Faecal microbiota signatures of IBD and their relation to diagnosis, disease phenotype, inflammation, treatment escalation and anti-TNF response in a European Multicentre Study (IBD-Character).

METHOD: We examined faecal samples, using the GA-map™ Dysbiosis Test, to associate gut microbiota composition with Crohn's disease (CD) and ulcerative colitis (UC) and to identify markers for future biomarker identification. We conducted a prospective case-control study (EU-ref. no. 305676) in an inception cohort of 324 individuals (64 CD, 84 UC, 116 symptomatic non-IBD controls and 44 healthy controls) across five European centres and examined 54 predetermined bacterial markers. We categorized patients according to the Montreal Classification and calculated the dysbiosis index (DI). Non-parametric tests were used to compare groups and the Bonferroni correction to adjust for multiple comparisons. RESULTS: The fluorescent signals (FSSs) for Firmicutes and Eubacterium hallii were lower in inflammatory bowel disease (IBD) vs. symptomatic controls (p<.05). FSS for Firmicutes, Lachnospiraceae, Eubacterium hallii and Ruminococcus albus/bromii were lower, whereas the signal for Bacteroides Fragilis was higher in UC vs. symptomatic controls (p<.05). FSS was higher for Bifidobacterium spp., Eubacterium hallii, Actinobacteria and Firmicutes among patients with ulcerative proctitis, compared to extensive colitis (p<.05). In CD, we observed no association with disease location. The DI correlated with faecal-calprotectin in both CD and in UC (p<.001). In terms of treatment escalation and anti-TNF response, differences were observed for some bacterial markers, but none of these associations were statistically significant. CONCLUSION: Our data reveal that the GA-map™ Dysbiosis Test holds the potential to characterize the faecal microbiota composition and to assess the degree of dysbiosis in new-onset IBD. On the other hand, our results cannot demonstrate any proven diagnostic or predictive value of this method to support clinical decision making.

The use of Gamma Knife stereotactic radiosurgery in the treatment of ameloblastic carcinoma.

A case of recurrent maxillary ameloblastic carcinoma treated with Gamma Knife stereotactic radiosurgery is reported. This case demonstrates an alternative treatment modality that has not been described previously for this rare and often difficult to treat odontogenic malignancy.

Hybrid central odontogenic fibroma with giant cell granuloma-like component: case report and review of literature.

Central odontogenic fibroma (COF) is a rare benign ectomesenchymal tumor of the jaws. Only 12 cases of COF with giant cell granuloma (GCG)-like lesion have been reported in the English literature. Here, we present a new case of COF epithelium rich type with a GCG-like component. Radiographically, this lesion presented as a well defined unilocular radiolucency in the body of the mandible. Histologically, the lesion showed a unique confluence of odontogenic epithelial rests with multinucleated giant cells (MNGCs) in a highly cellular fibrous connective tissue stroma, with osteoid and cementoid deposits. A distinct area showed the typical histological picture of each component separately. Immunohistochemical staining with pancytokeratin (CK) highlighted the odontogenic epithelial component merging with the GCG component throughout most of the lesion. The significance of GCG-like areas within COF is the reported increased risk of recurrence following curettage, possibly necessitating more aggressive therapy.

Effects of pentobarbital on GABA-activated currents in acutely-isolated rat dentate gyrus granule neurons.

Granule neurons from the rat dentate gyrus were acutely isolated and whole-cell currents recorded. Maximal enhancement of 7 microM gamma-aminobutyric acid (GABA; EC30) evoked currents was obtained with 100 microM pentobarbital where the peak-current was 2.1+/-0.2 of control. One hundred microM pentobarbital alone evoked no current response whereas 1 mM pentobarbital elicited a current response that was 0.4+/-0.2 of the 100 microM GABA-activated peak current. In 100 microM pentobarbital, the GABA EC50 value shifted from 14 to 3 microM but the peak-saturating-current value was not altered. An off-current was recorded on removal of 100 microM and higher pentobarbital concentrations. Ten mM pentobarbital abolished the peak-current response to 7 and 100 microM GABA. The results show that in the granule neurons the drug potency differs for the different effects of pentobarbital at GABAA receptors with the modulatory and inhibitory effects requiring lower concentrations than the direct activation of the receptors.

What is the optimal therapy of brain metastases?

The conclusions of a symposium held in London in October 1999 and devoted to the optimal management of brain metastatic disease were: 1. Prognostic factors are: size and number of metastases (and the presence of mass effect); the status of the systemic cancer outside the central nervous system; performance/neurological status; the age of the patient; and the type of cancer. 2. Surgical management of the single, superficially located brain metastasis with symptomatic mass effect is recommended in good performance status patients. Many would follow this routinely by whole brain radiotherapy. 3. Whole brain radiotherapy is often not followed by durable control of the disease and carries morbidity; better management plans are required. In poor prognosis patients the delivery of radiotherapy may not always be indicated. 4. The current literature demonstrates that stereotactic radiosurgery can enhance the likelihood of sterilizing individual brain metastases compared with whole brain radiotherapy alone. 5. The results of questionnaire showed that the histological diagnosis and latency to onset made little difference to the opinion of neuroscience clinicians, who generally favoured stereotactic radiation therapy over whole brain radiotherapy (with or without a conventionally delivered boost) for all patients with less than four metastases. The opinions of oncologists differed. For bronchial and breast cancer patients, whole brain radiotherapy, with or without a boost, was favoured by the majority, particularly in oat cell cancer. However, with a long latency to 'isolated' brain metastasis, oncologists favoured focal radiation therapy. There was a strong preference amongst oncology experts to reserve stereotactic radiation therapy for apparently isolated brain metastasis; this opinion applied to bronchus and breast cancer, and also to melanoma. 6. Whole brain radiotherapy followed by positron emission tomography scanning to determine what viable metastatic disease remained (and potentially treatable by stereotactic/focal technology) was favoured by most of delegates who answered this question.

Extracellular amino acid levels measured with intracerebral microdialysis in the model of posttraumatic epilepsy induced by intracortical iron injection.

An iron induced model of posttraumatic chronic focal epilepsy in rats was studied with respect to extracellular amino acids, electrophysiology, and morphology, approx. 6 months after intracortical injection of ferrous chloride. Twenty-six of the twenty-eight (93%) rats developed spontaneous epileptiform EEG-activity and electrical cortical stimulation done in eight animals evoked seizure activity in five animals (62.5%). Epileptic brain tissue displayed significantly higher extracellular interictal levels of aspartate (ASP), compared to normal brain, measured with intracerebral microdialysis. The interictal levels of serine (SER) were significantly higher at the lesion side compared to the contralateral cortex in epileptic animals. Spontaneous elevations of ASP and glutamate (GLU) levels up to 8 times the basal level were found in 4/5 (80%). There was no consistent amino acid pattern following the electrically induced seizures, but in association with more intense seizure activity ASP and GLU were elevated. Histopathologically, the necrotic lesions in the cortex contained small vessels and iron pigment loaded astrocytes. Scattered eosinophilic neurons were found in the hippocampus, bilaterally in 37% of the animals. The results show that a focal epileptiform activity developed in a high percentage of animals that received an intracortical iron injection. The observed amino acid changes in epileptic animals may be involved in the development of seizures in this model of posttraumatic epilepsy.

Trends in overweight and physical activity among U.S. military personnel, 1995-1998.

BACKGROUND: The purpose of this study was to deter mine whether changes in physical activity patterns account for the increasing prevalence of obesity, utilizing a large, representative sample of male and female U.S. military personnel. METHODS: Data from the 1995 and 1998 waves of the Department of Defense Survey of Health Related Behaviors among Military Personnel were utilized. Overweight was defined as body mass index > or =25. Respondents were classified as physically active if they reported > or =3 days/week of vigorous activity. Three sequential multivariate logistic regression models were analyzed separately for males and females with overweight regressed on year of study (1995 or 1998), demographic characteristics, and physical activity. RESULTS: Some 50% of military personnel in 1995 and 54% in 1998 were classified as overweight, representing a significant increase in overweight over the 3-year period for both males and females. Overweight military personnel were more likely to be male, older, African American or Hispanic, married, and enlisted personnel. Physical activity levels were high, with around 67% of the sample engaging in regular, vigorous physical activity. Although physical activity levels increased among male personnel between 1995 and 1998, there was not an independent association between physical activity and overweight, and changing physical activity patterns did not account for the increase in over weight from 1995 to 1998. CONCLUSIONS: The U.S. military is experiencing a trend toward increasing overweight that mirrors the pattern among the general population. The results of this study suggest that the rise in overweight among the military is not explained by a decrease in physical activity.

Review of evaluation tools used to assess the impact of nutrition education on dietary intake and quality, weight management practices, and physical activity of low-income audiences.

Nutrition education programs and social marketing campaigns frequently focus on low-income audiences with the goal of improving dietary intake and quality, weight management practices, and physical activity. The impact of nutrition education can be assessed by measuring change in relation to any or all of these broad variables. Unfortunately, little information is available concerning the reliability, validity, and sensitivity to change of measures used to assess these constructs with low-income audiences of adults and adolescents. This article reviews the literature and discusses the types of available measures that have been used and evaluated for the above audiences. It describes specific measures used to assess total diet, consumption of food groups from the Food Guide Pyramid, and behaviors related to weight management and physical activity. Overall, this review suggests that there is a critical need for additional development and evaluation of dietary quality measurement tools for low-income and minority audiences.

Comparison of children's dietary intake patterns with US dietary guidelines.

Monitoring dietary intake patterns among children is important in order to explore and prevent the onset of adult health problems. The aim of the present study was to compare children's dietary intakes with national recommendations and to determine whether sex or ethnic differences were evident. This was done using a methodology that allows assessment of intake from the major components of the Food Guide Pyramid developed by the United States Department of Agriculture (USDA: US Department of Agriculture and US Department of Health and Human Services (1992)). The sample studied included 110 African-American and Caucasian males and females (mean age 9.9 years, BMI 20.1 kg/m2) from Birmingham, AL, USA, who were participating in a study investigating the development of obesity. Dietary data were based on three 24 h recalls and food group intake was determined using the USDA Pyramid Servicing Database. The results indicated that a high percentage of subjects failed to meet the recommended number of servings from each of the food groups. For example, only 5 % and 9 % met fruit and dietary group recommendations respectively. Consumption of foods from the Pyramid 'tip' (including discretionary fat and added sugar) contributed almost 50 % of the diet. African-Americans were more likely to meet requirements for the meat group, with a higher proportion of Caucasians meeting dietary recommendations. Males were more likely to meet the vegetable group guidelines although females consumed more energy per day from discretionary fat. In conclusion, these results suggest that implementation of nutrition education programmes may be important for promoting healthy nutrition among American children.

Use of tape-recorded food records in assessing children's dietary intake.

BACKGROUND: Dietary assessment among children is particularly problematic when techniques are dependent on memory skills or advanced cognitive development. OBJECTIVE: The current study explored the use of self-report by tape recorders to document children's dietary intake immediately upon consumption, and compared this method with the traditional, interviewer-guided recall technique. In addition, the influence of body fatness and sociodemographic characteristics on the accuracy of recall and tape-recorded food records was determined. RESEARCH METHODS AND PROCEDURES: The sample included 30 black and white children aged 6.5 to 11.6 years (x = 9.5). Energy intake (EI), measured by six 24-hour food records (three for each method), was compared with total energy expenditure calculated by the doubly labeled water technique. Paired t tests, correlation analyses, and multiple regression analyses were performed. RESULTS: The analyses revealed poor validity of the tape recorder method (x misreporting score = -1.13+/-2.62 MJ/day, r for total energy expenditure and EI = -0.06, p = 0.74). Estimates of EI differed significantly between the tape recorder and recall methods (p<0.01). The traditional recall method was confirmed as a valid estimate of energy intake (x misreporting score = 0.04+/-2.38 MJ/day), although demonstrating a modest correlation with TEE (r = 0.32, p = 0.08). Although no significant predictors of misreporting using the recall method were identified in the multivariate analyses, older children and children with higher adiposity were more likely to misreport using the tape recorder method. DISCUSSION: The results suggest that the use of the tape recorder for estimating EI does not result in accurate assessments among children, although this technique may be useful for specific subgroups (i.e., younger and leaner children).

Role of dietary factors in ethnic differences in early risk of cardiovascular disease and type 2 diabetes.

BACKGROUND: The disparity in the prevalence of cardiovascular disease and type 2 diabetes between African Americans and whites has been well established, and ethnic differences in several risk factors for these diseases are evident in childhood. OBJECTIVE: The current study explored whether dietary factors explain ethnic differences in serum lipids and insulin profiles in children, independent of body composition and social class background. DESIGN: The sample included 95 African American and white children (mean age: 10.0 y). Macronutrient and food group intakes were derived from three 24-h recalls. Cardiovascular disease and type 2 diabetes risk were determined on the basis of total cholesterol, triacylglycerol, insulin sensitivity (S(i)), and acute insulin response (AIR). Data were analyzed by using t tests, analysis of covariance, and multiple regression. RESULTS: African American children had lower triacylglycerol (P < 0.01), lower S(i) (P < 0.001), and higher AIR (P < 0.001) than whites. Intake of fruit and vegetables was significantly higher, and dairy intake lower, in African American than in white children after adjustment for social class and total energy intake. Several direct relations were observed between diet and insulin action: carbohydrate and fruit intakes were positively associated with S(i) (P = 0.02), and vegetable intake was negatively associated with AIR (P = 0.01). However, neither macronutrient nor food group intake accounted for the ethnic differences in triacylglycerol and AIR. CONCLUSIONS: The African American children in our sample showed a greater disease risk than did the white children, even after body composition, social class background, and dietary patterns were adjusted for.

Influence of body composition on the accuracy of reported energy intake in children.

OBJECTIVE: Mis-reporting dietary intake is a substantial barrier to understanding the role of dietary behavior in disease. Work with adults indicates that heavier individuals under-report dietary intake and that under-reporting may be macronutrient-specific. Whether weight status and macronutrient intake influence the accuracy of dietary reports among children, however, is less clear. This research evaluated children's dietary reporting accuracy as a function of their relative weight, body composition, and macronutrient intake. RESEARCH METHODS AND PROCEDURES: Participants included 146 4- to 11-year-old children. Reported energy intake was determined by interviewing children in the presence of parents, using three multiple pass, 24-hour recalls. Children were classified as having had an under-reported, accurately reported, or over-reported dietary intake relative to total energy expenditure, as measured by doubly labeled water. Reporting accuracy was examined as a function of children's body weight, body composition (using dual energy x-ray absorptiometry), and macronutrient intake. RESULTS: Average reported intake was, on average, 14% greater than children's estimated expenditure (p < 0.01). Reporting accuracy varied as a function of children's relative weight and body composition; under-reporting tended to occur among heavier children, having the highest body fat content (p < 0.0001) and relative weight (p < 0.0001). DISCUSSION: These findings suggest that weight status influences the accuracy of dietary reports made by children and their parents. More research is needed to address possible psychological and social factors that introduce bias in reporting children's dietary data.

Sociocultural determinants of physical activity among children.

BACKGROUND: This study explores underresearched sociocultural predictors of children's physical activity and fitness, with particular attention paid to the influence of ethnicity independent from potential confounders such as social class. METHODS: Utilizing a 1997/1998 cross-sectional sample of 107 children (ranging in age from 6.5 to 13 years, mean = 10 years) participating in a longitudinal study of childhood obesity in Birmingham, Alabama, predictors of television viewing, vigorous exercise, habitual physical activity, exercise in school P.E. classes, sports team participation, and maximal aerobic capacity were identified, utilizing multiple regression analyses. RESULTS: The results indicated few ethnic differences in childhood physical activity once characteristics such as social class and single vs dual parent family background were controlled for. Specific multivariate findings included higher levels of television viewing and vigorous exercise among children from single parent homes; lower habitual physical activity among girls; less P.E. exercise among African Americans and children from single parent homes; higher sports team participation among older yet physically immature children; and higher physical fitness among boys, Caucasians, physically mature children, and children from single parent homes. CONCLUSIONS: This study illustrates the multidimensional nature of childhood physical activity and the influence of sociocultural factors on children's activity patterns.

Drinking patterns in the American Deep South.

OBJECTIVE: To determine whether the states of the Deep South are characterized by contradictory drinking norms: high abstinence paired with high consumption among drinkers. METHOD: Comparison of survey results of drinking patterns (N = 65,216) in four states of the Deep South (Alabama, Georgia, Louisiana and Mississippi) to those in leading states in the East (New York), Midwest (Illinois), Rocky Mountains (Colorado) and West (California) for the years 1990-93. Respondents were selected by random-digit dialing and interviewed by telephone as part of a larger study conducted by the Behavioral Risk Factor Surveillance System (BRFSS) of the Centers for Disease Control and Prevention (CDC). RESULTS: A higher proportion of persons drank alcohol in 1993 than in any of the previous 3 years. Persons with higher education, with higher income, of younger age, male, white and not living in the Deep South were more likely to drink. Among drinkers, the likelihood of episodic heavy drinking decreased with higher education, income and age. In addition, women, blacks and married respondents were less likely to report heavy drinking. Region of residence is not significantly associated with episodic heavy drinking. CONCLUSIONS: The Deep South has a significantly higher proportion of abstainers from alcohol use than other regions. Among drinkers, Southerners are not more likely to engage in occasions of heavy drinking. The results are discussed in relation to Southern culture and drinking norms.

Health behind bars: utilization and evaluation of medical care among jail inmates.

Jail and prison inmates experience disproportionately high levels of chronic and acute physical health problems, resulting in increased utilization of health services in correctional institutions. Variations in both health status and health care utilization are likely, although several important factors have been under-researched. Gender, in particular, is presumed to influence health outcomes and use of medical care in correctional facilities. The current study explores the physical health status of a systematic sample of 198 male and female inmates incarcerated in a large county jail located in a medium-sized Southern city. Using multiple regression analysis, predictors of physical health status, utilization of medical care, and inmates' evaluations of the accessibility and quality of health care are identified. The results indicate that gender and age are the most consistent demographic predictors of health status and medical care utilization, with females and older inmates reporting higher morbidity and concomitantly higher numbers of medical encounters. The experience of incarceration also appears to influence the physical health of inmates, as self-reported health problems increase with inmates' duration of incarceration. Evaluations of jail medical care differ significantly by gender, with female inmates reporting more difficulty accessing health services, yet higher satisfaction with the quality of services received. The results suggest a need for medical care in correctional settings to adapt to the medical needs of older inmates and women, in addition to improving treatment for chronic conditions and preventive services.

Role of physical activity in the prevention of obesity in children.

The increasing prevalence of childhood obesity and its concomitant health risks justify widespread efforts toward prevention. Although both diet and physical activity have been emphasized as appropriate interventions, the current paper focuses on the role of physical activity in obesity prevention. Children's levels of physical activity are highly variable, and may be influenced by a multitude of factors including physiological, psychological, sociocultural and environmental determinants. Although the relationship between physical activity and obesity is controversial and the protective mechanism unclear, physical activity is hypothesized to protect individuals from the development of obesity by increasing energy expenditure and resting metabolic rate (RMR) and leading to a favourable fuel utilization. The beneficial effect of physical activity in children is supported by controlled exercise intervention programs. Several broad-based public health interventions designed to increase children's levels of physical activity have been implemented in schools, families and communities, with results suggesting promising strategies for the prevention of childhood obesity. It is likely that successful prevention of childhood obesity through physical activity promotion will involve theory-based, culturally appropriate school, family and community interventions. Through policy changes, environmental planning and educational efforts in schools and communities, increased opportunities and encouragement for physical activity can be provided.

Lesion topography and outcome after thermocapsulotomy or gamma knife capsulotomy for obsessive-compulsive disorder: relevance of the right hemisphere.

OBJECTIVES: Obsessive-compulsive disorder is a common mental disorder, notorious for its chronicity and intractability. Stereotactic lesions within the anterior limb of the internal capsule have been shown to provide symptomatic relief in such refractory cases, but only few systematic evaluations have correlated anatomic lesion location with individual postoperative outcome. PATIENTS AND METHODS: Between 1976 and 1989, extremely disabled and otherwise intractable patients with a chronic deteriorating clinical course of obsessive-compulsive disorder underwent bilateral thermocapsulotomy (n = 22) or radiosurgical gamma knife capsulotomy (n = 13) at the Karolinska Hospital, Stockholm. Clinical morbidity was monitored prospectively pre- and postoperatively by using standardized psychiatric rating scales. In 29 patients (thermocapsulotomy, n = 19; gamma knife capsulotomy, n = 10), both psychiatric and magnetic resonance imaging follow-up data (median, 8.4 yr) were available. RESULTS: A right-sided anatomically defined lesion volume was identified in all successfully treated patients. This common topographic denominator was defined in the approximate middle of the anterior limb of the internal capsule on the plane parallel to the anterior commissure-posterior commissure line at the level of the foramen of Monro and 4 mm above on the plane defined by the internal cerebral vein. This region was unaffected in patients with poor outcomes. On the left side, no particular lesion topography was associated with clinical outcome. Topographic differences of lesion overlap between good and poor outcome groups were significant for the right side (Fisher's exact test, P < 0.005). CONCLUSION: The current anatomic long-term analysis after thermocapsulotomy or gamma knife capsulotomy for obsessive-compulsive disorder reveals common topographic features within the right-sided anterior limb of the internal capsule independent of treatment modality.

Lack of infection in HIV-exposed individuals is associated with a strong CD8(+) cell noncytotoxic anti-HIV response.

Individuals repeatedly exposed to HIV, but who remain uninfected, form a population enriched for persons likely to have either natural or acquired resistance to the virus. We have studied four such exposed uninfected cohorts, representing 60 individuals, for evidence of protective immunity. This population included participants exposed to HIV through anal or vaginal receptive intercourse on multiple occasions over many years. We observed CD8(+)-cell noncytotoxic inhibition of HIV replication in acutely infected CD4(+) cells in the vast majority of individuals most recently exposed to the virus (within 1 year). The levels of this CD8(+)-cell response were sufficient to inhibit the in vitro infection of the exposed subjects' peripheral blood mononuclear cells. We found no evidence of a significant role for CCR5 Delta32 mutation in this population, nor did CD4(+) cell susceptibility to infection or HIV-specific cytotoxic T-lymphocytes correlate with resistance to infection in the individuals tested. Therefore, the observed strong noncytotoxic CD8(+)-cell anti-HIV responses may be an antiviral immune activity contributing to the apparent protection from infection in these exposed uninfected individuals.