Health benefits and health claims of probiotics: bridging science and marketing

Health claims for probiotics are evaluated by the Panel on Dietetic Products, Nutrition and Allergies of the European Food Safety Authority. Despite a substantial amount of basic and clinical research on the beneficial effects of probiotics, all of the evaluated claim applications thus far have received a negative opinion. With the restrictions on the use of clinical endpoints, validated biomarkers for gut health and immune health in relation to reduction in disease risk are needed. Clear-cut criteria for design as well as evaluation of future studies are needed. An open dialogue between basic and clinical scientists, regulatory authorities, food and nutrition industry, and consumers could bridge the gap between science and marketing of probiotic

Prevention and treatment of deep sternal wound infection after cardiac surgery

Deep sternal wound infection is a devastating complication of cardiac surgery, with low incidence, but serious consequences in terms of morbidity and mortality. Measures to prevent deep sternal wound infection are reviewed in the first section of this thesis. We described and compared several treatment methods for deep sternal wound infection. Open packing of the wound showed to be inferior to vacuum-assisted closure when used as bridge to wound closure. Primary closure using Redon drains showed to be an effective treatment method, with a significantly reduced length of hospital stay when compared to vacuum assisted closure, without compromising survival. We performed a randomized trial to assess the effect of local gentamicin in the treatment of deep sternal wound infection. This trial revealed no reduction of hospital stay in patients treated with local gentamicin. Methods for secondary wound closure were compared. Titanium plate fixation was superior in providing sternal stability when compared to conventional wound closure methods. In the last section of this thesis risk mitigation of deep sternal wound infection is discussed. Tools are provided for risk assessment and evaluation of risk reduction. Our method on prevention, diagnosis and treatment of deep sternal wound infection is described, including the role of a dedicated mediastinitis multi-disciplinary team

Intra- and inter-metabolite correlation spectroscopy of tomato metabolomics data obtained by liquid chromatography-mass spectrometry and nuclear magnetic resonance

Nuclear magnetic resonance (NMR) and liquid chromatography-mass spectrometry (LCMS) are frequently used as technological platforms for metabolomics applications. In this study, the metabolic profiles of ripe fruits from 50 different tomato cultivars, including beef, cherry and round types, were recorded by both 1H NMR and accurate mass LC-quadrupole time-of-flight (QTOF) MS. Different analytical selectivities were found for these both profiling techniques. In fact, NMR and LCMS provided complementary data, as the metabolites detected belong to essentially different metabolic pathways. Yet, upon unsupervised multivariate analysis, both NMR and LCMS datasets revealed a clear segregation of, on the one hand, the cherry tomatoes and, on the other hand, the beef and round tomatoes. Intra-method (NMR¿NMR, LCMS¿LCMS) and inter-method (NMR¿LCMS) correlation analyses were performed enabling the annotation of metabolites from highly correlating metabolite signals. Signals belonging to the same metabolite or to chemically related metabolites are among the highest correlations found. Inter-method correlation analysis produced highly informative and complementary information for the identification of metabolites, even in de case of low abundant NMR signals. The applied approach appears to be a promising strategy in extending the analytical capacities of these metabolomics techniques with regard to the discovery and identification of biomarkers and yet unknown metabolites

Imaging and Treatment of Chronic Midportion Achilles Tendinopathy

Introduction: It is estimated that 30-50% of sports injuries are caused by tendon disorders. Chronic midportion Achilles tendinopathy is a frequent problem, particularly occurring in athletes but also affecting inactive people. Diagnosis is made based on clinical findings and currently the term Achilles tendinopathy is preferred. Until know, we assumed that a reduced tissue repair mechanism with tendon tissue degeneration is the cause of the persistence of symptoms. Ultrasonographic appearance of tendinopathy is characterised by a reduced tendon fibre structure and increased blood flow to the tendon (neovascularisation). Until recently, the prognostic value of ultrasound disorders was in this patient group. Ultrasonography has no added value: Chronic Achilles tendinopathy frequently leads to a reduction of sports activities and can even be career-threatening for an athlete. Currently, a standardised exercise program of 12 weeks is the first choice of treatment. The current conservative and surgical treatments often lead to an unsatisfactory result. This dissertation shows that the ultrasonographic tendon structure can be measured with a high reliability, using a novel innovative technique which was already validated in veterinary medicine. We also found that determining the degree of neovascularisation could be measured with an excellent reliability. There was a clear difference in ultrasonographic tendon structure and neovascularisation between healthy subjects and patients with tendinopathy. However, in follow-up studies the degree of tendon structure disorganisation and neovascularisation could not predict outcome after treatment. This means that ultrasound examination has no added value. A PRP injection is not effective for chronic Achilles tendon injuries: Injections with autologous growth factors, derived from autologous blood, are widely used in the United States. An increased concentration of blood platelets can be obtained, also known as Platelet-rich plasma (PRP). The promising results of PRP gained worldwide attention in the treatment of tendon injuries. In a systematic review of the literature, however, we found only limited evidence for the effect of PRP injections in the treatment of chronic tendinopathies. Therefore we conducted a prospective double-blind placebo-controlled randomised trial. This study showed that there is no added value of a PRP injection to the current usual care. The results of this study are published in JAMA, one of the leading scientific journals. This has led to major global debates about the usefulness of these injections

Psychologists’ Diagnostic Processes during a Diagnostic Interview

In mental health care, psychologists assess clients’ complaints, analyze underlying problems, and identify causes for these problems, to make treatment decisions. We present a study on psychologists’ diagnostic processes, in which a mixed-method approach was employed. We aimed to identify a common structure in the diagnostic processes of different psychologists. We engaged an actor to simulate a client. Participants were asked to perform a diagnostic interview with this “client”. This interview was videotaped. Afterwards participants first wrote a report and then were asked to review their considerations during the interview. We found that psychologists were comprehensive in their diagnostic interviews. They addressed the client’s complaints, possible classifications, explanations, and treatments. They agreed about the classifications, more than about causal factors and treatment options. The content of the considerations differed between the interviews and the reports written afterwards. We conclude that psychologists continuously shifted between diagnostic activities and revised their decisions in line with the dynamics of the interview situatio

Is Training Load Associated with Symptoms of Overuse Injury in Dancers? A Prospective Observational Study

Overuse injuries in dance are extremely common and often difficult to treat. High training load and dancing with pain are frequently regarded as risk factors for musculoskeletal injuries in professional dancers. The aims of this study were to assess for: 1. any association between training load (TL) and symptoms of overuse injury in professional dancers, and 2. any difference between the number of "time-loss" injuries and injuries causing significant symptoms not leading to decreased performance time. Twenty-one dancers from a professional contemporary dance company were followed for 7 weeks. They completed the dance-specific Self-Estimated Functional Inability because of Pain (SEFIP) questionnaire on a weekly basis to quantify musculoskeletal pain. Their TL was calculated by multiplying the Ratings of Perceived Exertion scale (RPE Borg CR10) by the daily training time. Associations between TL and SEFIP scores, recorded on a weekly basis, were evaluated using a mixed linear model with repeated measurements. No significant association was found between TL and severity of musculoskeletal pain. However, the TL of the dancers with no symptoms of overuse-injury, SEFIP = 0, was significantly lower compared to the dancers with symptoms, SEFIP > 0; p = 0.02. No time loss because of injury was reported during the study period. There were 251 symptoms of overuse injury reported, and 67% of the recorded time was danced with pain. It is concluded that dancers without musculoskeletal pain had lower TLs. While no time-loss injuries were found, two-third of the participants danced with pain during this 7-week period

Surgical resection of cardiac paragangliomas surrounding both coronary arteries

Paragangliomas are neuroendocrine tumours that are often highly vascularized and, in most cases, benign. The gold-standard treatment is surgical resection for various reasons; however, this can be challenging because of close proximity to coronary arteries. Paucity of data has resulted in different (hybrid) treatment strategies with unknown long -term outcomes, especially with respect to coronary reintervention after stenting. Here, we report a unique patient with multiple cardiac paragangliomas adjacent to both coronary arteries who underwent complete surgical resection. Cardioplegic arrest is recommended to facilitate resection and, if needed, to perform concomitant coronary artery bypass grafting or reconstruction of cardiovascular structures.Thoracic Surger

Deletion of various carboxy-terminal domains of Lactococcus lactis SK11 Proteinase : Effects on activity, specificity, and stability of the truncated enzyme

The Lactococcus lactis SK11 cell envelope proteinase is an extracellular, multidomain protein of nearly 2,000 residues consisting of an N-terminal serine protease domain, followed by various other domains of largely unknown function. Using a strategy of deletion mutagenesis, we have analyzed the function of several C-terminal domains of the SK11 proteinase which are absent in cell envelope proteinases of other lactic acid bacteria. The various deletion mutants were functionally expressed in L. lactis and analyzed for enzyme stability, activity, (auto)processing, and specificity toward several substrates. C-terminal deletions of first the cell envelope W (wall) and AN (anchor) domains and then the H (helix) domain leads to fully active, secreted proteinases of unaltered specificity. Gradually increasing the C-terminal deletion into the so-called B domain leads to increasing instability and autoproteolysis and progressively less proteolytic activity. However, the mutant with the largest deletion (838 residues) from the C terminus and lacking the entire B domain still retains proteolytic activity. All truncated enzymes show unaltered proteolytic specificity toward various substrates. This suggests that the main role played by these domains is providing stability or protection from autoproteolysis (B domain), spacing away from the cell (H domain), and anchoring to the cell envelope (W and AN domains). In addition, this study allowed us to more precisely map the main C-terminal autoprocessing site of the SK11 proteinase and the epitope for binding of group IV monoclonal antibodie

An Exact Diagonalization Demonstration of Incommensurability and Rigid Band Filling for N Holes in the t-J Model

We have calculated S(q) and the single particle distribution function for N holes in the t - J model on a non--square sqrt{8} X sqrt{32} 16--site lattice with periodic boundary conditions; we justify the use of this lattice in compariosn to those of having the full square symmetry of the bulk. This new cluster has a high density of vec k points along the diagonal of reciprocal space, viz. along k = (k,k). The results clearly demonstrate that when the single hole problem has a ground state with a system momentum of vec k = (pi/2,pi/2), the resulting ground state for N holes involves a shift of the peak of the system's structure factor away from the antiferromagnetic state. This shift effectively increases continuously with N. When the single hole problem has a ground state with a momentum that is not equal to k = (pi/2,pi/2), then the above--mentioned incommensurability for N holes is not found. The results for the incommensurate ground states can be understood in terms of rigid--band filling: the effective occupation of the single hole k = (pi/2,pi/2) states is demonstrated by the evaluation of the single particle momentum distribution function . Unlike many previous studies, we show that for the many hole ground state the occupied momentum states are indeed k = (+/- pi/2,+/- pi/2) states.Comment: Revtex 3.0; 23 pages, 1 table, and 13 figures, all include