[Erythema nodosum as a reaction pattern: a broad spectrum of underlying causes]. / Erythema nodosum als reactiepatroon.

Erythema nodosum is a skin disorder that is characterised by the presence of painful erythematous nodules and plaques, mainly located on the shins. This disorder is associated with comorbidities and can be considered as an aspecific reaction pattern to a broad range of causes. However, an idiopathic variant also exists, which occurs in 22-72% of cases. Erythema nodosum is pre-eminently a skin disease which, due to its multifactorial pathogenesis, occurs in a wider field than dermatology alone. Therefore, knowledge of this disorder is important for all practicing physicians. To illustrate this we describe three patients with erythema nodosum attributable to different causes.

Predictors for neoplastic progression in patients with Barrett's Esophagus: a prospective cohort study.

OBJECTIVES: Patients with Barrett's esophagus (BE) have an increased risk of developing esophageal adenocarcinoma (EAC). As the absolute risk remains low, there is a need for predictors of neoplastic progression to tailor more individualized surveillance programs. The aim of this study was to identify such predictors of progression to high-grade dysplasia (HGD) and EAC in patients with BE after 4 years of surveillance and to develop a prediction model based on these factors. METHODS: We included 713 patients with BE (≥ 2 cm) with no dysplasia (ND) or low-grade dysplasia (LGD) in a multicenter, prospective cohort study. Data on age, gender, body mass index (BMI), reflux symptoms, tobacco and alcohol use, medication use, upper gastrointestinal (GI) endoscopy findings, and histology were prospectively collected. As part of this study, patients with ND underwent surveillance every 2 years, whereas those with LGD were followed on a yearly basis. Log linear regression analysis was performed to identify risk factors associated with the development of HGD or EAC during surveillance. RESULTS: After 4 years of follow-up, 26/713 (3.4%) patients developed HGD or EAC, with the remaining 687 patients remaining stable with ND or LGD. Multivariable analysis showed that a known duration of BE of ≥ 10 years (risk ratio (RR) 3.2; 95% confidence interval (CI) 1.3-7.8), length of BE (RR 1.11 per cm increase in length; 95% CI 1.01-1.2), esophagitis (RR 3.5; 95% CI 1.3-9.5), and LGD (RR 9.7; 95% CI 4.4-21.5) were significant predictors of progression to HGD or EAC. In a prediction model, we found that the annual risk of developing HGD or EAC in BE varied between 0.3% and up to 40%. Patients with ND and no other risk factors had the lowest risk of developing HGD or EAC (<1%), whereas those with LGD and at least one other risk factor had the highest risk of neoplastic progression (18-40%). CONCLUSIONS: In patients with BE, the risk of developing HGD or EAC is predominantly determined by the presence of LGD, a known duration of BE of ≥10 years, longer length of BE, and presence of esophagitis. One or combinations of these risk factors are able to identify patients with a low or high risk of neoplastic progression and could therefore be used to individualize surveillance intervals in BE.

Screening for colorectal cancer: random comparison of guaiac and immunochemical faecal occult blood testing at different cut-off levels.

Immunochemical faecal occult blood testing (FIT) provides quantitative test results, which allows optimisation of the cut-off value for follow-up colonoscopy. We conducted a randomised population-based trial to determine test characteristics of FIT (OC-Sensor micro, Eiken, Japan) screening at different cut-off levels and compare these with guaiac-based faecal occult blood test (gFOBT) screening in an average risk population. A representative sample of the Dutch population (n=10 011), aged 50-74 years, was 1 : 1 randomised before invitation to gFOBT and FIT screening. Colonoscopy was offered to screenees with a positive gFOBT or FIT (cut-off 50 ng haemoglobin/ml). When varying the cut-off level between 50 and 200 ng ml(-1), the positivity rate of FIT ranged between 8.1% (95% CI: 7.2-9.1%) and 3.5% (95% CI: 2.9-4.2%), the detection rate of advanced neoplasia ranged between 3.2% (95% CI: 2.6-3.9%) and 2.1% (95% CI: 1.6-2.6%), and the specificity ranged between 95.5% (95% CI: 94.5-96.3%) and 98.8% (95% CI: 98.4-99.0%). At a cut-off value of 75 ng ml(-1), the detection rate was two times higher than with gFOBT screening (gFOBT: 1.2%; FIT: 2.5%; P<0.001), whereas the number needed to scope (NNscope) to find one screenee with advanced neoplasia was similar (2.2 vs 1.9; P=0.69). Immunochemical faecal occult blood testing is considerably more effective than gFOBT screening within the range of tested cut-off values. From our experience, a cut-off value of 75 ng ml(-1) provided an adequate positivity rate and an acceptable trade-off between detection rate and NNscope.

Description of a cellulose-binding domain and a linker sequence from Aspergillus fungi.

A family I cellulose-binding domain (CBD) and a serine- and threonine-rich linker peptide were cloned from the fungi Aspergillus japonicus and Aspergillus aculeatus. A glutathione S-transferase (GST) fusion protein comprising GST and a peptide linker with the CBD fused to its C-terminus, was expressed in Escherichia coli. The renatured GST-CBD recovered from inclusion bodies had a molecular mass of 36.5 kDa which agrees with the 29 kDa of the GST plus the calculated 7.5 kDa of the linker with the CBD. The isolated GST-CBD protein adsorbed to both bacterial microcrystalline cellulose and carboxymethyl cellulose. Deletion of the linker peptide caused a decrease in cellulose adsorbance and a higher sensitivity to protease digestion.

Weaning piglets, microbial fermentation, short chain fatty acids and diarrhoea.

The effect of weaning on the absorptive capacity of the large intestine (LI) of weaned and unweaned pigs for short chain fatty acids (SCFA), sodium, potassium, and water has been determined by perfusion studies. Ligated loops were formed at four sites in the LI. In both groups the rate of absorption of SCFA, sodium and potassium was increased from the proximal to the distal sites, but this increase was not followed by an increase in the absorption of water. It is concluded that unweaned and weaned pigs can absorb SCFA and electrolytes immediately after weaning, but that a period of adaptation is required for the optimal absorption of water. This lower capacity for the absorption of water in the first two weeks after weaning makes the recently weaned pig vulnerable to a loss of fluid from the intestines.

Weaning and the weanling diet influence the villous height and crypt depth in the small intestine of pigs and alter the concentrations of short-chain fatty acids in the large intestine and blood.

Effects of weaning pigs to different diets have been investigated in terms of the changes in the small intestinal morphology, and in the absorption of short-chain fatty acids (SCFA) and sodium from the large intestine. One piglet from each of six litters containing nine pigs was sampled on the day of weaning; the other eight piglets were divided into four equal groups and fed different diets as follows: unweaned, weanling diet, or sow's milk at high or low level. Four and seven days after weaning, measurements of the intestinal tissue and contents were made; the plasma concentrations of SCFA, aldosterone and sodium were also measured. The villous height in the small intestine was highest in the unweaned group and greater in the high milk group than in either the weanling diet or low milk group (P < 0.001). Apparently, villous atrophy was due more to the level of feed intake than to the composition of the diet. The concentrations of SCFA in the large intestine and portal blood were highest in the weanling diet group and lowest in the low milk group. The low milk group tended to have higher blood concentrations of aldosterone (P = 0.15), which may have compensated for the low concentrations of SCFA in maintaining a higher percentage of dry matter in the intestine. Pigs fed weanling diet may use the energy from the SCFA to maintain a body weight comparable to that of pigs fed milk at a low level.

Community structure and dynamics in desert ecosystems: potential implications for insecticide risk assessment.

Insecticides are increasingly being used in hot arid ecosystems. The evaluation of the ecological risk these insecticides may pose, however, is based largely on data derived from temperate organisms and ecosystems. The major differences in the composition, structure, and functioning of desert animal communities when compared to temperate terrestrial ecosystems are discussed. Desert communities are characterized by a high fraction of ectotherms (both vertebrates and invertebrates);rodents and insectivores appear to dominate the mammalian fauna; and detritivores make up a very large part of the arthropod fauna. Presently available toxicity data cover these groups only to a very limited extent. It is not known if the ranges of insecticide susceptibility observed in temperate species are representative of those in arid organisms. Thus, it is not certain that ecotoxicological assessments based on such data sets adequately protect desert animal communities. It is shown that food web connectance is higher in desert ecosystems than in temperate grasslands or forests. This may to a large extent be due to the high degree of omnivory among desert organisms. Population regulation between predators and prey appears to be weaker in deserts. The same is often, though not always, the case for competition among desert organisms. It is argued that such characteristics will reduce the chance that strong indirect effects of insecticide perturbations will occur. In spite of the fact that many desert organisms are well adapted to cope with high temporal and spatial environmental variability, there is no reason to believe that they will always recover more rapidly from population perturbations caused by insecticides. The relatively large physiological and life-history plasticity encountered in many desert animals may increase tolerance to insecticide stress. Food chains are longer in deserts than in temperate grasslands and forests. The implications of this observation for the risk of biomagnification of contaminants are discussed.

Subcellular Localization of Proteases in Developing Leaves of Oats (Avena sativa L.).

The distribution and subcellular localization of the two major proteases present in oat (Avena sativa L. cv Victory) leaves was investigated. Both the acidic protease, active at pH 4.5, and the neutral protease, active at pH 7.5, are soluble enzymes; a few percent of the enzyme activity was ionically bound or loosely associated with organellar structures sedimenting at 1000g. On the average, 16% of the acidic protease could be washed out of the intercellular space of the leaf. Since isolated protoplasts contained correspondingly lower activities as compared to crude leaf extracts, part of the acidic activity is associated with cell walls. No neutral protease activity was recovered in intercellular washing fluid. Of the activities present in protoplasts, the acidic protease was localized in the vacuole, whereas the neutral protease was not. The localization of the acidic protease in vacuoles did not change during leaf development up to an advanced stage of senescence, when more than 50% of the leaf protein had been degraded. These observations indicate that protein degradation during leaf senescence is not due to a redistribution of acidic protease activity from the vacuole to the cytoplasm.

Vital DNA staining of agarose-embedded protoplasts and cell suspensions of Nicotiana plumbaginifolia.

The DNA of agarose-embedded protoplasts of Nicotiana plumbaginifolia was stained with Hoechst 33342 by immersing microscope slides, coated with immobilized protoplasts, into Erlenmeyer flasks containing consecutively dye solution, pH-correcting washing solutions and culture medium. After staining, protoplasts regenerated cell walls, started to divide and proliferated to calli. The culture system with immobilized protoplasts permits rapid change of culture media and accurate control of experimental conditions. The staining technique offers the opportunity for continuous observation of chromosomal behaviour and cell dynamics in individual plant cells.The same staining procedure was successfully applied to DNA of plant cells in suspension. Flow cytometric analysis revealed a retarding effect of the dye on the cell cycle, but within hours the cells recovered and showed their normal growth characteristics as compared to the controls.