Noninvasive Prenatal Genetic Screening of Cell-Free Fetal DNA for Early Prediction of ß-Thalassemia Using Fiber Optic Nanogold-Linked Sorbent Assay.

ß-Thalassemia is a prevalent type of severe inherited chronic anemia, primarily identified in developing countries. The identification of single nucleotide polymorphisms (SNPs) plays a vital role in the early diagnosis of genetic diseases. Here, we reported the development of an amplification-free fiber optic nanogold-linked sorbent assay method using a fiber optic particle plasmon resonance (FOPPR) biosensor for rapid and ultrasensitive detection of SNPs. Herein, MutS protein was selected as the biorecognition capture probe and immobilized on the sensing region to capture the target mutant DNA, which was hybridized with a single-base mismatched single-stranded DNA labeled by a gold nanoparticle (AuNP). The AuNP acts as a signaling agent to be detected by the FOPPR biosensor when it is bound on the fiber core surface. The method effectively differentiates mismatched double-stranded DNA by MutS protein from perfectly matched/complementary dsDNA. It exhibits an impressively low detection limit for the detection of SNPs at approximately 10-16 M using low-cost sensor chips and devices. By determination of the ratio of mutant DNA to normal DNA in cell-free genomic DNA from blood samples, this method is promising for diagnosing ß-thalassemia in fetuses without invasive testing techniques.

Advanced electrochemical membrane technologies for near-complete resource recovery and zero-discharge of urine: Performance optimization and evaluation.

The depletion of nutrient sources in fertilizers demands a paradigm shift in the treatment of nutrient-rich wastewater, such as urine, to enable efficient resource recovery and high-value conversion. This study presented an integrated bipolar membrane electrodialysis (BMED) and hollow fiber membrane (HFM) system for near-complete resource recovery and zero-discharge from urine treatment. Computational simulations and experimental validations demonstrated that a higher voltage (20 V) significantly enhanced energy utilization, while an optimal flow rate of 0.4 L/min effectively mitigated the negative effects of concentration polarization and electro-osmosis on system performance. Within 40 min, the process separated 90.13% of the salts in urine, with an energy consumption of only 8.45 kWh/kgbase. Utilizing a multi-chamber structure for selective separation, the system achieved recovery efficiencies of 89% for nitrogen, 96% for phosphorus, and 95% for potassium from fresh urine, converting them into high-value products such as 85 mM acid, 69.5 mM base, and liquid fertilizer. According to techno-economic analysis, the cost of treating urine using this system at the lab-scale was $6.29/kg of products (including acid, base, and (NH4)2SO4), which was significantly lower than the $20.44/kg cost for the precipitation method to produce struvite. Excluding fixed costs, a net profit of $18.24/m3 was achieved through the recovery of valuable products from urine using this system. The pilot-scale assessment showed that the net benefit amounts to $19.90/m3 of urine, demonstrating significant economic feasibility. This study presents an effective approach for the near-complete resource recovery and zero-discharge treatment of urine, offering a practical solution for sustainable nutrient recycling and wastewater management.

Bone healing under different lay-up configuration of carbon fiber-reinforced PEEK composite plates.

Secondary healing of fractured bones requires an application of an appropriate fixator. In general, steel or titanium devices are used mostly. However, in recent years, composite structures arise as an attractive alternative due to high strength to weight ratio and other advantages like, for example, radiolucency. According to Food and Drug Administration (FDA), the only unidirectionally reinforced composite allowed to be implanted in human bodies is carbon fiber (CF)-reinforced poly-ether-ether-ketone (PEEK). In this work, the healing process of long bone assembled with CF/PEEK plates with cross- and angle-ply lay-up configurations is studied in the framework of finite element method. The healing is simulated by making use of the mechanoregulation model basing on the Prendergast theory. Cells transformation is determined by the octahedral shear strain and interstitial fluid velocity. The process runs iteratively assuming single load cycle each day. The fracture is subjected to axial and transverse forces. In the computations, the Abaqus program is used. It is shown that the angle-ply lamination scheme of CF/PEEK composite seems to provide better conditions for the transformation of the soft callus into the bone tissue.

Finite Element Analysis and Clinical Applications of Transverse Post for the Rehabilitation of Endodontically Treated Teeth.

Introduction The preservation of tooth structure during cavity preparation is crucial for maintaining tooth strength and longevity of restorations. The biomechanical behavior of teeth, especially those with mesio-occlusal-distal (MOD) cavity preparations, is significantly affected by the extent of cavity preparation and the type of restorative treatment employed. The aim of the current study was to evaluate and analyze the stress distribution seen in the mandibular molar with MOD cavity when restored with transverse post, using finite element analysis (FEA). Materials and methodology FEA was utilized to evaluate stress distribution in an endodontically treated mandibular first molar with MOD cavity preparation, restored using a transverse post and composite restoration. Three-dimensional models incorporating the tooth and the surrounding structures, along with the transverse post and composite restoration, were constructed based on known biomechanical properties. After meshing the models, loads were defined on the buccal and lingual cusps with a constant value of 600N and at an angle of 45 degrees. Preprocessing involved model preparation followed by postprocessing to obtain results representing the degree and type of stress distribution. Results FEA simulations revealed the distribution of stress within the tooth structure under functional occlusal forces. The transverse post system effectively reinforced the tooth by deflecting incident forces and providing uniform stress distribution. von Mises stresses were analyzed to assess the likelihood of material failure. The distribution of the stress in the restored tooth model was comparable to that seen in the intact model. Conclusion Transverse post along with composite restoration provides a conservative and cost-effective alternative to full coverage crowns while providing a functional and aesthetic outcome. Further research and clinical studies are warranted to validate these findings and optimize the clinical application of transverse post systems in restorative dentistry.

A cross-sectional study on the impact of hemodialysis duration on retinal nerve fiber layer thinning in hemodialysis patients.

This study aimed to investigate the relationship between hemodialysis duration (HDD) and retinal nerve fiber layer (RNFL) thickness. A total of 60 patients receiving maintenance hemodialysis and 67 healthy controls were analyzed. Spectral domain optical coherence tomography (SD-OCT) was employed to measure annular RNFL thicknesses. The hemodialysis group exhibited reduced temporal and inferior RNFL thicknesses relative to the control group. In hemodialysis patients, the inferior RNFL thickness was negatively correlated with HDD and positively correlated with intraocular pressure (IOP). Moreover, IOP was positively correlated with HDD. Mediation analysis showed that the negative correlation between HDD and inferior RNFL thickness was mediated by IOP. In conclusion, hemodialysis leads to temporal and inferior RNFL thinning, and the thickness reduction is proportional to hemodialysis duration. However, such changes are not induced by an increase in IOP.

Design and simulation of a compact polarization beam splitter based on dual-core photonic crystal fiber with elliptical gold layer.

For the polarization multiplexing requirements in all-optical networks, this work presents a compact all-fiber polarization beam splitter (PBS) based on dual-core photonic crystal fiber (PCF) and an elliptical gold layer. Numerical analysis using the finite element method (FEM) demonstrates that the mode modulation effect of the central gold layer effectively reduces the dimensions of the proposed PBS. By determining reasonable structural parameters of the proposed PCF, the coupling length ratio (CLR) between X- and Y-polarized super-modes can approach 2, achieving a minimal device length of 0.122 mm. The PBS exhibits a maximum extinction ratio (ER) of - 65 dB at 1.55 µm, with an operating bandwidth spanning 100 nm (1.5-1.6 µm) and a stable insertion loss (IL) of ~ 1.5 dB at 1.55 µm. Furthermore, the manufacture feasibility and performance verification scheme are also investigated. It is widely anticipated that the designed PBS will play a crucial role in the ongoing development process of miniaturization and integration of photonic devices.

Non-linear finite element analysis of SFRC beam-column joints under cyclic loading: enhancing ductility and structural integrity.

Brittle shear failure of beam-column joints, especially during seismic events poses a significant threat to structural integrity. This study investigates the potential of steel fiber reinforced concrete (SFRC) in the joint core to enhance ductility and overcome construction challenges associated with traditional reinforcement. A non-linear finite element analysis (NLFEA) using ABAQUS software was conducted to simulate the behavior of SFRC beam-column joints subjected to cyclic loading. Ten simulated specimens were analyzed to discern the impact of varying steel fiber volume fraction and aspect ratio on joint performance. Key findings reveal that a 2% volume fraction of steel fibers in the joint core significantly improves post-cracking behavior by promoting ductile shear failure, thereby increasing joint toughness. While aspect ratio variations showed minimal impact on load capacity, long and thin steel fibers effectively bridge cracks, delaying their propagation. Furthermore, increasing steel fiber content resulted in higher peak-to-peak stiffness. This research suggests that strategically incorporating SFRC in the joint core can promote ductile shear failure, enhance joint toughness, and reduce construction complexities by eliminating the need for congested hoops. Overall, the developed NLFEA model proves to be a valuable tool for investigating design parameters in SFRC beam-column joints under cyclic loading.

Novel multifibrillar carbon and oxidation-stable carbon/ceramic hybrid fibers consisting of thousands of individual nanofibers with high tensile strength.

In this study, multifibrillar carbon and carbon/ceramic (C/SiCON) fibers consisting of thousands of single nanofibers are continuously manufactured. The process starts with electrospinning of polyacrylonitrile (PAN) and PAN/oligosilazane precursors resulting in poorly aligned polymer fibers. Subsequent stretching leads to parallel aligned multifibrillar fibers, which are continuously stabilized and pyrolyzed to C or C/SiCON hybrid fibers. The multifibrillar carbon fibers show a high tensile strength of 911 MPa and Young's modulus of 154 GPa, whereas the multifibrillar C/SiCON fibers initially have only tensile strengths of 407 MPa and Young's modulus of 77 GPa, due to sticking of the nanofibers during the stabilization in air. Additional curing with electron beam radiation, results in a remarkable increase in tensile strength of 707 MPa and Young's modulus of 98 GPa. The good mechanical properties are highlighted by the low linear density of the multifibrillar C/SiCON fibers (~ 1 tex) compared to conventional C and SiC fiber bundles (~ 200 tex). In combination with the large surface area of the fibers better mechanical properties of respective composites with a reduced fiber content can be achieved. In addition, the developed approach offers high potential to produce advanced endless multifibrillar carbon and C/SiCON nanofibers in an industrial scale.

Ocular findings in Jansen metaphyseal chondrodysplasia.

Jansen metaphyseal chondrodysplasia (JMC) is an ultra-rare disorder caused by germline heterozygous PTHR1 variants resulting in constitutive activation of parathyroid hormone type 1 receptor. A description of ocular manifestations of the disease is lacking. Six patients with JMC underwent a detailed ophthalmic evaluation, spectral-domain optical coherence tomography (OCT), visual field testing, and craniofacial CT scans. Five of 6 patients had good visual acuity. All patients had widely spaced eyes; 5/6 had downslanted palpebral fissures. One patient had proptosis, and another had bilateral ptosis. Two patients had incomplete closure of the eyelids (lagophthalmos), one had a history of progressive right facial nerve palsy with profuse epiphora, while the second had advanced optic nerve atrophy with corresponding retinal nerve fiber layer (RNFL) thinning on OCT and significant bilateral optic canal narrowing on CT scan. Additionally, this patient also had central visual field defects and abnormal color vision. A third patient had normal visual acuity, subtle temporal pallor of the optic nerve head, normal average RNFL, but decreased temporal RNFL and retinal ganglion cell layer analysis (GCA) on OCT. GCA was decreased in 4/6 patients indicating a subclinical optic nerve atrophic process. None of the patients had glaucoma or high myopia. These data represent the first comprehensive report of ophthalmic findings in JMC. Patients with JMC have significant eye findings associated with optic canal narrowing due to extensive skull base dysplastic bone overgrowth that appear to be more prevalent and pronounced with age. Progressive optic neuropathy from optic canal narrowing may be a feature of JMC, and OCT GCA can serve as a useful biomarker for progression in the setting of optic canal narrowing. We suggest that patients with JMC should undergo regular ophthalmic examination including color vision, OCT, visual field testing, orbital, and craniofacial imaging.

Association between dietary fiber intake and kidney stones: results from the National Health and Nutrition Examination Survey (2011-2018).

BACKGROUND/OBJECTIVES: Studies on the impact of dietary fiber intake on kidney stones are few, and their results were controversial. This study aimed to explore the association between dietary fiber intake and kidney stones in the nationally representative population of the USA. SUBJECTS/METHODS: This cross-sectional research included 8,588 participants from the National Health and Nutrition Examination Survey, 2011 to 2018. Information regarding dietary fiber intake was obtained from a 24-h recall survey. Participants were categorized into different dietary fiber intake tertiles according to the average of 2 days of dietary recall data. The outcome was self-reported kidney stones. After adjusting for the traditional risk factors, a multivariate logistic regression model was used to examine the association between dietary fiber intake and kidney stones. RESULTS: Eight hundred seventy-two participants had kidney stones. The weighted prevalence (SE) of kidney stones in the lowest tertile, medium tertile, and highest tertile of dietary fiber intake was 11.8% (0.8%), 10.3% (0.8%), and 9.1% (0.8%), respectively. After adjusting for age, sex, race and ethnicity, education level, smoking status, alcohol consumption, physical activity, body mass index, hypertension, diabetes, dyslipidemia, daily water intake, chronic kidney disease stage 3-5, and total energy intake, participants with the highest tertile of fiber intake had a significantly lower risk of kidney stones (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.48-0.95) compared to those in the lowest tertile. Every 5 g/day increment in dietary fiber intake was associated with a significant decrease in risk of kidney stones (OR, 0.90; 95% CI, 0.83-0.98). CONCLUSION: An increase in dietary fiber intake was associated with a lower risk of kidney stones, suggesting adults should be encouraged to maintain an adequate dietary fiber intake to prevent the development of kidney stones. Our results provide evidence to formulate nutrition management strategies for the prevention of kidney stones.

Effects of yeast and exogenous fibrolytic enzyme additives on lamb performance and feed efficiency.

Yeast and fibrolytic enzymes serve as additives incorporated into the nutrition of ruminants to regulate rumen fermentation and increase the digestibility of fiber, thereby enhancing the efficiency of rumen fermentation. Two experiments were conducted to assess the impact of five diets: a control diet without additives, diets with yeast (Saccharomyces cerevisiae) or exogenous fibrolytic enzymes (EFE), and diets with a blend of 0.7yeast + 0.3EFE or 0.7EFE + 0.3Yeast (based on recommended levels in g/kg of total DM). In the first experiment, 40 five-month-old Santa Ines lambs (mean weight 25.0 ± 1.3 kg) were distributed in a completely randomized design (5 treatments and 8 lambs) for 81 days to evaluate performance, ingestive behaviour, and serum metabolites. In the second experiment, 25 Santa Ines male lambs weighing 25.7 ± 4.1 kg were housed in metabolic cages, in a randomized design with 5 treatments and 5 lambs, evaluating digestibility, nitrogen balance, and rumen pH. EFE supplementation increased intakes of dry matter (DM), total digestible nutrients (TDN), and apNDF (mean of 38.1, 5.26, and 27%, respectively) compared to yeast or the 0.7yeast-0.3EFE blend. Feed conversion was most efficient (mean of 27.1%) in lambs fed Yeast, 0.7EFE + 0.3yeast, and the control diet. Lambs fed 0.7yeast + 0.3EFE spent less time eating (mean of 16.5%) and more time idling (mean of 10.75%), whereas EFE-fed lambs spent more time eating (mean of 19.73%), and 0.7EFE + 0.3yeast-fed lambs spent more time ruminating (mean of 20.14%). Control group lambs chewed and ruminated less (means of 24.64 and 17.21%, respectively) compared to other treatments. Lambs on the 0.7yeast + 0.3EFE blend had higher eating and rumination efficiency rates for DM and apNDF (mean of 19.11 and 17.95%, respectively) compared to other additive treatments or individual additives. They also exhibited lower (means 7.59 g/d) urinary N excretion, with improved N retention (mean 3185 g/d) compared to the control group. There were significant effects on serum albumin and cholesterol concentrations, with the 0.7yeast + 0.3EFE blend showing higher albumin (mean 4.08 g/dL) levels, while diets without additives and yeast-EFE blends had higher cholesterol (mean of 62.51 g/dL) concentrations. Including Saccharomyces cerevisiae yeast along with 0.7 yeast + 0.3 EFE blend is recommended when feeding similar lamb diets to those used herein because it improves the efficiency of intake, rumination of DM and NDF, and nitrogen utilization without affecting the lamb performance.

Relationships between endurance exercise training-induced muscle fiber-type shifting and autophagy in slow- and fast-twitch skeletal muscles of mice.

PURPOSE: Endurance exercise induces muscle fiber-type shifting and autophagy; however, the potential role of autophagy in muscle fiber-type transformation remains unclear. This study examined the relationship between muscle fiber-type shifting and autophagy in the soleus (SOL) and extensor digitorum longus (EDL) muscles, which are metabolically discrete muscles. METHODS: Male C57BL/6J mice were randomly assigned to sedentary control (CON) and exercise (EXE) groups. After 1 week of acclimation to treadmill running, the mice in the EXE group ran at 12-15 m/min, 60 min/day, 5 days/week for 6 weeks. All mice were sacrificed 90 min after the last exercise session, and the targeted tissues were rapidly dissected. The right side of the tissues was used for western blot analysis, whereas the left side was subjected to immunohistochemical analysis. RESULTS: Endurance exercise resulted in muscle fiber-type shifting (from type IIa to type I) and autophagy (an increase in LC3-II) in the SOL muscle. However, muscle fiber-type transformation and autophagy were not correlated in the SOL and EDL muscles. Interestingly, in contrast to the canonical autophagy signaling pathways, our study showed that exercise-induced autophagy concurs with enhanced anabolic (increased p-AKTSer473/AKT and p-mTOR/mTORSer2448 ratios) and suppressed catabolic (reduced p-AMPKThr172/AMPK ratio) states. CONCLUSION: Our findings demonstrate that chronic endurance exercise-induced muscle fiber-type transformation and autophagy occur in a muscle-specific manner (e.g., SOL). More importantly, our study suggests that endurance training-induced SOL muscle fiber-type transition may underlie metabolic modulations caused by the AMPK and AKT/mTOR signaling pathways rather than autophagy.

Evaluation of filler activation for sustainable FRP composite by studying properties, mechanism, and stability.

The aim is to develop new fiber-reinforced polymer (FRP) water pipe by activating fiber glass (FG) by vinyltriethoxysilane (VS) getting vinylsilane-activated FG (AFG) for filling vinylester (VE) via continuous winding to make a novel VE-AFG composite. The novelty of this work is the activation of fiber glass by vinylsilane as a single filler in vinylester and compounding them via a two-dimensional continuous winding process for the first time. The crosslinking occurred in the AFG/VE/curing agent system after activation. The activated composites increased thermal stability; 25% VE-AGF increased the degradation temperatures at 10%, 25%, and 50% weight loss by 73.3%, 10%, and 7.2%. With the activated 20% composite, values of axial strength, hoop strength, and hardness were developed by 6.3%, 2%, and 8.7%, respectively. The decay resistance to different microorganisms was increased with VE-AFG composites as a result of a sharp decrease in biodegradability percentages. The activated composites are stable toward water absorption; the least percentage was recorded by 25% VE-AFG, which minimized the water absorptivity by more than 62%. The reported characterization sentence approves enhancement of thermal, physical, and mechanical stability of sustainable vinylester-fiber glass composites manufactured by continuous winding; this is recommended for application in water pipe systems.

Can the diameter of nerve fibers be effectively utilized to enhance the accuracy of determining the length of the aganglionic segment compared to intraoperative biopsy in patients with Hirschsprung's disease?

OBJECTIVE: The aim of this study is to investigate the accuracy of utilizing neural fiber trunk diameter in accurately diagnosing the length of the aganglionic segment in patients definitively diagnosed with Hirschsprung's disease. RESULTS: In this study, 40 patients (19 males, 21 females; mean age 2.5 ± 2.2646 years) were assessed for Hirschsprung's disease. Constipation was the main symptom (75%), followed by abdominal issues. All underwent contrast enema and rectal suction biopsy for diagnosis, followed by surgery (predominantly Soave and Swensen techniques). Majority (85%) had rectosigmoid involvement. Neural fiber diameter was measured, with 52.5% ≤40 µm and 47.5% >40 µm. Statistical analysis showed 40% sensitivity(CI:95%) and 47% specificity(CI:95%) with a cutoff of 40.5 µm. Cohen's kappa index for aganglionic segment size was 0.7.

Ultrasound-assisted enzymatic extraction of soluble dietary Fiber from Hericium erinaceus and its in vitro lipid-lowering effect.

Dietary fiber (DF) is an important active polysaccharide in Hericium erinaceus. Obesity can lead to a wide range of diseases. In this work, we investigated the in vitro lipid-lowering effect of soluble dietary fiber (SDF) from H. erinaceus, aiming to provide a basis for the subsequent development of lipid-lowering products. Ultrasound-assisted enzymatic extraction (UAEE) of SDF from H. erinaceus was performed. The optimal extraction parameters determined via single-factor experiments and response surface methodology (RSM) were as follows: Lywallzyme concentration, 1.0%; complex protease concentration, 1.2%; ultrasonication time, 35 min; and ultrasonication power, 150 W. In vitro lipid-lowering experiments revealed that the adsorption amount of cholesterol micelles by H. erinaceus SDF was 11.91 mg/g. The binding amount and binding rate of sodium taurocholate were 3.73 mg/g and 42.47%, respectively, and those of sodium glycocholate were 3.43 mg/g and 39.12%, respectively. The pancreatic lipase inhibition rate reached 52.11%, and the type of inhibition was competitive. Therefore, H. erinaceus SDF has good in vitro lipid-lowering ability.

Hemp hull fiber and two constituent compounds, N-trans-caffeoyltyramine and N-trans-feruloyltyramine, shape the human gut microbiome in vitro.

Mounting evidence supports the potential of dietary bioactives to reduce chronic disease risk. N-trans-caffeoyltyramine (NCT) and N-trans-feruloyltyramine (NFT) have been hypothesized to drive regulation of gut permeability, but these components have not yet been studied in the context of the human gut microbiome. This work examined whether purified NCT and NFT, or a hemp hull product containing NCT and NFT (Brightseed® Bio Gut Fiber™), can impact the gut microbiome using an in vitro fermentation assay. Representative human gut microbiomes were treated with Bio Gut Fiber™ or NCT and NFT and compared to starch and methylcellulose, as controls, in vitro. Stronger changes were exerted by Bio Gut Fiber™, NCT, and NFT. Communities treated with Bio Gut Fiber™ saw increased productivity and diversity. We found a dose-dependent effect of NCT and NFT on microbial communities. Here, we describe novel potential for hemp-derived bioactives to shape the gut microbiome.

High carbohydrate diet decreases microbial diversity and increases IL-1ß levels in mice colon.

Western diet is known to contribute to intestinal dysbiosis and the progression of inflammation. Although the Turkish diet has different macronutrient contents, the intestinal inflammatory disease incidences in Türkiye are comparable to Western countries. Thus, we hypothesized that high carbohydrate diets also contribute to inflammation of the colon. We compared diets with different macronutrient compositions and investigated their effects on colonic microbiota, cytokine, histology, and tight junction protein levels. High carbohydrate diet caused the lowest microbial diversity and is accompanied by the highest expression of interleukin-1ß and claudin-1. A low carbohydrate diet with zero fiber resulted in the lowest inflammatory markers as well as the lowest occludin and claudin levels. Overall, our results indicate that carbohydrate and fiber contents of the diets are important contributors to colon health.

Development and characterization of defatted coconut flour based oleogels: A fat substitute for application in oil-fortified surimi.

This research examined the impact of defatted coconut flour (DCF)-based oleogels on the quality of surimi. Microscopic analysis indicated that the dietary fiber present in DCF could act as the main structure of the oleogels network. The formation of the oleogels network primarily relies on the tensile intramolecular or intermolecular hydrogen bonds between DCF and corn oil. The oleogels displayed oil binding capacity of up to 96.95% and exhibited favorable mechanical and rheological properties. Efforts were undertaken to integrate the acquired oleogels into silver carp surimi to create oil-fortified surimi products. Adding oleogels significantly enhanced the gel strength, texture, and water-holding capacity of surimi compared to adding corn oil. Especially, oleogels containing 5.0 % (w/v) DCF concentration elevated the lipid content in the surimi and preserved the gel and texture properties. Therefore, incorporating oleogels in surimi presents a potential solution for enhancing the nutritional content of surimi products.

Metastatic Colon Cancer in an Individual Following Prolonged Daily Inulin Consumption.

Studies in rodents suggest that inulin supplements may be carcinogenic. We present a case implicating that this risk extends to humans. A healthy male from a family lacking history of cancer had his first cancer-screening colonoscopy at age 56. No intestinal polyps/abnormalities were detected. A second colonoscopy, performed 7 years later, revealed a tumor in the cecum, with evidence of metastasis to lymph nodes. The only known change in patient's lifestyle during that seven-year period was the addition of 4g of inulin powder as a daily supplement during the last 2 years. Such inulin consumption is a plausible contributor to his disease.