Analytical approaches for MCPD esters and glycidyl esters in food and biological samples: a review and future perspectives.

Esters of 2 - and 3-monochloropropane-1,2-diol (MCPD) and glycidol esters are important contaminants of processed edible oils used as foods or food ingredients. This review describes the occurrence and analysis of MCPD esters and glycidol esters in vegetable oils and some other foods. The focus is on the analytical methods based on both direct and indirect methods. Methods of analysis applied to oils and lipid extracts of foods have been based on transesterification to free MCPD and determination by gas chromatography-mass spectrometry (indirect methods) and by high-performance liquid chromatography-mass spectrometry (direct methods). The evolution and performance of the different methods is described and their advantages and disadvantages are discussed. The application of direct and indirect methods to the analysis of foods and to research studies is described. The metabolism and fate of MCPD esters and glycidol esters in biological systems and the methods used to study these in body tissues studies are described. A clear understanding of the chemistry of the methods is important when choosing those suitable for the desired application, and will contribute to the mitigation of these contaminants.

Review article: reflux and its consequences--the laryngeal, pulmonary and oesophageal manifestations. Conference held in conjunction with the 9th International Symposium on Human Pepsin (ISHP) Kingston-upon-Hull, UK, 21-23 April 2010.

BACKGROUND: Gastro-oesophageal reflux disease (GERD) is one of the commonest diseases of Western populations, affecting 20 to 30% of adults. GERD is multifaceted and the classical oesophageal symptoms such as heartburn and regurgitation often overlap with atypical symptoms that impact upon the respiratory system and airways. This is referred to as extra-oesophageal reflux disease (EERD), or laryngopharyngeal reflux (LPR), which manifests as chronic cough, laryngitis, hoarseness, voice disorders and asthma. AIM: The 'Reflux and its consequences' conference was held in Hull in 2010 and brought together a multidisciplinary group of experts all with a common interest in the many manifestations of reflux disease to present recent research and clinical progress in GERD and EERD. In particular new techniques for diagnosing reflux were showcased at the conference. METHODS: Both clinical and non-clinical key opinion leaders were invited to write a review on key areas presented at the `Reflux and its consequences' conference for inclusion in this supplement. RESULTS AND CONCLUSION: Eleven chapters contained in this supplement reflected the sessions of the conference and included discussion of the nature of the refluxate (acid, pepsin, bile acids and non-acid reflux); mechanisms of tissue damage and protection in the oesophagus, laryngopharynx and airways. Clinical conditions with a reflux aetiology including asthma, chronic cough, airway disease, LPR, and paediatric EERD were reviewed. In addition methods for diagnosis of reflux disease and treatment strategies, especially with reference to non-acid reflux, were considered.

New effective treatment regimen for children infected with a double-resistant Helicobacter pylori strain.

BACKGROUND: The increasing number of pediatric patients infected with multiresistant Helicobacter pylori strains calls for evaluation of treatment regimens. Second-line antibiotics such as tetracycline or quinolones are not licensed for children. Because in vivo resistance to metronidazole may be overcome in vivo by a high dose and prolonged intake, we evaluated the eradication rate and side effects of a high-dose triple therapy in pediatric patients with culture-proven double resistance. PATIENTS AND METHODS: In this open multicentre trial, 62 children (<18 years, body weight >15 kg) infected with an H pylori strain resistant to metronidazole and clarithromycin were treated according to body weight classes with amoxicillin (∼ 75 mg/kg/day), metronidazole (∼ 25 mg/kg/day) and esomeprazole (∼ 1.5 mg/kg/day) for 2 weeks. Adherence and adverse events were assessed by a 2-week diary and telephone interviews at days 7 and 14 of treatment. Primary outcome was a negative C-urea breath test after 6 weeks. RESULTS: Of 62 patients, 5 were lost to follow-up, 12 were nonadherent, and 45 treated per protocol. Eradication rates were 66% (41/62) [confidence interval 54-78] (intention to treat) and 73% (33/45) [confidence interval 60-86] (per protocol). Success of treatment was not related to dose per kilogram body weight. Mild to moderate adverse events were reported by 21 patients, including nausea (10.8%), diarrhoea (8.9%), vomiting (7.1%), abdominal pain (5.4%), and headache (3.6%), and led to discontinuation in 1 child. CONCLUSION: High-dose amoxicillin, metronidazole, and esomeprazole for 2 weeks is a good treatment option in children infected with a double resistant H pylori strain.

Impact of skin to skin care, prone and supine positioning on cardiorespiratory parameters and thermoregulation in premature infants.

BACKGROUND: Skin to skin care (SSC), prone (PP) and supine (SP) positions are standard positions in daily care for premature infants. Their influence on cardiorespiratory parameters and thermoregulation is discussed controversially. OBJECTIVES: We compared SSC with PP, the recommended position for preterm infants, and SP, the safest position for term infants, and tested the hypothesis that SSC has no impact on cardiorespiratory parameters and thermoregulation. METHODS: In 18 spontaneously breathing premature infants [median gestational 28 weeks (24-32); chronological age 36 days (7-64), and weight 1,543 g (750-2,100)], heart and respiratory rate, breathing pattern, episodes of desaturation (<85 but >or=80 and <80%), oxygen saturation and rectal temperature were analyzed with polygraphy (Alice 3(R) and 3.5(R)) in a 6-hour measuring cycle of three subsequent series (120 min each in SP, SSC and PP) and compared (Wilcoxon test). RESULTS: During SSC, we found no increase in apneic attacks and bradycardic episodes and no difference in respiratory rate, breathing pattern, oxygen saturation, episodes and duration of desaturation compared to SP and PP. Episodes of desaturation <85 but >or=80 and <80% were more frequent in SP compared to PP (p = 0.0421 and p = 0.0319). Heart rate increased in SSC and PP compared to SP (154.86 bpm, SD 11.55, and 153.33 bpm, SD 15.95 vs. 150.25 bpm, SD 14.64; p = 0.0013 and p = 0.0346). Temperature level was not significantly higher during SSC and PP compared to SP except a rise between the start and the end of the 6-hour measuring cycle (37.05 degrees C, SD 0.2 vs. 37.30 degrees C, SD 0.3; p = 0.0436). CONCLUSION: We found no significant SSC-mediated changes in quality and quantity of desaturations and in body temperature compared to PP in preterm infants.

Persistent cyanosis in a 4 month old infant with severe pneumonia and haemoglobin M.

M haemoglobinaemia is a rare cause of persistant cyanosis. We report a four months old infant who suffered from severe pneumonia and respiratory distress syndrome. After return of normal respiration, cyanosis persisted. Oxygen saturation on pulse oximetry never exceeded 85%. Finally, we succeeded in isolating a haemoglobin M Saskatoon. HbM Saskatoon is normally a harmless variant. However, in conjunction with severe pneumonia, we assume that it did not only affect clinical evaluation, but also exacerbated pneumonia by reducing the oxygen binding capacity.

Contralateral inguinal hernia in childhood and youth: which child will develop a contralateral inguinal hernia?

This work addresses the controversial topic of the exploration of the contralateral side in the presence of a one-sided inguinal hernia in infancy. In a prospective study of 368 children with one-sided inguinal hernia, we demonstrated the consecutive development of a contralateral hernia in 22 (6%) of the children. We found that the child's age at first operation represents a risk factor for the development of a consecutive hernia. At an age of less than two months we found a highly significant (P < 0.0001) accumulation of consecutive hernias. These consecutive contralateral hernias appear significantly often (P < 0.0009) within the first two post-operative months in children at least two months old. In view of these findings, we see an indication for routine simultaneous repair on both sides for children aged less than two months at first presentation.

[Pediatric bowel MRI--accelerated parallel imaging in a single breathhold]. / MRT des darms bei kindern--beschleunigte bildgebung in einem atemzug.

PURPOSE: To compare highly accelerated parallel MRI of the bowel with conventional balanced FFE sequences in children with inflammatory bowel disease (IBD). MATERIALS AND METHODS: 20 children with suspected or proven IBD underwent MRI using a 1.5 T scanner after oral administration of 700 -1000 ml of a Mannitol solution and an additional enema. The examination started with a 4-channel receiver coil and a conventional balanced FFE sequence in axial (2.5 s/slice) and coronal (4.7 s/slice) planes. Afterwards highly accelerated (R = 5) balanced FFE sequences in axial (0.5 s/slice) and coronal (0.9 s/slice) were performed using a 32-channel receiver coil and parallel imaging (SENSE). Both receiver coils achieved a resolution of 0.88 x 0.88 mm with a slice thickness of 5 mm (coronal) and 6 mm (axial) respectively. Using the conventional imaging technique, 4 - 8 breathholds were needed to cover the whole abdomen, while parallel imaging shortened the acquisition time down to a single breathhold. Two blinded radiologists did a consensus reading of the images regarding pathological findings, image quality, susceptibility to artifacts and bowel distension. The results for both coil systems were compared using the kappa-(kappa)-coefficient, differences in the susceptibility to artifacts were checked with the Wilcoxon signed rank test. Statistical significance was assumed for p = 0.05. RESULTS: 13 of the 20 children had inflammatory bowel wall changes at the time of the examination, which could be correctly diagnosed with both coil systems in 12 of 13 cases (92 %). The comparison of both coil systems showed a good agreement for pathological findings (kappa = 0.74 - 1.0) and the image quality. Using parallel imaging significantly more artifacts could be observed (kappa = 0.47) without impairing the diagnostic impact. The comparison of the bowel distension showed no significant differences. CONCLUSION: The highly accelerated parallel MRI using the SENSE technique and a 32-channel surface coil enables the examination of the entire bowel in a single breathhold without relevant restrictions in image quality and diagnostic impact.

European Union database of acrylamide levels in food: update and critical review of data collection.

The European Commission's Directorate General Joint Research Centre has been collecting data produced by European Union Member States on the acrylamide content of food since 2003. More than 9000 individual data points have been received from official food control laboratories directly or via their Competent Authorities, and from the food industry. Before being entered into the database, the data were assessed for their reliability. This paper presents an update of the database as well as results of the evaluation of data for selected food commodities in order to establish a trend concerning the content of acrylamide in food. Experience gained with the data collection and data assessment are described and recommendations for future data collection initiatives given.

[Depression of respiration via toxic effects on the central nervous system following use of topical brimonidine in an infant with congenital glaucoma]. / Zentralnervöse Atemdepression als Komplikation der Behandlung des kongenitalen Glaukoms mit Brominidin-Augentropfen.

We report the case of a premature newborn (gestational age 33 weeks) with congenital glaucoma. After a trabeculotomy high intraocular pressure persisted, leading to adjuvant treatment with timolol and--when the infant was 3 weeks old--with brimonidine. After the first application of topical brimonidine the infant developed such severe apnoeic spells that intubation and temporary ventilation were necessary. A review of the literature reveals that when used in young infants brimonidine eye drops can potentially have toxic effects on the central nervous system (e.g. respiratory depression). The use of topical brimonidine is therefore not advised in this age group.

Anomalous origin of the left coronary artery from the pulmonary artery in a premature infant with preserved left ventricular function.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare condition. The majority of cases present with impaired left ventricular function. We report on a premature infant who was diagnosed at a gestational age near term with ALCAPA during routine cardiac examination. The patient showed no signs of myocardial ischemia and is doing well after corrective surgery. This is the youngest patient reported with ALCAPA and preserved myocardial function.

[Peripheral analgesic effect of intra-articularly applied clonidine]. / Periphere analgetische Wirkung durch intraartikulär verabreichtes Clonidin.

BACKGROUND AND AIM: Clonidine applied intra-articularly into the knee joint has a peripheral analgesic effect. We examined intra-articularly injected clonidine to determine whether resorption with a measurable systemic concentration could be detected. METHODS: A randomised, placebo-controlled double-blind study was carried out on patients undergoing knee arthroscopies. The 69 patients were randomised into three groups: group 1 received 150 ug clonidine intra-articularly, group two 150 ug clonidine intravenously and group three a placebo. Postoperative pain therapy was carried out with i.v. morphine hydrochloride. Pain scores and side-effects were documented for 24 h. RESULTS: There were no significant differences between the three groups in demographics, duration of operation, duration of anaesthesia, diagnoses or type of operation. The pain score at rest was significantly lower in group 1. In the first 20 min, the systemic concentration of clonidine was significantly higher in the intravenous group than in the intra-articular group. CONCLUSION: Intra-articular clonidine has a postoperative analgesic effect after knee arthroscopies due to a peripheral action.

Effect of Gaviscon Infant on gastro-oesophageal reflux in infants assessed by combined intraluminal impedance/pH.

BACKGROUND: Gaviscon Infant (GI) has been recommended for gastro-oesophageal reflux (GOR) in infants. Its efficacy has not been examined with a physiologically appropriate denominator to define the degree of GOR. AIM: To investigate the influence of Gaviscon Infant on GOR in infants using combined pH and intraluminal impedance measurement. METHODS: Twenty infants (mean age 163.5 days, range 34-319 days) exclusively bottle fed, with symptoms clinically suggestive of GOR, underwent 24 hour studies of intra-oesophageal 6 channel impedance and dual channel pH monitoring, during which six random administrations (3+3) of Gaviscon Infant (625 mg in 225 ml milk) or placebo (mannitol and Solvito N, 625 mg in 225 ml milk) were given in a double blind fashion. Impedance/pH reflux data were recorded and analysed blind by one observer. RESULTS: The median number of reflux events/hour (1.58 v 1.68), acid reflux events/hour (0.26 v 0.43), minimum distal or proximal pH, total acid clearance time per hour (time with pH below pH 4), and total reflux duration per hour were not significantly different after GI than after placebo. Reflux height was marginally lower after GI (median 66.6% v 77.3% oesophageal length) compared with placebo. CONCLUSIONS: Results showed a marginal but significant difference between Gaviscon Infant and placebo in average reflux height, and raises questions regarding any perceived clinical benefit of its use.

Analytical methods for the determination of acrylamide in food products: a review.

In early 2002, the Swedish National Food Administration reported high acrylamide levels in heat-treated carbohydrate-rich foods. Consequently, intensive activity began examining the many different types of food, and thousands of analyses have been undertaken world wide. Measurement data have been published in many different types of media. Within this flood of publications, there are only a limited number of articles concerned with the technical aspects of the measurements. This review focuses on the state-of-the-art in the analysis of acrylamide in foodstuffs. It covers information on methods from peer-reviewed articles and other sources (e.g. a survey carried out among official and private laboratories of the Member States of the European Union). Alternative methods are presented and discussed alongside the more common measurement techniques for acrylamide in foodstuffs. Special attention is given to sample preparation. The greatest differences between the analytical methods was for acrylamide extraction and clean-up. The influence of different extraction techniques or extraction solvents/solvent mixtures on the measurement results has not yet been fully investigated. There is also a lack of understanding about the sample clean-up. Since both might have a large impact on the results of the analysis, this review should also be considered as a basis for further investigations.

Comparison of different extraction techniques for the determination of polychlorinated organic compounds in sediment.

The performance of various enhanced extraction techniques, such as accelerated solvent extraction, microwave-assisted extraction, Soxhlet extraction, ultrasonic extraction and fluidized-bed extraction for the determination of polychlorinated organic compounds in dry sediment was investigated in two laboratories. The results of the two laboratories were in good agreement. The extraction yields from the batch extraction methods were lower than those from the dynamic techniques. Accelerated solvent extraction, especially, exhibited higher extraction efficiency than the standard procedure, Soxhlet extraction, whereas the results of fluidized-bed extraction were comparable.

Comparative studies of the static and dynamic headspace extraction of saturated short chain aldehydes from cellulose-based packaging materials.

Aldehydes in cellulose-based materials such as cardboard are derived from lipid degradation. Depending on the production- and storage conditions of the cardboard, the aldehyde content changes. Owing to their sensorial properties, accurate control of their content is obligatory. The cardboard usually exhibits strong and even varying matrix effects and considerable inhomogeneity. The comparability of results of analysis after static and dynamic headspace extraction of short chained saturated aldehydes from cellulose-based matrices was studied. In the case of the static extraction technique, special attention was given to the establishment of the headspace equilibrium, which could be reached by the addition of water as a displacer. For dynamic headspace extraction, the volatiles were purged from the matrix by an inert gas and enriched on an adsorbent trap. In theory, the extraction yield should be 100%. Since there are no certified reference materials for verification of the extraction efficiency available, confirmation was achieved by determining the total amount of analytes in the sample by means of multiple headspace extraction.In comparison to the static operation mode, the major drawbacks of the dynamic technique were found to be based on a more complex parameter string and on limitations to the extractable sample quantities, which may result in enhanced uncertainty of the measurements. Nevertheless, the results of analysis pointed out that both headspace extraction techniques are suitable for the determination of volatile aldehydes from cellulose-based materials.