Systematic review: Disease-specific instruments to assess gastrointestinal symptoms in functional dyspepsia.

BACKGROUND: Functional dyspepsia (FD) is a common functional gastrointestinal disorder with incompletely understood pathophysiology and heterogeneous symptom presentation. Assessment of treatment efficacy in FD is a methodological challenge as response to treatment must be assessed primarily by measuring subjective symptoms. Therefore, the use of patient-reported outcome measures (PROMs) is recommended by regulatory authorities to assess gastrointestinal symptoms in clinical trials for FD. In the last decades, a multitude of outcome measures has been developed. However, currently no PROM has been approved by the regulatory authorities, and no consensus has been reached with regard to the most relevant outcome measure in FD. PURPOSE: This systematic review discusses the available disease-specific outcome measures for assessment of FD symptoms with psychometric validation properties, strengths, and limitations. Moreover, recommendations for use of current available outcome measures are provided, and potential areas of future research are discussed.

Dispersal capacity of Haematopota spp. and Stomoxys calcitrans using a mark-release-recapture approach in Belgium.

The dispersion potential of mechanical vectors is an important factor in the dissemination of pathogens. A mark-release-recapture experiment was implemented using two groups (unfed and partially fed) of the Tabanidae (Diptera) (Haematopota spp.) and biting Muscidae (Diptera) (Stomoxys calcitrans) most frequently collected in Belgium in order to evaluate their dispersion potential. In total, 2104 specimens of Haematopota spp. were collected directly from horses and 5396 S. calcitrans were collected in a cattle farm using hand-nets. Some of these insects were partially fed in vitro and all were subsequently coloured. Overall, 67 specimens of S. calcitrans (1.2%) and 17 of Haematopota spp. (0.8%) were recaptured directly on horses. Stomoxys calcitrans flew maximum distances of 150 m and 300 m when partially fed and unfed, respectively. Haematopota spp. travelled maximum distances of 100 m and 200 m when partially fed and unfed, respectively. Segregation measures seem essential in order to reduce the risk for pathogen transmission. A distance of 150 m appears to be the minimum required for segregation to avoid the risk for mechanical transmission, but in areas of higher vector density, this should probably be increased.

[A male with intra-abdominal nodules on a CT scan]. / Een man met intra-abdominale noduli op een CT-scan.

A 38-year-old male with a history of laparoscopic cholecystectomy and successfully treated Hodgkin lymphoma had a follow-up CT-scan which showed four nodular densities behind the bladder. Additional investigations demonstrated spilled gallstones instead of a relapse of Hodgkin lymphoma. Spillage of gallstones is relatively common and may mimic malignant diseases.

Q Fever Serological Survey and Associated Risk Factors in Veterinarians, Southern Belgium, 2013.

A sero-epidemiological survey was organized among veterinarians working in Southern Belgium to estimate the seroprevalence of Q fever and the risk factors associated with exposure. A total of 108 veterinarians took part to this cross-sectional study, with a majority practicing with livestock animals. The overall seroprevalence was 45.4%, but it increased to 58.3% among veterinarians having contact with livestock. Three main serological profiles were detected (relatively recent, past and potentially chronic infections). The contact with manure during the prior month was the risk factor associated with seropositivity after multivariate logistic regression analysis. Classification and regression tree analysis identified the age as the most predictive variable to exclude potentially chronic infection in apparently healthy seropositive veterinarians. In conclusion, livestock veterinarians practicing in Southern Belgium are highly exposed to Q fever, a neglected zoonosis for which serological and medical examinations should be envisaged in at risk groups.

[An 87-year-old-man with late-onset frontotemporal dementia: a case-study]. / Een 87-jarige man met late-onset frontotemporale dementie.

An 87-year-old man showed behavioral disinhibition and nocturnal restlessness as well as short-term memory problems. We diagnosed late-onset frontotemporal dementia (LO-FTD), a relatively rare disease. Based on the course of the disease progress, we ruled out medication-induced mania and bipolar disorder. Given the results of the CT-scan, we also dismissed the possibility that the patient was suffering from dementia based on Alzheimer's disease and vascular factors that followed an atypical course. Our article illustrates the complexity of the diagnostic process investigating LO-FTD.

Esophagogastric junction distensibility in the management of achalasia patients: relation to treatment outcome.

BACKGROUND: Achalasia is characterized by a functional esophagogastric junction (EGJ) obstruction. The functional luminal imaging probe (EndoFLIP) is a method to assess EGJ distensibility. In a homogeneous group of newly diagnosed achalasia patients treated with pneumatic dilation (PD), we aimed (i) to determine whether the assessment of EGJ distensibility has added value in the management of achalasia patients and (ii) to evaluate whether EGJ distensibility differs between achalasia subtypes. METHODS: Twenty-six newly diagnosed achalasia patients were treated by graded PD (30 and 35 mm) separated by 1 week. EGJ distensibility was measured with the EndoFLIP technique before and after 30 mm PD. Good clinical outcome was defined as an Eckardt score <4 at 1-year follow-up. Fifteen healthy controls underwent an EndoFLIP measurement as control group. KEY RESULTS: Newly diagnosed achalasia patients had reduced EGJ distensibility compared to healthy controls (0.9 [0.7-1.5] vs 3.4 [2.7-4.2] mm(2) /mmHg, p < 0.01), and EGJ distensibility was lower in type II compared to type I patients (0.8 [0.7-1.1] vs 1.5 [0.9-1.9] mm(2) /mmHg, p = 0.02). EGJ distensibility was increased after PD from 0.9 (0.7-1.5) to 4.2 (3.0-5.7) mm(2) /mmHg (p < 0.001). No difference was found in EGJ distensibility directly after PD between patients with good and poor clinical outcome at 1-year follow-up. CONCLUSIONS & INFERENCES: Assessment of EGJ distensibility with the EndoFLIP technique is able to demonstrate the functional EGJ obstruction in newly diagnosed achalasia patients and EGJ distensibility differs between achalasia subtypes. Although PD improves EGJ distensibility, assessment of EGJ distensibility with a limited number of distension steps provides no additional information that is useful for clinical evaluation and management of achalasia patients.

Culicoides monitoring in Belgium in 2011: analysis of spatiotemporal abundance, species diversity and Schmallenberg virus detection.

In 2011, Culicoides (Diptera: Ceratopogonidae) were collected at 16 locations covering four regions of Belgium with Onderstepoort Veterinary Institute (OVI) traps and at two locations with Rothamsted suction traps (RSTs). Quantification of the collections and morphological identification showed important variations in abundance and species diversity between individual collection sites, even for sites located in the same region. However, consistently higher numbers of Culicoides midges were collected at some sites compared with others. When species abundance and diversity were analysed at regional level, between-site variation disappeared. Overall, species belonging to the subgenus Avaritia together with Culicoides pulicaris (subgenus Culicoides) were the most abundant, accounting for 80% and 96% of all midges collected with RSTs and OVI traps, respectively. Culicoides were present during most of the year, with Culicoides obsoletus complex midges found from 9 February until 27 December. Real-time reverse-transcription polymerase chain reaction screening for Schmallenberg virus in the heads of collected midges resulted in the first detection of the virus in August 2011 and identified C. obsoletus complex, Culicoides chiopterus and Culicoides dewulfi midges as putative vector species. At Libramont in the south of Belgium, no positive pools were identified.

Identification of CodY targets in Bacillus anthracis by genome-wide in vitro binding analysis.

In Gram-positive bacteria, CodY is an important regulator of genes whose expression changes under conditions of nutrient limitation. Bacillus anthracis CodY represses or activates directly or indirectly approximately 500 genes. Affinity purification of CodY-DNA complexes was used to identify the direct targets of CodY. Of the 389 DNA binding sites that were copurified with CodY, 132 sites were in or near the regulatory regions governing the expression of 197 CodY-controlled genes, indicating that CodY controls many other genes indirectly. CodY-binding specificity was verified using electrophoretic mobility shift and DNase I footprinting assays for three CodY targets. Analysis of the bound sequences led to the identification of a B. anthracis CodY-binding consensus motif that was found in 366 of the 389 affinity-purified DNA regions. Regulation of the expression of the two genes directly controlled by CodY, sap and eag, encoding the two surface layer (S-layer) proteins, was analyzed further by monitoring the expression of transcriptional lacZ reporter fusions in parental and codY mutant strains. CodY proved to be a direct repressor of both sap and eag expression. Since the expression of the S-layer genes is under the control of both CodY and PagR (a regulator that responds to bicarbonate), their expression levels respond to both metabolic and environmental cues.

Testing the hypothesis that psychotic illness begins when subthreshold hallucinations combine with delusional ideation.

OBJECTIVE: While hallucinations and delusions are often considered as a single class of 'positive symptoms', little is known about their dynamic cooccurrence in relation to clinical outcome in non-help-seeking people. METHOD: The Netherlands Mental Health and Incidence Study (NEMESIS-1) is a longitudinal study of mental disorders (n = 7075) with three measurements over a 3-year period. Risk factors, persistence of psychotic experiences, and clinical outcome were analyzed for groups with: i) no psychotic experiences, ii) only delusions, iii) only hallucinations, and iv) both delusions and hallucinations. RESULTS: Hallucinations and delusions occurred together more often (T0, 3.5%; T1, 1.0%; T2, 0.9%) than that predicted by chance (T0, 1.0%; T1, 0.1%; T2, 0.04%). The group with both symptoms showed more 'first-rank'-like delusions compared with the group with only delusions. Having both hallucinations and delusions, compared to isolated symptoms, was associated more strongly with risk factors, comorbid affective symptoms, negative symptoms, and persistence of psychotic experiences. This was not an artifact of having more symptoms in general. CONCLUSION: Experiencing both delusions and hallucinations is an indicator of greater etiological load resulting in more clinical outcome. A specific 'hallucinatory-delusional state' may represent an early phase of exacerbation of aberrant attribution of salience, increasing risk for clinical outcome.

Detection of Schmallenberg virus in different Culicoides spp. by real-time RT-PCR.

To identify possible vectors of Schmallenberg virus (SBV), we tested pools containing heads of biting midges (Culicoides) that were caught during the summer and early autumn of 2011 at several places in Belgium by real-time RT-PCR. Pools of heads originating from following species: C. obsoletus complex, C. dewulfi and C. chiopterus were found positive, strongly indicating that these species are relevant vectors for SBV.

Prefrontal cortex atrophy predicts dementia over a six-year period.

The present study investigated prefrontal cortex (PFC) atrophy as a possible predictor of dementia. Eighty-eight older participants of the Maastricht Aging Study (MAAS) were administered for neuropsychological tests at baseline and after three years (t(3)). Magnetic resonance images were acquired at t(3) and nine years after baseline all participants were screened for dementia. Three groups were distinguished: (1) participants who did not develop dementia or cognitive decline, (2) participants who did not develop dementia but did show significant cognitive decline, and (3) participants who developed dementia. Gray matter volume of structures in the PFC and medial temporal lobe (MTL) was measured. Prefrontal volume was significantly smaller in group 3 than in the other two groups, and PFC volume was significantly better than MTL volume in distinguishing between groups 2 and 3. These findings suggest that PFC atrophy is highly associated with dementia and can be considered an important predictor of the disease. It may even be a better predictor than the MTL atrophy that has been found in earlier studies.

Enrichment of fetal nucleated red blood cells from the maternal circulation for prenatal diagnosis: experiences with triple density gradient and MACS based on more than 600 cases.

OBJECTIVE: We wanted to obtain statistically relevant data about the efficiency of our method for the isolation of fetal nucleated red blood cells (NRBCs) from the maternal circulation. METHODS: More than 600 samples were investigated using a triple density gradient followed by magnetic separation of anti-CD71-labeled cells, and yields and purities of recovered NRBCs were determined. RESULTS: The enrichment effectivity as well as the morphological condition of cells was reproducibly good, if blood samples were enriched within 48 h after sampling. The efficacy was independent of various methodological parameters and our technique was superior to other magnetic cell-sorting techniques. Mean yields and purities of NRBCs increased with increasing gestational age, ranging from 100 to 1,000 cells per 40-ml blood sample and from 0.1 to 1%, respectively, from the 6th week of gestation to term. In pregnancies with preeclampsia NRBCs were increased by a factor of 10. CONCLUSION: Our enrichment technique proved to be optimized with respect to various methodological parameters, which were compared in the present study, and it is efficient and reproducible for the enrichment of NRBCs from the maternal circulation in all three gestational trimesters.

Consumption of foods and micronutrients and the risk of cancer of the biliary tract.

BACKGROUND: Gallstones and obesity have been suggested as risk factors for cancer of the biliary tract. Since both factors are related to diet, we studied the relationship between dietary intake and the cancer of interest in a population-based case-control study. METHODS: The study population comprised 111 patients and 480 controls. Food intake was assessed by means of a semiquantitative food frequency questionnaire. Estimates of the intake of foods and micronutrients were obtained from cases and controls themselves (direct respondents) or from relatives (indirect respondents). Participants were categorized into tertiles of intake. Risk ratios were estimated by logistic regression analysis. RESULTS: The major findings are a monotonic decrease in risk associated with the consumption of vegetables (ORs 1.0, 0.7, 0.4, P value trend < 0.01) and a monotonic increase in risk associated with sugar added to drinks and desserts (ORs 1.0, 1.3, 2.5; P value trend < 0.01). CONCLUSIONS: The finding on added sugar corresponds to our earlier report that the group monosaccharides and disaccharides is a potential risk factor for this cancer. Sugar may influence bile composition through lipoprotein metabolism. The protective effect of vegetables is in accordance with the reported inverse relationship between vegetables and many epithelial cancers of the alimentary tract.

Regional fat distribution as risk factor for clinically diagnosed gallstones in middle-aged men: a 25-year follow-up study (the Zutphen Study).

Obesity is considered to be an important risk factor for the formation of gallstones. The relationship is well established for women but not for men. In a long-term follow-up study of middle-aged men the relationship between various markers of obesity and the incidence of clinically diagnosed gallstones during 25 years of follow-up was studied. Information on the presence of gallstones was obtained by self-report and verified through medical records after death. Of the 860 men who were between 40 and 59 years old at the start of the study, 54 developed gallstones, yielding an incidence rate of 3.1/1000 person-years. Cox proportional hazard models were used to examine the associations between the risk factors and newly diagnosed gallstones. Univariate analysis revealed that the subscapular-to-triceps skinfold thickness ratio (STR) yields a significant positive association (HR upper quartile: 2.5, 95% CI: 1.1-5.7). Subscapular skinfold thickness had a borderline significant, positive association, which became significant after exclusion of subjects who developed symptomatic gallstones within the first 3 years of follow-up (HR upper quartile: 2.5, 95% CI: 1.0-6.2). The multivariate model revealed that the association of STR with clinically diagnosed gallstones was independent of Body Mass Index. Our results indicate that regional fat distribution, as measured by the subscapular-to-triceps skinfold thickness ratio, may play an important role in the formation of gallstones in men, as was previously found for women in other studies.

Dietary risk factors for clinically diagnosed gallstones in middle-aged men. A 25-year follow-up study (the Zutphen Study).

In a long-term follow-up study of middle-aged men, the relation between the intake of energy, nutrients, and foods and the 25-year incidence of clinically diagnosed gallstones was studied. Information on the presence of gallstones was obtained by self-report and verified through medical records after death. Of 860 men, 54 developed symptomatic gallstones, yielding an incidence rate of 3.1/1000 person-years. The present study provides a comprehensive picture of dietary risk factors for clinically diagnosed gallstones based on a long-term follow-up. Calcium intake was inversely associated with gallstone incidence in the univariate and multivariate Cox proportional hazards analyses (hazard ratio (HR) upper tertile: 0.3; 95% CI: 0.1 to 0.7). A positive association with sugars (monosaccharides and disaccharides) appeared after the introduction of age, body mass index, calcium intake, and the intake of energy from nutrients other than sugars into the model (HR upper tertile: 2.3; 95% CI: 1.0 to 4.8). Calcium may alter the composition of bile by preventing the reabsorption of secondary bile acids in the colon, whereas sugars may influence bile composition through lipoprotein metabolism.

Prognosis of severely hypoxemic patients receiving long-term oxygen therapy.

Two hundred seventy severely hypoxemic (PaO2 < or = 55 mm Hg: mean +/- SD = 48 +/- 6) COPD patients (232 men) were selected for long-term oxygen therapy (LTOT). They were old (mean = 66 +/- 8 years), with severe airflow limitation (FEV1 = 30 +/- 12 percent of predicted), some CO2 retention (PaCO2 = 47 +/- 9 mm Hg), and compensated respiratory acidosis. Eighteen percent of the patients presented some complicating pleuropulmonary diseases (pleural thickening, sequelae of tuberculosis, etc). Overall survival proportion was poor: 70, 50, and 43 percent at 1, 2, and 3 years, respectively. The Cox model showed that the factors which independently reduced survival were lower CO transfer coefficient, smaller intrathoracic gas volume, more severe bronchial obstruction, the fact that oxygen administration did not increase PaO2 above 65 mm Hg, increasing age, and the presence of chest wall abnormalities. When the patients were divided into three groups according to mortality risk, the mean clinical and functional profile of the high-mortality risk group was consistent with the prevalence of emphysematous lesions. Moreover, the best survivors fitted better into the "bronchitic" type; they showed a higher mean PaCO2, suggesting that some degree of hypoventilation could delay muscular fatigue and improve survival. The difference in the proportion of "emphysematous" and "bronchitic" patients is a possible explanation for the variability of the mortality rate reported in literature.