Absorption and isomerization of caffeoylquinic acids from different foods using ileostomist volunteers.

BACKGROUND: Polyphenols are thought to play important roles in human nutrition and health but these health effects are dependent on their bioavailability. This study is one of a series with the aim of determining possible effects of food matrices on caffeoylquinic acid (CQA) bioavailability using ileostomy volunteers. METHODS: After a CQA-free diet, ileostomists consumed coffee (746 µmol total CQA), and CQAs in excreted ileal fluid were subsequently identified and quantified with HPLC-diode array detection and HPLC-ESI-MS/MS. In our previous studies, other food sources such as cloudy apple juice (CAJ) (358 µmol CQA) and apple smoothie (AS) (335 µmol CQA) were investigated with the same model. RESULTS: Interesterification of CQA from both apple matrices was observed during gastrointestinal passage, whereas CQA consumed in coffee was not influenced by interesterification reactions. In total, 74.3, 22.4, and 23.8 % of the CQA from CAJ, AS, and coffee, respectively, were absorbed or degraded. CONCLUSION: Our results show that variations in food matrices and variations in phenolic composition have a major influence on intestinal bioavailability and interesterification of the investigated subclass of polyphenols, the CQAs.

Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group.

Choosing the right operation for metastatic spinal tumours is often difficult, and depends on many factors, including life expectancy and the balance of the risk of surgery against the likelihood of improving quality of life. Several prognostic scores have been devised to help the clinician decide the most appropriate course of action, but there still remains controversy over how to choose the best option; more often the decision is influenced by habit, belief and subjective experience. The purpose of this article is to review the present systems available for classifying spinal metastases, how these classifications can be used to help surgical planning, discuss surgical outcomes, and make suggestions for future research. It is important for spinal surgeons to reach a consensus regarding the classification of spinal metastases and surgical strategies. The authors of this article constitute the Global Spine Tumour Study Group: an international group of spinal surgeons who are dedicated to studying the techniques and outcomes of surgery for spinal tumours, to build on the existing evidence base for the surgical treatment of spinal tumours.

Improved metabolic control after 12-week dietary intervention with low glycaemic isomalt in patients with type 2 diabetes mellitus.

The polyol isomalt (Palatinit) is a very low glycaemic sugar replacer. The effect of food supplemented with isomalt instead of higher glycaemic ingredients like sucrose and/or starch hydrolysates on metabolic control in patients with type 2 diabetes was examined in this open study. Thirty-three patients with type 2 diabetes received a diet with foods containing 30 g/d isomalt instead of higher-glycaemic carbohydrates for 12 weeks. Metformin and/or thiazolidindiones were the only concomitant oral antidiabetics allowed during the study. Otherwise, the participants maintained their usual diet during the test phase, but were instructed to refrain from additional sweetened foods. Before start, after 6 weeks and 12 weeks (completion of the study), blood samples were taken and analysed for clinical routine parameters, metabolic, and risk markers. Thirty-one patients completed the study. The test diet was well accepted and tolerated. After 12 weeks, significant reductions were observed for: glycosylated haemoglobin, fructosamine, fasting blood glucose, insulin, proinsulin, C-peptide, insulin resistance (HOMA-IR), and oxidised LDL (an atherosclerosis risk factor). In addition, significant lower nonesterified fatty acid concentrations were found in female participants. Routine blood measurements and blood lipids remained unchanged. The substitution of glycaemic ingredients by isomalt and the consequent on reduction of the glycaemic load within otherwise unchanged diet was accompanied by significant improvement in the metabolic control of diabetes. The present study is in agreement with findings of previous reported studies in human subjects demonstrating beneficial effects of low glycaemic diets on glucose metabolism in patients with diabetes mellitus type 2.

[Oncological surgery of the spine]. / Onkologische Chirurgie der Wirbelsäule.

Spine surgery has been significantly influenced during the past 20 years by improvements in anaesthesia and radiology. This progress has also been promoted by technical developments in spinal instrumentation, mainly the introduction of pedicle screws and anterior support with cages. Both techniques allow correction and stabilisation methods that have had a major effect on tumour surgery. These advancements have allowed less experienced spine surgeons to perform tumour surgery, which may have a negative effect on the outcome. From our point of view, it should be required that tumour surgery be performed only in hospitals managing a certain number of tumours annually. For optimal results, en bloc resection and intralesional marginal resection in particular are highly demanding of the surgeon's technical skills and experience. Second and third operations complicate the intervention unnecessarily. Normally, R0 resection can not be achieved by a second or third revision. For this reason tumour surgery requires a standardised overall concept which must be suited to individual problems. This can be best decided in a tumour board meeting for choosing the options for adjuvant therapy. Only by such a coordinated effort may good mid- and long-term results be achieved.It must be pointed out that en bloc resection is the only surgical therapy that makes a curative approach possible. On the other hand it can also be demonstrated that by making extended, intralesional marginal resections as radical as possible, good mid-term results can be achieved. Here the adjuvant chemo- and radiotherapy play an important role.

SNP-Array genotyping and spectral karyotyping reveal uniparental disomy as early mutational event in MSS- and MSI-colorectal cancer cell lines.

In this study nine colorectal cancer cell lines were analysed by 10K SNP-arrays and spectral karyotyping (SKY). Complex chromosomal alterations and breakpoints of deleted or translocated fragments found by SKY could further be characterized by SNP-array analysis. Interestingly many monoallelic regions identified by SNP-array analysis display no copy number alterations, representing uniparental disomy (UPD). It was demonstrated that UPD seems to be involved in activation of early-acting tumor suppressor genes in MSS- (APC, CDKN2A) and MSI- (MLH1, MSH2, APC, CDKN2A) colorectal cancer cell lines. Genes involved later on in the adenoma-carcinoma sequence (i.e. TP53/SMAD4) were not found to be inactivated by UPD. Furthermore, identified amplified monoallelic regions may include oncogenes activated by allele-specific-amplification (i.e. Cyclin D1). However, at present, the majority of the monoallelic regions located in the present study have not yet been associated with known tumor suppressor genes and oncogenes. Further studies are warranted to identify relevant genes in the respective regions and to further verify the results presented here.

Evaluation of the reject waters from co-digestion of solid wastes from agro-industries in a municipal WWTP.

Overcapacities of anaerobic digesters at municipal WWTPs are frequently used for the treatment of organic wastes in order to increase the biogas production. However, "co-digestion" of organic wastes leads to additional nitrogen loading and to additional loads of non-biodegradable COD. The effects of (co-) digestion of organic wastes from agro-industries (slaughterhouses, dairies and leather industry) on the wastewater cycle have been evaluated in full-scale investigations at Leoben WWTP with a capacity of 90,000 pe where the methane production was increased from 700 to more than 1700 Nm3 CH4 per day. For this evaluation, mass balances for COD and nitrogen have been applied to estimate the fluxes of these substances. Application of this method is described in detail. As the additional loadings, it was found that related to methane production less nitrogen is released from the organic wastes than from the waste sludge. While the ammonia nitrogen load in the effluent from sludge digestion was about 100 g NH4-N per Nm3 of CH4 produced, in the effluent from the digestion of organic wastes only 70 g NH4-N/Nm3 CH4 were found. The decrease in the COD removal efficiency after digestion of the organic wastes started was not regarded as significant enough to be seen as a consequence of the treatment of external substrate.

[Special gastrointestinal problems of elderly patients]. / Symptomarmer Verlauf--ernste Folgen.

Only a few gastrointestinal diseases develop specifically at advanced ages (e.g. Zenker diverticulum, atrophic gastritis, mesenterial ischaemia). However, the frequency of certain diseases increases and various illnesses are found to take other, mostly silent, courses in elderly people. As a rule, more complications in gastrointestinal diseases are to be expected and the presence of comorbidities can make diagnosis and therapy more difficult. The possibility of tumours should always be considered in the differential diagnosis of elderly patients. The diagnosis and treatment of elderly patients for gastrointestinal diseases are no different from that of other age groups.

[The role of the diet in the prevention of gastrointestinal tumors]. / Ernährungstipps zur Prävention gastrointestinaler Tumoren. Obst und Gemüse sind die Favoriten.

Second only to cardiovascular diseases, malignant tumors are the most common fatal disease, with malignant neoplasms in the gastrointestinal tract playing an important role. Underlying the most numerous of these malignancies is a complex interaction between genetic and environmental factors. The data relating to the role of environmental factors (for the most part dietary factors) in the development of gastrointestinal tumors derive mainly from, epidemiological research. The current evidence is "convincin" with regard to complex lifestyle patterns, but at most "plausible" when the chemically defined individual substances are considered. Summarizing the potential protective value of dietary factors reveals that the risk of contracting the majority of the gastrointestinal tumors can be reduced by increasing the intake of fruit and vegetables. An additional protective effect is associated with a balanced diet, physical activity, preservation of normal weight, avoidance of smoking, and moderation in the amount of alcohol consumed.

Butyrate and aspirin in combination have an enhanced effect on apoptosis in human colorectal cancer cells.

Laboratory and epidemiological studies suggest that butyrate, a metabolic product of microbial fermentation of dietary fibre, and aspirin, a non-steroidal antiphlogistic drug, both reduce the risk of developing colon cancer. Notably, few data exist on potential interactions of these two substances. In this study, the effects of a butyrate-aspirin combination on human colon cancer cells were compared with treatment with aspirin or butyrate alone. Both substances decreased proliferation and induced differentiation and apoptosis. Butyrate reduced mutant p53 expression, whereas aspirin did not affect p53 expression. Butyrate-induced apoptosis correlated with an increase in Bak expression and a decrease in the expression of Bcl-XL. Aspirin had no effect on the investigated apoptosis-controlling factors. The antiproliferative and pro-apoptotic effects of the butyrate-aspirin combination were markedly enhanced. The combination resulted in a stronger decrease in the expression of PCNA and cdk2. Our data suggest that the anticarcinogenic effect of aspirin might effectively be augmented by combination with the short-chain fatty acid butyrate.

Stability of ketone bodies in serum in dependence on storage time and storage temperature.

The serum concentrations of beta-hydroxybutyrate and acetoacetate as well as the beta-hydroxybutyrate/acetoacetate ratio are important parameters for the differential diagnosis of certain inborn errors of metabolism. Acetoacetate, however, is an unstable compound which becomes rapidly decarboxylated. At a storage temperature of -20 degrees C about 40% of the acetoacetate is lost within 7 days and after 40 days storage at this temperature virtually all of the acetoacetate has become degraded. At -80 degrees C the decomposition of acetoacetate occurs with a much slower rate and only 15% of the initial acetoacetate is lost after 40 days storage. The rate constants for the decarboxylation reaction were found to be (6.4 +/- 2.9) * 10(-5) [min(-1)] at -20 degrees C and (0.4 +/- 0.3) * 10(-5) [min(-1)] at -80 degrees C. In contrast, beta-hydroxybutyrate is very stable during storage and hence should be used as main parameter for the evaluation of ketonemia. If determination of acetoacetate and/or of the beta-hydroxybutyrate/acetoacetate ratio is necessary, an assay immediately after collecting the serum samples is recommended. Otherwise, the serum samples should be frozen as soon as possible and stored at -80 degrees C during transport and storage.

Posterior C1-C2 fusion with polyaxial screw and rod fixation.

STUDY DESIGN: A novel technique of atlantoaxial stabilization using individual fixation of the C1 lateral mass and the C2 pedicle with minipolyaxial screws and rods is described. In addition, the initial results of this technique on 37 patients are described. OBJECTIVES: To describe the technique and the initial clinical and radiographic results for posterior C1-C2 fixation with a new implant system. SUMMARY OF BACKGROUND DATA: Stabilization of the atlantoaxial complex is a challenging procedure because of the unique anatomy of this region. Fixation by transarticular screws combined with posterior wiring and structural bone grafting leads to excellent fusion rates. The technique is technically demanding and has a potential risk of injury to the vertebral artery. In addition, this procedure cannot be used in the presence of fixed subluxation of C1 on C2 and in the case of an aberrant path of the vertebral artery. To address these limitations, a new technique of C1-C2 fixation has been developed: bilateral insertion of polyaxial-head screws in the lateral mass of C1 and through the pars interarticularis into the pedicle of C2, followed by a fluoroscopically controlled reduction maneuver and rod fixation. METHODS: After posterior exposure of the C1-C2 complex, the 3.5-mm polyaxial screws are inserted in the lateral masses of C1. Two polyaxial screws are then inserted into the pars interarticularis of C2. Drilling is guided by anatomic landmarks and fluoroscopy. If necessary, reduction of C1 onto C2 can be accomplished by manipulation of the implants, followed by fixation to the 3-mm rod. For definitive fusion, cancellous bone can be added. No structural bone graft or wiring is required. In selected cases, e.g., C1-C2 subluxation or fractures in young patients in whom only temporary fixation is necessary, the instrumentation can be removed after an appropriate time. Because the joint surfaces stay intact, the patient can regain motion in the C1-C2 joints. RESULTS: Thirty-seven patients underwent this procedure. No neural or vascular damage related to this technique has been observed. The early clinical and radiologic follow-up data indicate solid fusion in all patients. CONCLUSION: Fixation of the atlantoaxial complex using polyaxial-head screws and rods seems to be a reliable technique and should be considered an efficient alternative to the previously reported techniques.

Analytical method for the determination of acrylonitrile in rat plasma at the nanograms per milliliter level.

A method is described for the determination of acrylonitrile (propenenitrile, vinyl cyanide, AN) in rat plasma at the ng/mL level by gas chromatography (GC) utilizing a modified delayed injection technique (DIT) and a nitrogen-phosphorus detector. The method was developed to determine the acrylonitrile plasma profile following administration of various dose levels of AN via different routes. A remote injection apparatus was placed in-line with the purge gas to the precolumn of the DIT. Using this arrangement, matrix interferences in rat plasma samples normally incurred during GC analysis were overcome, while a high sensitivity for acrylonitrile was maintained. The ability to analyze 20-microL samples made serial kills unnecessary and duplicate injections possible with an analysis time of approximately 10 min/sample. The average detection limit for the entire study (3 x background) was 2.0 ng/mL.

Medical student attitudes toward elderly patients: effects of social attractiveness.

The purpose of this study was to determine if medical students' attitudes toward the elderly can be modified through social attractiveness cues in the form of descriptions of abilities and photographs of the patients. The results indicated that students were most personally and professionally attracted to the mentally alert patient, and they were most personally attracted to the patient whose photograph was included in the medical record. Furthermore, inclusion of previous and current photographs had a mediating effect on attitude formation and the formation of stereotypes. These results suggest that presenting social attractiveness information may be useful in countering negative perceptions of the elderly.

Pressure sores in the elderly. A systematic approach to management.

Pressure sores are a serious but often avoidable problem. The best management plan focuses on early identification of high-risk patients, appropriate allocation of resources, and adequate techniques of pressure relief. A standardized treatment plan that is familiar to care givers should be followed. The clinician must correct all conditions that retard the healing process, including nutritional deficits and underlying medical problems. Multiple-drug therapy must be eliminated, and only established skin care protocols should be followed. Use of systemic antibiotics is reserved for complications, such as osteomyelitis, cellulitis, and sepsis.

[Anatomic reduction and monosegmental fusion for high-grade developmental spondylolisthesis L5/S1]. / Anatomische Reposition und monosegmentale Fusion bei hochgradiger dysplastischer Spondylolisthese L5/S1.

INTRODUCTION: Developmental spondylolisthesis leads to lumbosacral kyphosis with retroversion of the sacrum and lumbar hyperlordosis. The overall sagittal profile of the spine is affected. The deformity is progressive during growth. This retrospective study describes a technique for complete reduction with clinical and radiological evaluation. PATIENTS: Thirty-four patients (mean age 16 years 3 months, 10 males, 24 females) with severe developmental spondylolisthesis L5/S1 (Meyerding grades 3 to 5) were operated on between February 1997 and July 2002. METHOD: Reduction was achieved by temporary transpedicular instrumentation of L4. These screws were removed at the end of the operation or 12 weeks later. RESULTS: Mean slippage was corrected from 76 % preoperatively to 10 % postoperatively. Segmental kyphosis L5/S1 improved from + 21 degrees preoperatively to - 7 degrees postoperatively. Sacral inclination was 34 degrees preoperatively, 43 degrees postoperatively, and 47 degrees at latest follow-up. 76 % of the patients were pain free at the latest follow-up. In 4 patients a fusion at L4/5 was performed due to subsequent decompensation. CONCLUSION: The technique described allows for a nearly anatomic reduction with correction of slippage as well as segmental kyphosis. Correction of the local deformity with monosegmental fusion L5/S1 improves dramatically the overall sagittal profile of the spine. Fusion of the primarily healthy segment L4/5 can be avoided.

Effects of isomalt consumption on gastrointestinal and metabolic parameters in healthy volunteers.

The polyol isomalt (Palatinit) is a well established sugar replacer. The impact of regular isomalt consumption on metabolism and parameters of gut function in nineteen healthy volunteers was examined in a randomised, double-blind, cross-over trial with two 4-week test periods. Volunteers received 30 g isomalt or 30 g sucrose daily as part of a controlled diet. In addition to clinical standard diagnostics, biomarkers and parameters currently discussed as risk factors for CHD, diabetes or obesity were analysed. Urine and stool Ca and phosphate excretions were measured. In addition, mean transit time, defecation frequency, stool consistency and weight were determined. Consumption of test products was affirmed by the urinary excretion of mannitol. Blood lipids were comparable in both phases, especially in volunteers with hyperlipidaemia, apart from lower apo A-1 (P=0.03) for all subjects. Remnant-like particles, oxidised LDL, NEFA, fructosamine and leptin were comparable and not influenced by isomalt. Ca and phosphate homeostasis was not affected. Stool frequency was moderately increased in the isomalt phase (P=0.006) without changes in stool consistency and stool water. This suggests that isomalt is well tolerated and that consumption of isomalt does not impair metabolic function or induce hypercalciuria. In addition, the study data indicate that isomalt could be useful in improving bowel function.

Collection and ion chromatographic determination of ammonia and methylamines in air.

A method is described for the collection of ammonia (NH3), monomethylamine (MMA), dimethylamine (DMA), and trimethylamine (TMA) from air and their subsequent determination by ion chromatography. Samples are collected with 800-mg silica gel sampling tubes at a flow rate of 1 L/min for 10 minutes or at 100 mL/min for up to 7.5 hours. Samples collected with sulfuric acid-treated tubes can be stored at room temperature for at least 21 days with no loss in recovery. Untreated samples can be stored in a refrigerator up to 32 days. The method has been validated from 2 to 50 ppm v/v when a 10 L air sample is taken. No loss in recovery was observed when sampling up to 23 L of air at 100% relative humidity. The recovery and total precision (95% confidence level) for NH3, MMA, DMA, and TMA were 91 +/- 12.5%, 93 +/- 10.3%, 92 +/- 9.6% and 84 +/- 17.6%, respectively.

Concentration and determination of the propylene glycol butyl ether esters of 2,4-dichlorophenoxyacetic acid (PGBE 2,4-D) in air.

A method has been developed and validated for the determination of airborne propylene glycol butyl ether ester and the dipropylene glycol butyl ether ester of 2,4-dichlorophenoxyacetic acid. The method is designed to collect samples in the breathing zone of workers for 4 hours at 150 mL/min. using a tube containing 750 mg of Amberlite XAD-2 resin and a portable pump. Recoveries of 85.2% and 81.4% were obtained for the two esters over a range of 0.67 and 13.3 mg/m3 by desorption wih hexane. The extracts were analyzed by electron capture gas chromatography using a highly efficient and inert bonded Carbowax 20-M column packing. The recovery was not affected by 80% relative humidity or refrigerated storage for two weeks. Some loss in recovery was observed for the 0.67 mg/m3 level when samples were stored at room temperature for two weeks. The overall precision of the method for the two esters is +/- 17% and +/- 16% at the 95% confidence level.

Phase equilibrium method for determination of desorption efficiencies.

The principle of phase equilibrium is applied to the determination of desorption efficiencies of organic compounds collected on activated charcoal. The method depends on the existance of a true equilibrium distribution between the adsorbed and solution phases of organics in the desorption solvent--adsorbent matrix. Improved and more consistant desorption efficiencies are obtained by considering the effects of variations in the adsorbent--solvent ratio and equilibrium temperature at time of analysis. The technique may also provide early detection of interaction or reaction of the sorbate on the adsorbent surface.