Microplastic in Dredged Sediments: From Databases to Strategic Responses.

Microplastics (MPs) accumulate in sediments, yet guidelines for evaluating MP risks in dredged sediments are lacking. The objective of this study was to review existing literature on MPs in sediments to improve fundamental knowledge of MP exposures and develop a publicly available database of MPs in sediments. Twelve percent of the reviewed papers (nine studies) included sediment core samples with MP concentrations generally decreasing with depth, peaking in the top 15 cm. The remaining papers evaluated surficial grab samples (0 to 15 cm depth) from various water bodies with MPs detected in almost every sample. Median MP concentrations (items/kg dry sediment) increased in this order: lakes and reservoirs (184), estuarine (263), Great Lakes nearshore areas and tributaries (290), riverine (410), nearshore marine areas (487), dredge activities (817), and harbors (948). Dredging of recurrent shoaling sediments could be expected to contain MPs at various depths with concentrations influenced by the time elapsed since the last dredging event. These results offer key insights into the presence and variability of MPs in dredged sediments, informing environmental monitoring and risk assessment strategies.

Stereotactic Radiosurgery for Benign Cavernous Sinus Meningiomas: A Multicentre Study and Review of the Literature.

Cavernous sinus meningiomas (CSMs) remain a surgical challenge due to the intimate involvement of their contained nerves and blood vessels. Stereotactic radiosurgery (SRS) is a safe and effective minimally invasive alternative for the treatment of small- to medium-sized CSMs. Objective: To assess the medium- to long-term outcomes of SRS for CSMs with respect to tumour growth, prevention of further neurological deterioration and improvement of existing neurological deficits. This multicentric study included data from 15 European institutions. We performed a retrospective observational analysis of 1222 consecutive patients harbouring 1272 benign CSMs. All were treated with Gamma Knife stereotactic radiosurgery (SRS). Clinical and imaging data were retrieved from each centre and entered into a common database. All tumours with imaging follow-up of less than 24 months were excluded. Detailed results from 945 meningiomas (86%) were then analysed. Clinical neurological outcomes were available for 1042 patients (85%). Median imaging follow-up was 67 months (mean 73.4, range 24-233). Median tumour volume was 6.2 cc (+/-7), and the median marginal dose was 14 Gy (+/-3). The post-treatment tumour volume decreased in 549 (58.1%), remained stable in 336 (35.6%) and increased in only 60 lesions (6.3%), yielding a local tumour control rate of 93.7%. Only 27 (2.8%) of the 60 enlarging tumours required further treatment. Five- and ten-year actuarial progression-free survival (PFS) rates were 96.7% and 90.1%, respectively. Tumour control rates were higher for women than men (p = 0.0031), and also for solitary sporadic meningiomas (p = 0.0201). There was no statistically significant difference in outcome for imaging-defined meningiomas when compared with histologically proven WHO Grade-I meningiomas (p = 0.1212). Median clinical follow up was 61 months (mean 64, range 6-233). Permanent morbidity occurred in 5.9% of cases at last follow-up. Stereotactic radiosurgery is a safe and effective method for treating benign CSM in the medium term to long term.

Variability of core microbiota in newly diagnosed treatment-naïve paediatric inflammatory bowel disease patients.

BACKGROUND & AIMS: Intestinal microbiota is considered to play a crucial role in the aetiology of inflammatory bowel disease (IBD). We aimed to describe faecal microbiota composition and dynamics in a large cohort of children with de novo (naïve) IBD, in comparison to healthy paediatric controls (HC). METHODS: In this prospective study, performed at two tertiary centres, faecal samples from newly diagnosed, treatment-naïve paediatric IBD patients were collected prior to bowel cleansing for colonoscopy (t0) and 1, 3 and 6 weeks and 3 months after initiation of therapy. The microbial profiles of Crohn's disease (CD) and Ulcerative colitis (UC) patients were compared with HC and linked to therapeutic response. Microbiota composition was analysed by IS-pro technology. RESULTS: Microbial profiles of 104 new IBD-patients (63 CD, 41 UC, median age 14.0 years) were compared to 61 HC (median 7.8 years). IBD was mainly characterised by decreased abundance of Alistipes finegoldii and Alistipes putredinis, which characterize a healthy state microbial core. The classifier including these core species as predictors achieved an AUC of the ROC curve of .87. Core bacteria tended to regain abundance during treatment, but did not reach healthy levels. CONCLUSION: Faecal microbiota profiles of children with de novo CD and UC can be discriminated from HC with high accuracy, mainly driven by a decreased abundance of species shaping the microbial core in the healthy state. Paediatric IBD can therefore be characterized by decreased abundance of certain bacterial species reflecting the healthy state rather than by the introduction of pathogens.

Interpretation of microbiota-based diagnostics by explaining individual classifier decisions.

BACKGROUND: The human microbiota is associated with various disease states and holds a great promise for non-invasive diagnostics. However, microbiota data is challenging for traditional diagnostic approaches: It is high-dimensional, sparse and comprises of high inter-personal variation. State of the art machine learning tools are therefore needed to achieve this goal. While these tools have the ability to learn from complex data and interpret patterns therein that cannot be identified by humans, they often operate as black boxes, offering no insight into their decision-making process. In most cases, it is difficult to represent the learning of a classifier in a comprehensible way, which makes them prone to be mistrusted, or even misused, in a clinical environment. In this study, we aim to elucidate microbiota-based classifier decisions in a biologically meaningful context to allow their interpretation. RESULTS: We applied a method for explanation of classifier decisions on two microbiota datasets of increasing complexity: gut versus skin microbiota samples, and inflammatory bowel disease versus healthy gut microbiota samples. The algorithm simulates bacterial species as being unknown to a pre-trained classifier, and measures its effect on the outcome. Consequently, each patient is assigned a unique quantitative estimation of which species in their microbiota defined the classification of their sample. The algorithm was able to explain the classifier decisions well, demonstrated by our validation method, and the explanations were biologically consistent with recent microbiota findings. CONCLUSIONS: Application of a method for explaining individual classifier decisions for complex microbiota analysis proved feasible and opens perspectives on personalized therapy. Providing an explanation to support a microbiota-based diagnosis could guide decisions of clinical microbiologists, and has the potential to increase their confidence in the outcome of such decision support systems. This may facilitate the development of new diagnostic applications.

Robust Microbiota-Based Diagnostics for Inflammatory Bowel Disease.

Strong evidence suggests that the gut microbiota is altered in inflammatory bowel disease (IBD), indicating its potential role in noninvasive diagnostics. However, no clinical applications are currently used for routine patient care. The main obstacle to implementing a gut microbiota test for IBD is the lack of standardization, which leads to high interlaboratory variation. We studied the between-hospital and between-platform batch effects and their effects on predictive accuracy for IBD. Fecal samples from 91 pediatric IBD patients and 58 healthy children were collected. IS-pro, a standardized technique designed for routine microbiota profiling in clinical settings, was used for microbiota composition characterization. Additionally, a large synthetic data set was used to simulate various perturbations and study their effects on the accuracy of different classifiers. Perturbations were validated in two replicate data sets, one processed in another laboratory and the other with a different analysis platform. The type of perturbation determined its effect on predictive accuracy. Real-life perturbations induced by between-platform variation were significantly greater than those caused by between-laboratory variation. Random forest was found to be robust to both simulated and observed perturbations, even when these perturbations had a dramatic effect on other classifiers. It achieved high accuracy both when cross-validated within the same data set and when using data sets analyzed in different laboratories. Robust clinical predictions based on the gut microbiota can be performed even when samples are processed in different hospitals. This study contributes to the effort to develop a universal IBD test that would enable simple diagnostics and disease activity monitoring.

Long Term Development of Gut Microbiota Composition in Atopic Children: Impact of Probiotics.

INTRODUCTION: Imbalance of the human gut microbiota in early childhood is suggested as a risk factor for immune-mediated disorders such as allergies. With the objective to modulate the intestinal microbiota, probiotic supplementation during infancy has been used for prevention of allergic diseases in infants, with variable success. However, not much is known about the long-term consequences of neonatal use of probiotics on the microbiota composition. The aim of this study was to assess the composition and microbial diversity in stool samples of infants at high-risk for atopic disease, from birth onwards to six years of age, who were treated with probiotics or placebo during the first year of life. METHODS: In a double-blind, randomized, placebo-controlled trial, a probiotic mixture consisting of B. bifidum W23, B. lactis W52 and Lc. Lactis W58 (Ecologic® Panda) was administered to pregnant women during the last 6 weeks of pregnancy and to their offspring during the first year of life. During follow-up, faecal samples were collected from 99 children over a 6-year period with the following time points: first week, second week, first month, three months, first year, eighteen months, two years and six years. Bacterial profiling was performed by IS-pro. Differences in bacterial abundance and diversity were assessed by conventional statistics. RESULTS: The presence of the supplemented probiotic strains in faecal samples was confirmed, and the probiotic strains had a higher abundance and prevalence in the probiotic group during supplementation. Only minor and short term differences in composition of microbiota were found between the probiotic and placebo group and between children with or without atopy. The diversity of Bacteroidetes was significantly higher after two weeks in the placebo group, and at the age of two years atopic children had a significantly higher Proteobacteria diversity (p < 0.05). Gut microbiota development continued between two and six years, whereby microbiota composition at phylum level evolved more and more towards an adult-like configuration. CONCLUSION: Perinatal supplementation with Ecologic® Panda, to children at high-risk for atopic disease, had minor effects on gut microbiota composition during the supplementation period. No long lasting differences were identified. Regardless of intervention or atopic disease status, children had a shared microbiota development over time determined by age that continued to develop between two and six years.

Fecal microbiome analysis as a diagnostic test for diverticulitis.

Disease-specific variations in intestinal microbiome composition have been found for a number of intestinal disorders, but little is known about diverticulitis. The purpose of this study was to compare the fecal microbiota of diverticulitis patients with control subjects from a general gastroenterological practice and to investigate the feasibility of predictive diagnostics based on complex microbiota data. Thirty-one patients with computed tomography (CT)-proven left-sided uncomplicated acute diverticulitis were included and compared with 25 control subjects evaluated for a range of gastrointestinal indications. A high-throughput polymerase chain reaction (PCR)-based profiling technique (IS-pro) was performed on DNA isolates from baseline fecal samples. Differences in bacterial phylum abundance and diversity (Shannon index) of the resulting profiles were assessed by conventional statistics. Dissimilarity in microbiome composition was analyzed with principal coordinate analysis (PCoA) based on cosine distance measures. To develop a prediction model for the diagnosis of diverticulitis, we used cross-validated partial least squares discriminant analysis (PLS-DA). Firmicutes/Bacteroidetes ratios and Proteobacteria load were comparable among patients and controls (p = 0.20). The Shannon index indicated a higher diversity in diverticulitis for Proteobacteria (p < 0.00002) and all phyla combined (p = 0.002). PCoA based on Proteobacteria profiles resulted in visually separate clusters of patients and controls. The diagnostic accuracy of the cross-validated PLS-DA regression model was 84 %. The most discriminative species derived largely from the family Enterobacteriaceae. Diverticulitis patients have a higher diversity of fecal microbiota than controls from a mixed population, with the phylum Proteobacteria defining the difference. The analysis of intestinal microbiota offers a novel way to diagnose diverticulitis.

Long-term tumor control of benign intracranial meningiomas after radiosurgery in a series of 4565 patients.

BACKGROUND: Radiosurgery is the main alternative to microsurgical resection for benign meningiomas. OBJECTIVE: To assess the long-term efficacy and safety of radiosurgery for meningiomas with respect to tumor growth and prevention of associated neurological deterioration. Medium- to long-term outcomes have been widely reported, but no large multicenter series with long-term follow-up have been published. METHODS: From 15 participating centers, we performed a retrospective observational analysis of 4565 consecutive patients harboring 5300 benign meningiomas. All were treated with Gamma Knife radiosurgery at least 5 years before assessment for this study. Clinical and imaging data were retrieved from each center and uniformly entered into a database by 1 author (A.S.). RESULTS: Median tumor volume was 4.8 cm³, and median dose to tumor margin was 14 Gy. All tumors with imaging follow-up < 24 months were excluded. Detailed results from 3768 meningiomas (71%) were analyzed. Median imaging follow-up was 63 months. The volume of treated tumors decreased in 2187 lesions (58%), remained unchanged in 1300 lesions (34.5%), and increased in 281 lesions (7.5%), giving a control rate of 92.5%. Only 84 (2.2%) enlarging tumors required further treatment. Five- and 10-year progression-free survival rates were 95.2% and 88.6%, respectively. Tumor control was higher for imaging defined tumors vs grade I meningiomas (P < .001), for female vs male patients (P < .001), for sporadic vs multiple meningiomas (P < .001), and for skull base vs convexity tumors (P < .001). Permanent morbidity rate was 6.6% at the last follow-up. CONCLUSION: Radiosurgery is a safe and effective method for treating benign meningiomas even in the medium to long term.

[Robotic surgery in paediatric urology: current status and perspectives]. / Robotische Chirurgie in der Kinderurologie: Aktueller Stand und Perspektiven.

The increasing experience obtained through laparoscopy has resulted in the evolution of ablative and reconstructive procedures in the field of paediatric urology. Apart from the established methods of laparoscopic nephrectomy and orchidopexy, nowadays laparoscopic hemi-nephrectomy and pyeloplasty have become standard therapeutic surgical alternatives. Nevertheless, many of these procedures require a high level of experience in laparoscopic preparation and stitching techniques and are thus performed in institutions with greater laparoscopic experience. With the introduction and evolution of the robotic-assisted technique and the availability of smaller instruments and ports (8 and 5 mm), there has been an evolution in the spectrum of complex ablative and reconstructive procedures in the field of paediatric urology as well. Nevertheless, there is a lack of randomised trails and the literature available in this area consists manly of case reports. The purpose of this article is to present the current status and perspectives of robotic-assisted surgery in the field of paediatric urology.

[Linking: relationships between health professionals in the informal health networks]. / Créer des liens : les relations soignants-soignants dans les réseaux de soins informels.

BACKGROUND: During the last years, the french health system has been developing formal health networks. So, it was necessary to study informal health networks as <> networks. More precisely, we studied the nature of relationships between various stakeholders around general practionners wich are commonly considering as the <> stakeholder of the health system private sector. METHODS: Fieldwork (ethnography based on direct observations and interviews) was conducted between October 2002 and april 2004, in the South-East of France. Ten monographs of general practioner's offices were achieved in a rural area; then, we achieved fieldwork of the informal health networks identified. RESULTS: There is a cultural frame wich is common to all private professionals. This frame includes a triple ideal (teamwork built up the hospital model, independance, and an relational approach with patients). This frame does not square with the real practices. In fact, regulation mechanisms preserve the balance of relashionships between professionnal groups, by restricting/promoting exchanges and complex alliance strategies. These mecanisms include: (1) a few professionnal's rule as disponibility (to the patients and to the professionnals), as communication about patient, as patient's reference, as obligation to communicate between professionals; (2) some constraints such as territory superposition and competition with other professional groups; (3) some needs for: rileiving (of emotions and worries connected to work), sharing (decisions, responsabilities), of delegation (medical treatment, practices), protection against social and legal risk through the creation of trust relationships. These trust relationships are based on several logics (affinity, solidarity, similarity). The study shows the major place of the patient who is often the main organizer of his network, and even though he makes an important structuring work between medical staff, and an information transfer (on his diagnosis, on his treatment, and << on >> professionals). The patient's role of <> is underestimated. CONCLUSION: The results show that in studied informal networks, professionnals do not have a transversal view of the patient's care management. This is due to the lack of knowledge of each health agent about the work of others, to the symbolic compartmentalization between professional groups, and because the difficulties encountered (i.e. burden work).

[Users sceptical about generic drugs: an anthropological approach]. / Des usagers sceptiques face aux médicaments génériques: une approche anthropologique.

BACKGROUND: Since the enactment of the 2002 legislative measures favoring the prescription of generic drugs, various quantitative studies have shown that approval by prescribers and users has risen in France. Nevertheless, scepticism remains as well as distrust towards these drugs focusing on their effectiveness compared with brand-name drugs, on potential dangers, and on the interruption they cause in prescription and consumption habits. Using a comprehensive approach, this article analyzes the social and cultural logic behind the negative image of generic drugs. METHODS: The materials issued from an ethnographic study on the prescription of drugs for high blood pressure. Sixty-eight interviews were undertaken between April 2002 and October 2004 with people (39 women and 29 men, between the age of 40 and 95, 52 over the age of 60) treated for over a year for high blood pressure in rural areas in the Southeast of France. Thirteen people provided unsolicited opinions about generic drugs. RESULTS: Analysis of the information collected shows that users have various representations of generic drugs, including the idea of counterfeited and foreign drugs. These representations interfere with the adjustment process and the development of consumer loyalty. They are part of a set of social representations about drugs which form and express the user's reality. In these representations, the drug is an ambivalent object, carrier of both biological effectiveness and toxicity; it is also the metonymical extension of the prescriber, bestowing upon the prescription a symbolic value. CONCLUSION: By placing the generic drug in its network of symbolic and social meaning, this study highlights the coherence of the scepticism towards generic drugs by consumers (and prescribers) with a system of common opinion in which drugs are everyday things, personalized and compatible with users, symbolic exchange carriers in the physician-patient relationship, and in which confidence in the drug is also that given to the health care system in general.

Treatment of chronic subdural haematoma with percutaneous needle trephination and open system drainage with repeated saline rinsing.

Fifty three patients with symptomatic chronic subdural haematomas were treated with single needle trephination followed by open system drainage with repeated saline rinsing for two days. After single trephination good outcome was achieved in 84% of the patients. Early recurrence was found in 11.3% of the cases. After a second needle trephination good outcome increased to 89%. Mortality rate was 4%. Long term follow up (mean 30 months) showed 6.7% recurrence rate. There were no complications. Single needle trephination with open system drainage and repeated rinsing is an effective and safe minimal invasive procedure for patients with chronic subdural haematomas.

[The treatment of brain metastases]. / De behandeling van hersenmetastasen.

Patients with cancer have a 15 to 30% risk of developing symptomatic brain metastases. The prognosis is extremely poor then: the median survival period is less than one year. Treatment strategies aim to guarantee an optimal quality of life. Curative treatment can only be given in just a few unique cases. Besides the previous standard treatment of whole-brain radiotherapy, the efficacy of other treatment modalities as surgery, radiosurgery, and systemic chemotherapy has been demonstrated to have additional value for certain indications. Important factors that play a role in the decision to give a specific treatment are the age and performance status of the patient, the number of brain metastases and their location, the systemic tumour activity, and the radiosensitivity and chemosensitivity of the primary tumour. A multidisciplinary approach is necessary to guarantee an optimal treatment plan.

First clinical experience with the automatic positioning system and Leksell gamma knife Model C. Technical note.

In May of 1999, the first Leksell Model C gamma knife was installed at the Gamma Knife Zentrum in Krefeld, Germany. The authors recount their experience with this latest technical gamma knife development. Until the end of 1999, extensive physical and technical tests were performed and the system's hardware and software were continuously improved and adapted to the user's needs. By the end of 1999, 163 GKSs had been performed using the new functionality of the Model C in manual or "trunnion" mode. The trunnions, the two parts of the system that fix the patient headframe to the gamma knife when the isocenter positions, are checked manually. During the same period the new automatic positioning system (APS) was extensively tested and refined so that the first APS treatment could be performed in January 2000. Fifty GKSs have been performed with the APS capability of the Model C. It was possible to use APS alone in 74% of surgeries whereas in 14% some shots were given with APS and some with trunnions. In 12%, GKS was scheduled and planned for APS, but due to unexpected technical (6%) or mechanical (6%) reasons the treatment had to be performed manually. At present there are some spatial restrictions with Model C in APS mode when compared with the Model B. The most significant restriction is the narrow space for the patient's shoulders, especially when deep-seated lesions are treated. Through mechanical changes of the APS motor housing and some modifications of and to the motor driven couch adjustment, these limitations will be reduced in the future. The APS treatment runs smoothly and fast. In no case did any relevant safety error occur during GKS. The more stringent mechanical limitations of the APS compared with the Model B means that frame placement on the head is more critical than before.

Job-related education and training: their impact on earnings.

A worker's education and an appropriate job requiring education or training are significant determinants of earnings; qualifying training and training taken to improve skills play different roles in the workplace, but both contribute to greater earnings.

Caries experience of 15-year-old children in The Netherlands after discontinuation of water fluoridation.

In 1973 the fluoridation of drinking water in the Dutch town of Tiel was discontinued. In order to monitor the effect of this measure, the caries experience in 15-year-old children was investigated annually from 1979 to 1988, both in Tiel and in Culemborg. In the latter town the drinking water had never been fluoridated. The caries data of 15-year-old children examined between 1968 and 1969 in Tiel (children having used fluoridated water from birth) and Culemborg were used as historical controls. In Tiel the mean number of DMFS increased between 1968/69 and 1979/80 from 10.8 to 12.7 (+18%) and decreased to 9.6 (-26%) in the following years; in 1987/88 the mean DMFS was 11% lower than in 1968/69. In Culemborg the mean DMFS score decreased between 1968/69 and 1987/88 from 27.7 to 7.7 (-72%). In 1968/69 the mean DMFS score in Tiel was 61% lower and in 1987/88 17% higher than in Culemborg. The question as to whether water fluoridation would have had an additional effect if it had been continued (presuming the application of existing preventive measures) cannot be answered, as there are no remaining communities with fluoridated water in The Netherlands.

[Cessation of fluoridation of drinking water; results of caries research in Tiel and Culemborg in the period of 1968-1988]. / Stopzetting van drinkwaterfluoridering. Resultaten van het cariësonderzoek in Tiel en Culemborg in de periode 1968-1988.

In December 1973 water fluoridation was discontinued in Tiel, the Netherlands. Six years later an epidemiological study was started, with the aim to investigate the consequences. In the period from 1979 to 1988 a yearly caries investigation was carried out in 15 year old children born and living in Tiel and children living in the control town of Culemborg, where the drinking water had never been fluoridated. The 15 year old children in 1979-1980 in Tiel had a 18% higher caries experience than the same age group in 1968-1969, to whom fluoridated water had been available from birth onward. In the same period a 28% decrease of the caries was found in Culemborg. In 1979-1980 the DMFS-index in Tiel was still 36% lower than in Culemborg. Between 1979-1980 and 1987-1988 the caries experience decreased in both towns.

[Dental fluorosis in relation to the use of fluoride tablets]. / Fluoridetabletten en glazuurfluorose. Een epidemiologisch onderzoek bij 15-jarigen in Tiel en Culemborg.

The prevalence of dental fluorosis on the buccal tooth surfaces was investigated in 15-year-old children in the towns Tiel and Culemborg, using the Tylstrup-Fejerskov scoring system. A study done in 1980 revealed that at the age of six, 53% of the children in Tiel and 30% of the children in Culemborg took one or more fluoride tablets (0.25 mg F-) daily. In Tiel the tablets were provided free of charge in a centre for child dental care. On the basis of the number of tablets supplied in the age period 1.5-6 years, most of the 15 year olds in Tiel could be classified as regular, irregular or non-tablet user. Only mild fluorosis (TF-score 1, 2 or 3) was found. The percentage of children with one or more buccal surfaces affected with fluorosis was 24 in Tiel and 22 in Culemborg. The percentages of buccal surfaces with fluorosis were 6 (Tiel) and 7 (Culemborg). In Tiel the percentages of surfaces with fluorosis in the groups regular, irregular and non-tablet users were 12%, 5% and 2% respectively.

Fluoride in caries prevention: is the effect pre- or post-eruptive?

A longitudinal study of children from ages 7 to 18 showed that, if enamel lesions were included, the overall number was the same in fluoridated and non-fluoridated areas. However, a significant reducing effect of pre-eruptive fluoride could be seen in the number of dentinal lesions in a fluoridated area, provided that fluoride was also consumed post-eruptively for a considerable period of time. A precise estimation of both pre- and post-eruptive effects was obtained when teeth were classified according to their eruption time as related to the onset of water fluoridation. About 66% of the greatest reduction in pit and fissure caries came from pre-eruptive fluoride, while in smooth surfaces, this effect was reduced to 25%. In approximal surfaces, the reduction was due half to pre- and half to post-eruptive fluoride. Post-eruptive fluoride became more important with decreasing severity of caries attack. Thus, assuming a continuing decline in dental caries, the majority of such populations will benefit most from the use of topical fluorides. However, in high-risk groups, supplementation of pre-eruptive fluoride can still be of major importance.