Modern trends in minimally invasive versus open hepatectomy for colorectal liver metastasis: an analysis of ACS-NSQIP.

BACKGROUND: Surgical resection of colorectal liver metastasis (CRLM) provides the best opportunity for prolonged survival. Eligibility for metastasectomy has expanded with technical advancements including parenchymal-sparing hepatectomy (PSH). Meanwhile, enthusiasm for minimally invasive surgery (MIS) has increased, though this approach may be preferentially utilized for technically straightforward cases. The purpose of this study is to characterize modern trends in open versus MIS approaches to partial hepatectomy and anatomic hepatectomy for CRLM within a nationwide cohort. METHODS: The American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) was used to investigate trends in MIS versus open hepatectomy for CRLM from 2015 to 2019. We examined baseline clinicopathologic and disease-related characteristics and compared trends in treatments over the study period. RESULTS: A total of 7457 patients undergoing hepatectomy for CRLM were identified (1367 MIS, 6090 open). Patients had similar clinicopathologic features between the two groups. Patients undergoing MIS resection less frequently received neoadjuvant therapy (51.1% vs 64.0%, p < 0.001) or concurrent intraoperative ablation (15.0% vs 21.3%, p < 0.001). Patients with tumors < 2 cm (34.9% vs 26.8%, p < 0.001) or only one to two tumors (82.8% vs 65.0%, p < 0.001) more commonly underwent MIS. MIS and open partial hepatectomies both significantly increased over the study period, but open partial hepatectomy increased at a greater rate than MIS (p < 0.001). Rates of anatomic resections have remained the same, with a greater proportion performed using an open approach (34.9% vs 16.4%, p < 0.001). Rates of operations consisting of > 1 concurrent partial hepatectomy are stable, but significantly more likely to be performed open (p < 0.001). CONCLUSIONS: Hepatectomy for CRLM has increased from a rise in partial hepatectomy, potentially translating to increased use of PSH. Current trends suggest MIS approaches appear to be increasing, but selectively implemented for patients with less technically demanding disease characteristics. Educational efforts should be directed towards increased dissemination of parenchymal-sparing MIS techniques for more complex resections.

Wnt/ß-catenin pathway regulates bone morphogenetic protein (BMP2)-mediated differentiation of dental follicle cells.

BACKGROUND AND OBJECTIVE: Bone morphogenetic protein 2 (BMP2)-induced osteogenic differentiation has been shown to occur through the canonical Wnt/ßcatenin pathway, whereas factors promoting canonical Wnt signaling in cementoblasts inhibit cell differentiation and promote cell proliferation in vitro. The aim of this study was to investigate whether putative precursor cells of cementoblasts, dental follicle cells (murine SVF4 cells), when stimulated with BMP2, would exhibit changes in genes/proteins associated with the Wnt/ß-catenin pathway. MATERIAL AND METHODS: SVF4 cells were stimulated with BMP2, and the following assays were carried out: (i) Wnt/ß-catenin pathway activation assessed by western blotting, ß-catenin/transcription factor (TCF) reporter assays and expression of the lymphoid enhancer-binding factor-1 (Lef1), transcription factor 7 (Tcf7), Wnt inhibitor factor 1 (Wif1) and Axin2 (Axin2) genes; and (ii) cementoblast/osteoblast differentiation assessed by mineralization in vitro, and by the mRNA levels of runt-related transcription factor 2 (Runx2), osterix (Osx), alkaline phosphatase (Alp), osteocalcin (Ocn) and bone sialoprotein (Bsp), determined by quantitative PCR after treatment with wingless-type MMTV integration site family, member 3A (WNT3A) and knockdown of ß-catenin. RESULTS: WNT3A induced ß-catenin nuclear translocation and up-regulated the transcriptional activity of a canonical Wnt-responsive reporter, suggesting that the Wnt/ß-catenin pathway functions in SVF4 cells. Activation of Wnt signaling with WNT3A suppressed BMP2-mediated induction of cementoblast/osteoblast maturation of SVF4 cells. However, ß-catenin knockdown showed that the BMP2-induced expression of cementoblast/osteoblast differentiation markers requires endogenous ß-catenin. WNT3A down-regulated transcripts for Runx2, Alp and Ocn in SVF4 cells compared with untreated cells. In contrast, BMP2 induction of Bsp transcripts occurred independently of Wnt/ß-catenin signaling. CONCLUSION: These data suggest that stabilization of ß-catenin by WNT3A inhibits BMP2-mediated induction of cementoblast/osteoblast differentiation in SVF4 cells, although BMP2 requires endogenous Wnt/ß-catenin signaling to promote cell maturation.

Using the Flipped Classroom Model in Surgical Education: Efficacy and Trainee Perception.

OBJECTIVE: To describe the feasibility, efficacy, and learner perception of the flipped classroom model for teaching conferences within surgical training programs. DESIGN: For the flipped classroom conferences, video lectures were prepared by a faculty member, and sent to all attendees at least 2 days prior to lecture. The conference time was then spent going over cases and questions, rather than traditional lecture. We conducted a qualitative survey to assess learner's perceptions and pre-lecture quizzes to assess trainee preparedness. SETTING: The comparison of pre-conference quizzes between flipped classroom and traditional models was carried out at Brooke Army Medical Center (BAMC) in San Antonio, TX, a tertiary care facility with a general surgery residency program. The survey was conducted at BAMC and within the Complex General Surgical Oncology fellowship program at University of Texas MD Anderson Cancer Center, where a flipped classroom model was similarly employed. PARTICIPANTS: Surgical residents BAMC participated in pre-lecture quizzes. BAMC residents and MD Anderson fellows were invited to complete the online survey. RESULTS: Lecture videos did not increase mean preparation time (1.53 vs. 1.46 hours without vs. with video, p = 0.858), but did increase mean quiz scores from 67% to 80% (p = 0.031) with 32/35 learners utilizing videos. Videos increased the proportion of learners who self-reported preparing at all from 42% to 95% (p = 0.28), and preparing for at least one hour for conference from 23% to 49% (p = 0.014). Of survey respondents, 90% said videos were very helpful, 90% would use them weekly if available, and 90% prefer this format to traditional lecture. CONCLUSIONS: Utilization of a flipped classroom method was well received and preferred by surgical trainees, and it increased performance on pre-conference quizzes without increasing preparation time. Although creation of video lectures is work-intensive for lecturers, these results suggest it is more effective for learner preparation. These results could be generalizable to surgical residents nationwide as technology utilization increases in surgical education.

Growth dynamics among adolescent girls in Bangladesh: Evidence from nationally representative data spanning 2011-2014.

BACKGROUND: Adolescence is the last opportunity to reverse any growth faltering accumulated from fetal life through childhood and it is considered a crucial period to optimize human development. In Bangladesh, a growing double burden of underweight and obesity in adolescents is recognized, yet limited data exists on how, when, and where to intervene. This study assesses the dynamics of growth among adolescent girls in Bangladesh, providing insight about critical junctures where faltering occurs and where immediate interventions are warranted. METHODS: We pooled data from Bangladesh's Food Security and Nutrition Surveillance Project collected between 2011 and 2014 to document the age dynamics of weight and linear growth. 20,572 adolescent girls were measured for height and 19,345 for weight. We constructed growth curves for height, weight, stunting, and underweight. We also stratified growth dynamics by wealth quintile to assess socioeconomic inequities in adolescent trajectories. RESULTS: Height-for-age z-score (HAZ) in Bangladeshi girls deteriorates throughout adolescence and especially during the early years. Mean HAZ decreases by 0.20 standard deviations (sd) per year in early adolescence (10-14 years) vs 0.06 sd/year during late adolescence (15-19 years), while stunting increases by 16 percentage points (pp) vs 6.7 pp, respectively. Conversely, BMI-for-age z-score (BAZ) increases by 0.13 sd/year in early adolescence vs 0.02 sd/year in late adolescence, and underweight decreases by 12.8 pp vs 3.2 pp. Adolescent girls in all socioeconomic groups show a similar pattern of HAZ and BAZ dynamics, but the curve for the richest quintile stays above that of the poorest across all ages. CONCLUSIONS: Trends and levels of stunting and underweight among adolescent girls in Bangladesh are worrisome, suggesting substantial linear growth faltering in early adolescence, with improving weight-for-age occurring only as linear growth slows and stops. Given the rising burden of non-communicable diseases (NCDs) in Bangladesh and emerging evidence of the link between stunting and later chronic diseases, greater attention to adolescent growth and development is needed. Our findings suggest that, to address stunting, interventions in early adolescence would have the greatest benefits. School-based interventions could be a way to target this population.

The Clock Counts - Length Effects in English Dyslexic Readers.

In reading, length effects (LEs) are defined as an increment in the time taken to read as a function of word length and may indicate whether reading is proceeding in an efficient whole word fashion or by serial letter processing. LEs are generally considered to be a pathognomonic symptom of developmental dyslexia (DD) and predominantly have been investigated in transparent orthographies where reading impairment is characterized as slow and effortful. In the present study a sample of 18 adult participants with DD were compared to a matched sample of typical developing readers to investigate whether the LE is a critical aspect of DD in an opaque orthography, English. We expected that the DD group would present with marked LEs, in both words and non-words, compared to typical developing readers. The presence of LEs in the DD group confirmed our prediction. These effects were particularly strong in low frequency words and in non-words, as observed in reading speed. These preliminary findings may have important theoretical implications for current understanding of DD.

Altered myogenesis and premature senescence underlie human TRIM32-related myopathy.

TRIM32 is a E3 ubiquitin -ligase containing RING, B-box, coiled-coil and six C-terminal NHL domains. Mutations involving NHL and coiled-coil domains result in a pure myopathy (LGMD2H/STM) while the only described mutation in the B-box domain is associated with a multisystemic disorder without myopathy (Bardet-Biedl syndrome type11), suggesting that these domains are involved in distinct processes. Knock-out (T32KO) and knock-in mice carrying the c.1465G > A (p.D489N) involving the NHL domain (T32KI) show alterations in muscle regrowth after atrophy and satellite cells senescence. Here, we present phenotypical description and functional characterization of mutations in the RING, coiled-coil and NHL domains of TRIM32 causing a muscle dystrophy. Reduced levels of TRIM32 protein was observed in all patient muscle studied, regardless of the type of mutation (missense, single amino acid deletion, and frameshift) or the mutated domain. The affected patients presented with variable phenotypes but predominantly proximal weakness. Two patients had symptoms of both muscular dystrophy and Bardet-Biedl syndrome. The muscle magnetic resonance imaging (MRI) pattern is highly variable among patients and families. Primary myoblast culture from these patients demonstrated common findings consistent with reduced proliferation and differentiation, diminished satellite cell pool, accelerated senescence of muscle, and signs of autophagy activation.

Comparative analysis of antisense oligonucleotide sequences for targeted skipping of exon 51 during dystrophin pre-mRNA splicing in human muscle.

Duchenne muscular dystrophy (DMD) is caused by mutations in the dystrophin gene that result in the absence of functional protein. In the majority of cases these are out-of-frame deletions that disrupt the reading frame. Several attempts have been made to restore the dystrophin mRNA reading frame by modulation of pre-mRNA splicing with antisense oligonucleotides (AOs), demonstrating success in cultured cells, muscle explants, and animal models. We are preparing for a phase I/IIa clinical trial aimed at assessing the safety and effect of locally administered AOs designed to inhibit inclusion of exon 51 into the mature mRNA by the splicing machinery, a process known as exon skipping. Here, we describe a series of systematic experiments to validate the sequence and chemistry of the exon 51 AO reagent selected to go forward into the clinical trial planned in the United Kingdom. Eight specific AO sequences targeting exon 51 were tested in two different chemical forms and in three different preclinical models: cultured human muscle cells and explants (wild type and DMD), and local in vivo administration in transgenic mice harboring the entire human DMD locus. Data have been validated independently in the different model systems used, and the studies describe a rational collaborative path for the preclinical selection of AOs for evaluation in future clinical trials.

Morphological changes in cultured human periodontal ligament cells exposed to dental materials.

The cytotoxicity of a range of dental restorative cements was assessed by continuous observation of cultures with inverted microscopy and by light microscopic study of fixed preparations, using an in vitro model with cultured test cells derived from human periodontal ligament. The sequential morphological changes observed over a seven day period showed different degrees of cell loss and patterns of injury in response to different restorative materials, reflecting primarily either nuclear or cytoplasmic damage. Attempts at recovery were frequently identified as the culture period was extended and were characterized by recolonization of denuded areas of the culture well. It was concluded that differing dental cements damage cells through a variety of mechanisms and that the test cells exhibit differing degrees of susceptibility to injury. Assays based on short-term cultures may overestimate cytotoxicity by not allowing for cell recovery from reversible injury or repopulation of monolayers by proliferation of resistant cells.

Detection of macrophages and the characterization of Fc receptor-bearing cells in the mouse decidua, placenta and yolk sac using the macrophage-specific monoclonal antibody F4/80.

A mouse macrophage-specific rat monoclonal antibody, F4/80, has been used to detect directly macrophages in short term cultures of mouse decidua, fetal placenta and yolk sac and to investigate the identity of Fc receptor (FcR) bearing cells in these tissues. We find that a significant proportion of FcR positive cells in decidual, placental and yolk sac tissues are macrophages as defined by the expression of the macrophage marker, F4/80 antigen. Macrophages may act as immunocompetent cells near to the maternal-fetal interface and play a significant role in the mechanism of the transfer of passive immunity from mother to fetus across the mouse yolk sac.

Gender, socioeconomic development and health-seeking behaviour in Bangladesh.

In efforts to reduce gender and socioeconomic disparities in the health of populations, the provision of medical services alone is clearly inadequate. While socioeconomic development is assumed important in rectifying gender and socioeconomic inequities in health care access, service use and ultimately, outcomes, empirical evidence of its impact is limited. Using cross-sectional data from the BRAC-ICDDR,B Joint Research Project in Matlab, Bangladesh, this paper examines the impact of membership in BRAC's integrated Rural Development Programme (RDP) on gender equity and health-seeking behaviour. Differences in health care seeking are explored by comparing a sample of households who are BRAC members with a sample of BRAC-eligible non-members. Individuals from the BRAC member group report significantly less morbidity (15-day recall) than those from the non-member group, although no gender differences in the prevalence of self-reported morbidity are apparent in either group. Sick individuals from BRAC member households tend to seek care less frequently than non-members. When treatment is sought, BRAC members rely to a greater extent on home remedies, traditional care, and unqualified allopaths than non-member households. While reported treatment seeking from qualified allopaths is more prevalent in the BRAC group, non-members use the para-professional services of community health care workers almost twice as frequently. In both BRAC member and non-member groups, women suffering illness report seeking care significantly less often than men. The policy and programmatic implications of between group and gender differences in care seeking are discussed with reference to the literature.

Seasonal variations in energy balance among agriculturalists in central Mali: compromise or adaptation?

OBJECTIVE: This paper considers whether seasonal variations in the energy balance of adult agriculturalists in Central Mali exceed acceptable risk, or whether they represent a short-term adaptive response without functional consequence. DESIGN: Prospective/longitudinal study design. SETTING: Agricultural village in rural Mali. SUBJECTS: From a total population of 166 adults aged > or = 16 years, two cohorts of 63 men and 73 non-pregnant women with complete records were retained for analysis. INTERVENTIONS: Over a 12-month period, monthly anthropometry and biweekly retrospective assessments of morbidity were made on every adult in the sample. Direct measures of household food consumption were collected twice in harvest, dry and rainy seasons respectively. Continuous 15-h observations of time-use and work intensity were conducted on a sub-sample of active adults and used to calculate mean seasonal energy expenditure. RESULTS: Energy balance as measured by body mass index (BMI; kg/m2) declines significantly in the rainy season (P < 0.01), corresponding to a seasonal weight loss of 2-3 kg. A similar seasonal trend in % body fat (P < 0.0001) suggests that most of this loss represents adipose tissue. A rainy season increase in arm muscle area (AMA) implies that there is no seasonal compromise in lean tissue. Among men and women with BMI > 18.5, seasonal fat loss is significantly greater than their leaner counterparts. Considering the likely determinants of variations in energy balance, an increase in the duration and incidence of adult morbidity is observed; however, no significant intercorrelations exist between it and seasonal nutritional indices. Comparing trends in energy expenditure and intake, a disturbance in energy homeostasis is apparent as energy expenditure increases in the rainy season relative to constant household food consumption across seasons. While seasonal variations in energy expenditure are not as dramatic in the female sample, they appear to have less opportunity to recover from so-called 'heavy' levels of expenditure experienced in successive dry and rainy seasons. Periods of 'light' activity in both harvest and dry seasons provide the male sample with a reasonable length of time in which to reconstitute energy stores after the physical demands of the rainy season. CONCLUSIONS: In the year of study, the modest loss of body fat recorded in the rainy season (< 5% body mass) represents a successful physiological response to energy imbalance, and is unlikely to compromise adult productive and reproductive function.

Cultural and morphological characteristics of human periodontal ligament cells in vitro.

Primary cell lines from explants of human periodontal ligament were established in vitro to assess their suitability as test cells in a biocompatibility assay. They were maintained over nine passages. The constituent fibroblast-like cells (F-cells) were monitored throughout by light and electron microscopy. Although F-cells from several different donors displayed stable and consistent growth characteristics, after the ninth subculture changes in the fine structure suggested that some cells were undergoing differentiation or senescence. It is therefore recommended that cells from earlier passages be used in in vitro biocompatibility assays.

Effect of amphotericin B on human periodontal ligament cells cultured in vitro.

Three micrograms of amphotericin B/ml nutrient medium markedly inhibited the monolayer outgrowth of cells from explants of human periodontal ligament. Amphotericin B (1.5 microgram/ml) retarded outgrowth with morphological evidence of cell injury. The addition of 3 micrograms/ml amphotericin B to existing monolayers initially caused disruption of the majority of cells but those which survived then proliferated. Thus, routine use of amphotericin B is contra-indicated in tissue culture of human periodontal ligament.

Survival of Anisakis simplex in microwave-processed arrowtooth flounder (Atheresthes stomias).

The purpose of this study was to define the relationship between survival and temperature of nematodes of the species Anisakis simplex in microwave-processed arrowtooth flounder (Atheresthes stomias). Ten fillets (each 126 to 467 g, 0.5 to 1.75 cm thick), with an average of five larvae of Anisakis simplex per fillet, were processed to target temperatures on high (100%) power using a commercial 700-W microwave oven. Fillets were neither covered nor rotated and had a temperature probe inserted to two-thirds depth into the thickest portion. After the fillet was digested using a 1% pepsin solution, the viability of nematodes was determined by viewing them under a dissecting microscope. Survival rates were 31% at 140 degrees F (60 degrees C), 11% at 150 degrees F (65 degrees C), 2% at 160 degrees F (71 degrees C), 3% at 165 degrees F (74 degrees C), and 0% at 170 degrees F (77 degrees C). Microwave processing of standardized fillet "sandwiches," 14 cm long, 4.5 cm wide, and approximately 1.75 cm high, each of which was preinoculated with 10 live nematodes, resulted in no survival at either 160 degrees F or 170 degrees F. Using ultraviolet light to detect both viable and nonviable nematodes in fillet sandwiches as an alternative method to pepsin digestion resulted in survival rates of 1% at 140 degrees F (60 degrees C), 3% at 145 degrees F (63 degrees C), and 0% at 150 degrees F (65 degrees C). Smaller fillet sandwiches, which most likely had fewer cold spots during microwave processing, required 150 degrees F (65 degrees C), whereas larger whole fillets required 170 degrees F (77 degrees C) to kill larvae of Anisakis simplex. The parasites were most likely inactivated by a thermal mechanism of microwave treatment. Damage to the nematodes was often evident from ruptured cuticles that were no longer resistant to digestive enzymes. The high hydrostatic pressure and low chloride content of the pseudocoelomic fluid probably contributed greatly to the damage incurred by the larvae.

Template preparation for PCR and RFLP of amplification products for the detection and identification of Cyclospora sp. and Eimeria spp. Oocysts directly from raspberries.

Raspberries were epidemiologically associated with cyclosporiasis outbreaks during 1996 and 1997. The 18S rRNA genes of Cyclospora cayetanensis and several species of a closely related genus, Eimeria, were sequenced and primers for a nested PCR developed in a previous study. The ability to distinguish amplified products of Cyclospora sp. from those of Eimeria spp. is important for testing food and environmental samples. Therefore, an RFLP analysis of amplified products was used to differentiate Cyclospora cayetanensis from Eimeria spp. PCR inhibitors and the low levels of Cyclospora oocysts present in raspberries make template preparation for PCR challenging. Several approaches for PCR template preparation from raspberry samples were evaluated. Template preparation methods using various washing and concentration steps, oocyst disruption protocols, resin matrix treatment, DNA precipitation, and/or the addition of nonfat dried milk solution to a PCR using modified primers were evaluated first with oocysts of Eimeria tenella then refined with oocysts of C. cayetanensis. Approximately 10 E. tenella oocysts per PCR or approximately 19 C. cayetanensis oocysts per PCR were detected with the optimized template preparation method. The addition of 20 microliters of raspberry wash sediment extract and nonfat dried milk solution did not inhibit the amplification of DNA from as few as 10 E. tenella and 25 C. cayetanensis oocysts in a 100-microliter PCR. The nucleotide sequences of C. cayetanensis and the Eimeria spp. are 94 to 96% similar in the amplified region, but the amplification products from the two genera were distinguished using an RFLP analysis with the restriction enzyme MnlI.

An oligonucleotide-ligation assay for the differentiation between Cyclospora and Eimeria spp. polymerase chain reaction amplification products.

An oligonucleotide-ligation assay (OLA) was developed and compared to a restriction fragment length polymorphism (RFLP) test for distinguishing between 294-bp polymerase chain reaction (PCR) amplification products of the 18S rRNA gene from Cyclospora and Eimeria spp. The PCR/OLA correctly distinguished between three Cyclospora, three E. tenella, and one E. mitis strains and the ratio of positive to negative spectrophotometric absorbance (A490) values for each strain ranged from 4.086 to 15.280 (median 9.5). PCR/OLA provides a rapid, reliable, spectrophotometric alternative to PCR/RFLP.

Natural transfer of helminths of marine origin to freshwater fishes with observations on the development of Diphyllobothrium alascense.

Infective stages of helminths of 5 species that occur as adults in marine mammals were found in burbot, Lota lota (L.) (Gadidae), from the lower Kuskokwim River (southwestern Alaska): Diphyllobothrium alascense Rausch et Williamson, 1958; Pyramicocephalus phocarum (Fabricius, 1780); Corynosoma strumosum (Rudolphi, 1801); Corynosoma semerme (Forsell, 1904); and Pseudoterranova decipiens (Krabbe, 1878). Some larval stages were obtained also from smelt, Osmerus mordax dentex Steindachner, an anadromous fish important as prey of burbot. Burbot, which are freshwater fish, could become paratenic hosts of those helminths by means of at least 3 interactions: by consuming marine fishes in brackish waters at river mouths, by feeding on marine fishes that enter lower reaches of rivers, or by preying on anadromous fishes as they migrate up rivers. Consumption of burbot by people may result in infection by helminths of marine origin; of those recorded, only P. decipiens may be significantly pathogenic. Attempts to rear P. phocarum in dogs were unsuccessful. Plerocercoids of D. alascense, of very small size and found only in the gastric lumen of burbot, readily infected dogs. For study of their development, strobilae were obtained at intervals of 48 hr to 32 days postinfection. In heavy infections, some strobilae developed slowly, while others underwent rapid development.

Occurrence and morphological comparisons of Campula oblonga (Digenea: Campulidae), including a report from an atypical host, the thresher shark, Alopias vulpinus.

New host records for Campula oblonga Cobbold, 1858 from the common dolphin, Delphinus delphis L., and from the thresher shark, Alopias vulpinus (Bonnaterre), are reported herein. Campulids have not been reported previously from a host that was not a marine mammal. The excellent condition and small size of the gravid specimen and the diet and natural history of the thresher shark lead us to conclude that the digene was acquired from the consumption of infected fish. Specimens of C. oblonga from these 2 hosts and from harbor porpoises, Phocoena phocoena (L.), and from Dall's porpoises, Phocoenoides dalli (True), are compared, and a wide variation in ranges and values for characters is noted. The synonymy of Campula folium Ozaki, 1935 with C. oblonga is further supported by the apparent effect of the host on the size of the trematodes. Due to the degree of variation in measurements and the numerous factors that may impact these values, we recommend the use of qualitative morphologic characters for the identification of C. oblonga.

Parasites of fish and risks to public health.

A multitude of parasites have been reported in fish, but only a few species are capable of infecting humans. The most important of the helminths acquired by humans from fish are the anisakid nematodes (particularly Anisakis simplex and Pseudoterranova decipiens), cestodes of the genus Diphyllobothrium and digenetic trematodes of the families Heterophyidae, Opisthorchiidae and Nanophyetidae. Seafood-associated infections by acanthocephalans are rarely reported in humans. All of the helminths mentioned above are associated with social-cultural and behavioural factors, in particular the consumption of raw or undercooked seafood. Measures can be taken during harvesting, processing or post-processing (e.g., by the consumer) to mitigate the risks of infection. The seafood industry and government authorities can apply various programmes to reduce these risks, including good manufacturing practices (GMPs) and hazard analysis and critical control point (HACCP) systems. Such measures may include avoiding particular harvest areas, sizes of fish, or even particular species of fish. The method of capture, handling and storage of the catch can directly affect the quality of the seafood with regard to the presence and numbers of parasites. The extent of processing--including heading and gutting, candling and trimming--and the type of product derived (fresh, frozen, salted or pickled) can all contribute to the control of the risks posed by helminths. The most effective means of killing the parasites are either freezing or heat inactivation.