysis is widely used in the treatment of disease of the lumbar intervertebral disk. From a series of 28 patients, the authors report their experience using this technique at the cervical level using aprotinin instead of chymopapain.

[Percutaneous drainage of a presacral and spinal extra-dural abscess complicating Crohn's disease]. / Drainage percutané d'un abcès présacré et rachidien extra-dural compliquant une maladie de Crohn.

A 43-year-old man with Crohn's disease was hospitalized because of bilateral radicular pain secondary to a presacral abscess penetrating into the extra-dural space from L5 to S3. Conservative treatment using computed tomography guided percutaneous drainage of the abscess and parenteral antibiotherapy allowed complete recovery.

[Oculocephalomotor disorders and bilateral thalamo-subthalamic infarction (author's transl)]. / Troubles oculo-céphalomoteurs et infarctus thalamo-sous-thalamique bilatéral.

A 33-year-old woman on oral contraceptives suddenly developed neurological disorders characterised by decreased alertness, absence of motor and verbal spontaneity, anterograde amnesia with difficulties in verbal and visual learning. She also presented paralysis of upwards and downwards ocular movements affecting mainly saccadic movements while convergence was normal. An initial almost total absence of spontaneous head movements and later an impossibility to carry out downwards movements of the head. This apparently represents a syndrome still not reported in human pathology. The clinical course was favourable. CT scan suggested the presence of a paramedian infarct of the region supplied by the thalamosubthalamic artery of the type II b of Percheron. An analogy is suggested between these disorders of oculocephalomotor behaviour and those observed by Denny-Brown in experimental bilateral retrorubric lesions. The possibility of a lesion in the internal thalamic nucleis and the adjacent subthalamic region is considered.

[Magnetic resonance imaging of the facial nerve in a case of Melkerson-Rosenthal syndrome]. / Imagerie par résonance magnétique du nerf facial dans un cas de syndrome de Melkerson-Rosenthal.

A 35-year-old man treated for a Crohn's disease presented with a second facial palsy in a setting of recurrent labial edema known since childhood. The diagnosis of Melkerson-Rosenthal syndrome was established. MRI showed a small T1 gadolinium-enhanced lesion of the facial nerve suggesting an inflammatory process. Similarities of pathologic lesions found in Melkerson-Rosenthal syndrome, Crohn's disease and sarcoidosis raise the question of the relationships between these disorders.

[Alzheimer's disease. Statistical analysis of CT scanner data]. / Maladie d'Alzheimer. Analyse statistique des résultats du scanner X.

Brain CT's of 30 patients with early onset probable Alzheimer's disease (according to NINCDS-ADRDA work-group criteria), were compared to those of 30 sex- and age-matched control subjects. This study has confirmed that patients with Alzheimer's disease have higher cerebral atrophy than control subjects, and that cerebral atrophy is correlated with the severity of the disease appreciated with the mini-mental state and the global deterioration scales. It revealed that patients were more different from control subjects for the subjective index and for the third ventricle index. CT has a good predictive value in differentiating groups, but has a poor predictive value in differentiating individuals.