Aryl hydrocarbon receptor activation during in vitro and in vivo digestion of raw and cooked broccoli (brassica oleracea var. Italica)

Broccoli is rich in glucosinolates, which can be converted upon chewing and processing into Aryl hydrocarbon Receptor (AhR) ligands. Activation of AhR plays an important role in overall gut homeostasis but the role of broccoli processing on the generation of AhR ligands is still largely unknown. In this study, the effects of temperature, cooking method (steaming versus boiling), gastric pH and further digestion of broccoli on AhR activation were investigated in vitro and in ileostomy subjects. For the in vitro study, raw, steamed (t = 3 min and t = 6 min) and boiled (t = 3 min and t = 6 min) broccoli were digested in vitro with different gastric pH. In the in vivo ileostomy study, 8 subjects received a broccoli soup or a broccoli soup plus an exogenous myrosinase source. AhR activation was measured in both in vitro and in vivo samples by using HepG2-Lucia™ AhR reporter cells. Cooking broccoli reduced the AhR activation measured after gastric digestion in vitro, but no effect of gastric pH was found. Indole AhR ligands were not detected or detected at very low levels both after intestinal in vitro digestion and in the ileostomy patient samples, which resulted in no AhR activation. This suggests that the evaluation of the relevance of glucosinolates for AhR modulation in the gut cannot prescind from the way broccoli is processed, and that broccoli consumption does not necessarily produce substantial amounts of AhR ligands in the large intestine

Renal cancer seeding metastases following retroperitoneoscopicassisted cryoablation: A case report

Nephron-sparing laparoscopy is the standard surgical treatment for clinical T1a renal tumours. However, the laparoscopic technique brings in its specific oncological safety concerns. Seeding metastases are reported: peritoneal metastases, port-tract metastases, and (sub-) cutaneous metastases. The method of laparoscopic assisted renal mass cryoablation is marked by the fact that traumatic tumour tissue handling is unavoidable. This case report reviews the rare occasion of seeding metastases in the retroperitoneal space following laparoscopic cryoablation of a small renal mass. The primary tumour showed no focal recurrence as reported by histological examination. The combination of two events as harming the integrity of cancer tissue and gas-circulation leading to the development of metastases in the retroperitoneal cavity is discussed. The combination of iatrogenic harming cancer tissue integrity and CO2-circulation leads to metastases in the retroperitoneal cavity. Therefore, we recommend performing image-guided renal mass biopsies before considering cryoablative surger

Attitude and behaviour of Dutch Otorhinolaryngologists to Evidence Based Medicine.

OBJECTIVE:The objective of this study was to assess the attitude and behaviour of Dutch ENT surgeons and ENT residents towards Evidence Based Medicine. INTRODUCTION:Evidence Based Medicine is the cornerstone of modern clinical care. It is considered of crucial importance for optimal patient care and health care quality. Practicing it requires positive attitude and behaviour. Little is known about the attitude and behaviour towards Evidence Based Medicine in otorhinolaryngology. METHODS:We performed a web-based questionnaire among 607 Dutch Ear- Nose & Throat surgeons of whom 106 residents (cross-sectional study). The questionnaire consisted of 3 parts; (1) personal characteristics, (2) questions regarding Evidence Based Medicine attitude (McColl questionnaire, scale 0-100%) and (3) questions regarding Evidence Based Medicine behaviour (barriers and information seeking behaviour). Data were collected between March 26th 2018 and June 1st 2018. RESULTS:The median score on the overall McColl questionnaire was 50 (IQR 35). The main barriers respondents experienced were time related. Limited time in the outpatient clinic was considered a more important barrier for residents to practice EBM compared to ENT surgeons. Respondents' gut feeling and their own preference were identified as the main contributing factors in clinical decision making. CONCLUSION:In conclusion Dutch ENT surgeons have a moderate attitude on the McColl questionnaire. The main barriers to practice Evidence Based Medicine they experience are time related