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Most children with spinal muscular atrophy (SMA) develop spinal deformity, which may require surgical intervention. In addition to poor bone stock, vertebral body shape may hinder the placement of spinal implants resulting in complications and poor outcome. The aim of this study was to analyze whether vertebral body morphology of children and adolescents with SMA is altered in comparison to healthy age-matched controls.In this prospective cohort study, 17 children with SMA (mean age 8.7 ±1.0 years) and 13 adolescents with SMA (mean age 13.6 ±1.4 years), all with some degree of neuromuscular scoliosis, were analyzed by standardized radiographic measurements to evaluate vertebral body height and depth. Results were compared with age-matched healthy controls (n = 10 children; mean age 9.1 ± 1.6 years; n = 20 adolescents, mean age 13.1 ± 0.5 years). Computed tomography scans of 27 adolescents with SMA (13.5 ±1.2 years) and 25 healthy age-matched controls (13.8 ±2.0 years) were analyzed to define pedicle diameters.All children and adolescents with SMA had decreased vertebral height and depth in comparison to age-matched healthy controls. In adolescents, reduced depth was more pronounced than height in the thoracic spine. Pedicle size was significantly reduced in the lower thoracic and lumbar area.Reduced vertebral body height and depth and pedicle size in children and adolescents with SMA may influence surgical treatment of spinal deformity. Surgeons should be aware of anatomical differences and choose implant devices accordingly.

Duchenne muscular dystrophy is a progressive disease usually associated with loss of ambulation and progressive scoliosis. Immobilisation and glucocorticoid treatment are predisposing factors for reduced bone mineral density (BMD). Analysis of quantitative computed tomography revealed low BMD in thoracic and lumbar vertebrae in comparison to age- and sex-matched healthy controls.Evaluation of vertebral bone mineral density (BMD) in Duchenne Muscular Dystrophy (DMD) adolescents with untreated advanced scoliosis and comparison with the BMD values of healthy age-matched controls, based on quantitative computer tomography.Thirty-seven DMD adolescents (age 15.6 ± 2.5 years) with spinal deformity were evaluated clinically and radiologically prior to definite spinal fusion and compared to 31 male and age-matched healthy individuals (age 15.7 ± 2.3 years). Data related to previous medical treatment, physiotherapy and ambulatory status was also analysed. Scoliotic curves were measured on plain sitting radiographs of the spine. The BMD Z-scores of the thoracic and lumbar vertebrae were calculated with QCTpro® (Mindways Software Inc., USA), based on data sets of preoperative, phantom pre-calibrated spinal computed tomography scans.A statistically significant lower BMD could be found in DMD adolescents, when compared to healthy controls, showing an average value for the lumbar spine of 80.5 ± 30.5 mg/cmDMD adolescents with scoliosis have strongly reduced BMD Z-scores, especially in the lumbar spine in comparison to healthy controls. These findings support the implementation of a standardised screening and treatment protocol. Level of evidence/clinical relevance: therapeutic level III.

Skoliosen im Kindes- und Jugendalter benotigen haufig aufwendige konservative und operative Therapieverfahren. Zur Vermeidung unerfreulicher Verlaufe ist die detaillierte Kenntnis des Wachstumsverhaltens, der Prognose und von Begleitproblematiken unerlasslich. Kenntnisse zu Atiologie, Prognose, Diagnostik und Therapie von Wirbelsaulendeformitaten im Wachstumsalter sollen vermittelt werden. Die vorliegende Arbeit beruht auf einer selektiven Literaturrecherche und auf den Ergebnissen mehrerer eigener prospektiver und retrospektiver Untersuchungen. Abhangig von Atiologie und Patientenalter ist eine detaillierte und interdisziplinare Diagnostik notig. Konservative Therapien, z. B. die Versorgung mithilfe eines Cheneau-Korsetts, konnen Krummungen bestenfalls aufhalten, aber nicht auf lange Sicht umkehren. Operative Therapien mit wachstumsfreundlichen Implantaten sind aufwendig sowie mit Komplikationen und Mehrfacheingriffen verbunden. Von extern zu verlangernde, magnetische Implantate vermindern die Zahl notwendiger operativer Eingriffe, tragen aber nicht zur Erhohung der Lebensqualitat bei. Unterschiedliche Formen der Skoliose benotigen verschiedene Therapieansatze. Wichtig ist die Kenntnis von der Art der Skoliose und dem wahrscheinlichen Verlauf. Abhangig davon muss die Familie entsprechend beraten und ein Therapiekonzept entwickelt werden. Wachstumsfreundliche Implantate werden als Ubergangslosung bis zur Wirbelsaulenversteifung eingesetzt.

Spinal muscular atrophy (SMA) is a fatal neurodegenerative disease of newborns and children caused by mutations or deletions of the survival of motoneuron gene 1 resulting in low levels of the SMN protein. While neuromuscular degeneration is the cardinal symptom of the disease, the reduction of the ubiquitously expressed SMN additionally elicits non-motoneuron symptoms. Impaired bone development is a key feature of SMA, but it is yet unknown whether this is an indirect functional consequence of muscle weakness or caused by bone-intrinsic mechanisms. Therefore, we radiologically examined SMA patients in a prospective, non-randomized cohort study characterizing bone size and bone mineral density (BMD) and performed equivalent measurements in pre-symptomatic SMA mice. BMD as well as lumbar vertebral body size were significantly reduced in SMA patients. This growth defect but not BMD reduction was confirmed in SMA mice by μCT before the onset of neuromuscular symptoms indicating that it is at least partially independent of neuromuscular degeneration. Interestingly, the number of chondroblasts in the hypertrophic zone of the growth plate was significantly reduced. This was underlined by RNAseq and expression data from developing SMA mice vertebral bodies, which revealed molecular changes related to cell division and cartilage remodeling. Together, these findings suggest a bone intrinsic defect in SMA. This phenotype may not be rescued by novel drugs that enhance SMN levels in the central nervous system only.

Reduktion und Retention des Krummungswinkels bei Kindern mit neuromuskularen Erkrankungen und progredienten Wirbelsaulendeformitaten. Progressive neuromyopathische Skoliose, welche konservativ nicht beherrscht werden kann (v. a. beim nicht gehfahigen Kind), und/oder Entwicklung eines Thoraxinsuffizienzsyndroms (TIS). Ungenugende Weichteildeckung, Korpergewicht 25 oder >50 kg, fehlende knocherne Verankerungsstrukturen (Rippen), ausgewachsenes Skelett (normalerweise Alter 50 % erzielt und eine Progression uber Jahre effektiv verhindert werden. Bei 495 ambulanten Verlangerungsprozeduren betrug die Rate an operationspflichtigen implantatassoziierten Komplikationen 3,7 %. Im Verlauf erhielten 29 % der 45 Kinder eine operative Revision. Mit der vorgestellten operativen „No-touch“-Technik zur Skoliosekorrektur kindlicher neuromyopathischer Deformitaten kann eine effektive Reduktion des Skoliosekrummungswinkels erreicht und gehalten werden. Vorteile der Methode sind ein teilweiser Erhalt der Wirbelsaulenflexibilitat und eine Reduktion wirbelsaulennaher Ossifikationen, was die definitive dorsale Spondylodese als Endpunkt der Behandlung erleichtert.

ZusammenfassungDer kindliche Knick-Senk-Fuß ist eine 3-dimensionale Fußfehlstellung mit vermehrter Valgusstellung der Ferse, Abflachung der medialen Längswölbung und Abduktion des Vorfußes. Man unterscheidet die flexible von der kontrakten (rigiden) Form. Die Diagnostik gliedert sich in Anamnese, klinische Untersuchung, apparative Diagnostik wie Pedobarografie und die Ganganalyse sowie bildgebende Verfahren. Wichtig ist die Einbeziehung in ein Therapieschema von eventuell vorliegenden pädiatrischen oder neuropädiatrischen Erkrankungen (z. B. Muskeldystrophien, Ehlers-Danlos- oder Marfan-Syndrom u. Ä.). Es zeigt sich, dass bei Kindern ≤ 6 Jahre der flexible Knick-Senk-Fuß fast ausschließlich physiologisch vorkommt (bei 97% aller 19 Monate alten Kinder). Bis zum Alter von 10 Jahren bildet sich die mediale Fußlängswölbung zunehmend aus. Bei einem kleinen Anteil (10-jährige Kinder 4%) persistiert der Knick-Senk-Fuß oder wird progredient. Oberhalb von 10 Jahren besteht die Gefahr der Dekompensation mit zunehmender Rigidität. Nur die Minderheit der Kinder entwickelt eine Schmerzsymptomatik (

BACKGROUND Almost all children with spinal muscular atrophy (SMA) develop a scoliosis during childhood and adolescence. In the last decades, growth-friendly spinal implants have been established as an interim solution for these patients until definite spinal fusion can be performed. The effect of those implants on the final outcome has yet to be described. OBJECTIVE To assess the effect of prior growth-friendly spinal surgical treatment on the outcome after spinal fusion in SMA children in comparison to untreated SMA patients through the prospective study. METHODS A total of 28 SMA patients with (n = 14) and without (n = 14) prior surgical treatment with growth-friendly implants were included. Average surgical treatment prior to definite spinal fusion was 4.9 yr. Scoliotic curve angle, pelvic obliquity, spinal length, kyphosis, and lordosis were evaluated for children with prior treatment and before and after dorsal spondylodesis for all children. RESULTS The curve angle before definite spinal fusion averaged at 104° for SMA patients without prior treatment and 71° for patients with prior treatment. Spondylodesis reduced the scoliotic curve to 50° and 33°, respectively, which equals a correction of 52% vs 54%. Pelvic obliquity could be improved by spinal fusion in all patients with better results in the pretreated group. Results for spinal length, kyphosis, and lordosis were similar in both groups. CONCLUSION These data show the positive effect of prior growth-friendly surgical treatment on radiographic results of spinal fusion in children with SMA. Both scoliotic curve angles and pelvic obliquity showed significantly better values when patients had growth-friendly implants before definite spinal fusion.

The objective of this study was to evaluate the presence of Aspergillus section Flavi and A. section Nigri in cashew nuts harvested in the Northern Guinea (NG) and Southern Sudanian (SS) agro-ecological zones of Benin. Also, the presence of aflatoxins was investigated. For detection of fungal contamination, a total of 100 kernels/sample (with disinfection) and 40 kernels/sample (without disinfection) were plated. Seventy samples from fourteen villages were used. Aflatoxins occurrence was analysed on 84 samples by ultraehigh performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS). The average water content and the cashew nuts count were respectively 8.6% and 172 nuts/kg in NG and 8.7% and 174 nuts/kg in SS. Significant differences between villages in both zones were found for both water content and nuts count. In disinfected samples, strains of Aspergillus section Nigri were predominant, in NG and SS zones (90.2% and 87.2%) respectively. When non disinfected kernels were plated, A. section Nigri was predominant in both NG and SS zones, with percentages of 89.7% and 93.4%, respectively. None of the 84 nuts samples were positive for natural occurrence of aflatoxins with a detection limit of 0.05 e0.2 mg/kg.

Patients with psychiatric disorders of significant neurodevelopmental origin, such as schizophrenia and autism frequently experience genuine motor abnormalities, such as neurological soft signs (NSS). Previous MRI studies in patients with schizophrenia have shown that NSS are associated with abnormal cortical, thalamic and cerebellar structure and function. So far, however, no neuroimaging study focused on the role of the local gyrification index (LGI) in the pathophysiology of NSS. This study sought to explore the relationship between NSS and folding patterns of the cerebral cortex that are thought to be established during early brain development. In this study, whole brain high-resolution magnetic resonance imaging (MRI) at 3 Tesla was used to investigate the LGI in 33 patients with recent-onset schizophrenia. Cortical reconstruction was performed with the Freesurfer image analysis suite. NSS were examined on the Heidelberg Scale and related to LGI. Age, gender, years of education and medication were considered as potential confounding variables. In summary, higher NSS scores were positively associated with morphological changes of LGI predominantly in parietal and occipital areas. Our results confirm the hypothesis of a significant relationship between LGI changes and the NSS expression in schizophrenia. Investigation of LGI may help to explain subtle motor symptoms such as NSS in schizophrenia.

Frakturen des proximalen Radiusendes im Wachstumsalter weisen 3 Besonderheiten auf: Das Radiuskopfchen artikuliert mit 2 Gelenkpartnern und ist somit fur eine ungestorte Ellbogenfunktion unerlasslich. Die Versorgung des proximalen Radiusendes erfolgt durch periostale Gefase im Sinne einer Endstrombahn. Hieraus resultiert eine extreme Vulnerabilitat, sodass bei schweren Traumata – sei es durch Unfall oder Behandlung – Teil- oder Vollnekrosen mit Verplumpungen im Kopf-Hals-Bereich entstehen. Irreversible Komplikationen bilden die radioulnare Synostose und die chronische Epiphysenlosung, welche auch nach exzessiver Physiotherapie entstehen kann. Trotz einer niedrigpotenten Fuge zeigt das proximale Radiusende beim jungen Patienten eine enorme Spontankorrektur von Abkippungen. Seit-zu-Seit-Verschiebungen werden allerdings nicht remodelliert. Therapeutisch sollte moglichst atraumatisch vorgegangen werden. Wegen der Blutversorgungssituation sollten bei entsprechender Indikation unbedingt die Spontankorrektur und eine kurze Ruhigstellungszeit ohne Physiotherapie in ein Therapiekonzept integriert werden. Falls operiert werden muss, sind wiederholte traumatisierende Repositionsmanover zu unterlassen, im Zweifelsfall kann mit einem intramedullaren Nagel geschlossen oder schonend offen reponiert werden. Um den Besonderheiten des proximalen Radiusendes therapeutisch gerecht zu werden, mussen Vulnerabilitat und Korrekturpotenz gegeneinander abgewogen werden. Die Therapie muss so atraumatisch wie moglich sein. Das Spontankorrekturpotenzial sollte in die Primartherapie integriert werden, ohne dieses Potenzial in Bezug auf Ausmas und Alter der Patienten zu uberfordern.

Cassava chips were stored for 8 months in PICS bags, with half of the bags having a natural initial insect infestation, and the other half having this initial natural infestation augmented with 50 Prostephanus truncatus adults. Chips stored in traditional woven polypropylene bags served as controls. Oxygen levels varied during storage from 19.98 to 17.56%, 20.4 to 18.40%, and 20.24 to 19.92%, respectively, in PICS bags with augmented infestation (PICS-A), PICS bags under natural infestation levels (PICS-N) and polypropylene bags (WPP). Carbon dioxide levels varied from 0.73 to 3.90%, 0.65–3.56%, and 0.20–0.61%, respectively, in the three types of bags. P. truncatus populations were significantly higher in PICS-A reaching 98.66 ± 7.21 individuals/kg at the end of storage, compared to 92.66 ± 4.71 in PICS-N and 100.55 ± 3.56 in WPP. Dinoderus spp. density was significantly higher in WPP with 270.55 ± 20.59 individuals/kg after 8 months. The number of holes on chips and weight losses also increased with storage duration in all three treatments, but were significantly higher in WPP. Holes created by insects were noticed in PICS bags and were more important in the inner HDPE (high-density polyethylene) layer than in the outer HDPE layer. Up to 1913.00 ± 114.13 holes were observed on the inner HDPE layer of PICS bags and 1039.00 ± 29.40 in the outer HDPE layer. Hermetic storage bags prolong the storability of chips by approximately 1 month. PICS efficacy was probably affected by the large size of traditional cassava chips with large airspaces between individual chips, leading to a large oxygen store for insects which could not be used up through biotic activity, so that bags were not hermetic. In conclusion, PICS bags cannot be recommended for the storage of large sized traditional cassava chips.

A total of 420 samples were collected from agrarian households. Whereas 51% (215/420) of the samples were contaminated with one or more toxins, the contamination rates for maize, peanut, and cassava products were 74, 62, and 24%, respectively. The fumonisins (20-5412 μg/kg), aflatoxin B1 (6-645 μg/kg), roquefortine C (1-181 μg/kg), and deoxynivalenol (27-3842 μg/kg) were the most prevalent contaminants in maize. For peanut samples, aflatoxin B1 (6-125 μg/kg) and ochratoxin A (0.3-12 μg/kg) were the main contaminants, whereas aflatoxin B1 (6-194 μg/kg) and penicillic acid (25-184 μg/kg) were detected in the cassava products. Exposures calculated through maize intake for fumonisin B1 and aflatoxin B1 were several-fold higher (2-5 for fumonisin B1 and 10(4)-10(5) for aflatoxin B1) than the health-based guidance values of 2 μg/kg bw/day and 0.15 ng/kg bw/day, respectively. The study design constitutes a good model that can be implemented in other sub-Saharan African countries.

The purpose of this research is to screen different processes that could potentially decrease or even eliminate rotenone, a toxic isoflavonoid, from Pachyrhizus seeds. Yam bean seeds have very interesting nutritional characteristics, especially their high protein and lipid contents, and could potentially increase food security in under-nourished populations. However, they contain rotenone, a natural molecule previously used as an insecticide inhibiting the respiratory mitochondrial chain. It was also proven to be toxic to mammals as chronic exposure leads to the development of Parkinson-like symptoms in rats. As the thermosensitivity of rotenone had been reported, this study tested different processes (drying, roasting, boiling, frying, alcohol extraction), tegument removal, and traditional Beninese culinary recipes. Rotenone was then quantified in end-products by a validated method, associating microwave extraction, solid phase extraction (SPE), and HPLC-UV. With these processes a rotenone removal of up to 80% was obtained. The most effective methods were the drying and roasting of the seeds and the maceration of their flour in local alcohol. Rotenone degradation and elimination were confirmed by cytotoxic assays, effectively inducing a decrease in sample toxicity.

Fungal contaminants in major food staples in Kenya have negatively impacted food security. The study sought to investigate peanut market characteristics and their association with levels of aflatoxin in peanuts from Western, Nyanza and Nairobi Provinces of Kenya. Data were collected from 1263 vendors in various market outlets using a structured questionnaire, and peanuts and peanut products from each vendor were sampled and analyzed for aflatoxin levels. Thirty seven per cent of the samples exceeded the 10 μg/kg regulatory limit for aflatoxin levels set by the Kenya Bureau of Standards (KEBS). Raw podded peanuts had the lowest (χ2 = 167.78; P 10 μg/kg of aflatoxin. Over 70% of all storage structures were poorly ventilated and dusty. Sorting comprised 53% of the various crop protection measures used by traders post-harvest. To reduce aflatoxin exposure to consumers, set standards need to be complemented by strict monitoring systems and education of producers, processors and consumers in crop commodities other than maize, which has received the most attention in Kenya. Alternative uses of contaminated produce need to be explored.

In West Africa, the most damaging lepidopteran pest of maize ears is the pyralid Mussidia nigrivenella . Although it is mostly described as a field pest, it can be found feeding on maize stored for up to 4 months. A survey was conducted in Benin in 2006 to assess M. nigrivenella infestations in different maize storage systems in the Southern (SGS) and Northern Guinea Savanna (NGS). In SGS and NGS the percentage of infested stores decreased from 86.7% to 26.7% and from 51.4% to 14.3%, respectively, during the first 28 weeks of storage. During the same time, mean numbers of M. nigrivenella per cob decreased from 0.36 to 0.04 across both zones. All larval stages, but mostly 3rd–5th instars, were frequently found even after more than 12 weeks, indicating that M. nigrivenella may have reproduced in storage, although reinfestation or delayed development could also explain this observation. The highest M. nigrivenella incidences of 16.8% and 14.4% were found in the “Ava” and crib stores, respectively. Infestations were highest in “Ava” and lowest in maize grain stored in polyethylene bags or in mud silos. In a laboratory experiment, the presence of post-harvest beetles negatively affected the bionomics of M. nigrivenella , indicating strong interspecific competition.

Fungal infection and aflatoxin contamination was evaluated on 180 samples of dried vegetables such as okra, hot chilli, tomato, melon seeds, onion and baobab leaves from Benin, Togo and Mali collected in September to October 2006. These products are dried to preserve them for lean periods and decrease their perishability. Fungal contamination was evaluated after plating on selective media with a total of 561 fungal isolates identified, ranging from 18 in tomato and 218 in baobab leaves. Baobab leaves, followed by hot chilli and okra showed high incidence of fungal contamination compared to the other dried vegetables, while shelled melon seeds, onion leaves and dried tomato had lower levels of fungal contamination. Species of Aspergillus were dominant on all marketed dried vegetables irrespective of country. Mycotoxin assessment by Reversed-Phase High Performance Liquid Chromatography showed that only okra and hot chilli were naturally contaminated with aflatoxin B(1) and aflatoxin B(2), at concentrations of 6.0 microg/kg on okra and 3.2 microg/kg on hot pepper. This is the first time that mycotoxigenic fungi and resultant toxins were found on dried vegetable products sampled from African markets. Previous reports have mostly highlighted the risk of mycotoxin exposure from staple crops in Africa, but such risks now need to be evaluated for other products such as dried vegetables.

Food safety and compliance with international standards is a major challenging to achieve food security in sub-Saharan Africa. The present study evaluated the occurrence of Aspergillus flavus, Fusa...

Bei Kindern und Jugendlichen mit spastischer Hemiparese sind Torsionsdifferenzen an der unteren Extremitat bekannt, wahrend Torsionsverhaltnisse der oberen Extremitat weitgehend unerforscht sind. Die Torsionsanderungen der unteren Extremitat beeinflussen das Gangbild und Veranderungen der Drehverhaltnisse der oberen Extremitat (etwa nach Frakturen) fuhren zu Bewegungseinschrankungen der Arme bzw. zum geanderten Bewegungsradius der Arme. In der vorliegenden Studie wurde an Kindern und Jugendlichen mit spastischer Hemiparese untersucht, ob eine Torsionsdifferenz zwischen dem Humerus der gesunden und der erkrankten oberen Extremitat besteht, von welchen Faktoren eine mogliche Differenz abhangig ist und inwieweit diese sich auf die Beweglichkeit des Armes auswirken. Anamnestisch, klinisch, photographisch und mittels einer neuartigen sonographischen Methode wurden 33 Kinder und Jugendliche mit spastischer Hemiparese [Mittel 9,7 (3–16) Jahre] sonographisch untersucht. Eine Einteilung nach dem Grad der Spastik erfolgte in 3 Gruppen. Die Humerustorsionsmessungen wurden mit den Ergebnissen eines Normalkollektivs verglichen (n=149). Bei etwa der Halfte (n=16; 48,5%) der Kinder und Jugendlichen war die sonographisch gemessene Humerustorsion der erkrankten Seite mehr nach innen, bei 17 (51,5%) der Kinder war die Humerustorsion im Vergleich zur gesunden Seite mehr nach ausen gerichtet. Die Veranderung der Humerustorsion der erkrankten Seite im Vergleich zum gesunden Arm war mit p

BACKGROUND: Maize constitutes the main staple food and most important crop grown in Zambia. However, maize incurs considerable losses both in field and storage due to pathogens and insects. Some of the pathogens and resultant mycotoxins reduce the nutritional quality of the product. Mycotoxins are toxigenic fungal compounds that can cause cancer and suppress growth. In spite of this health hazard, there has been very little research to document their occurrence. Maize grains stored for human consumption were sampled from different agro-ecosystems (forest, valley and plateau areas) of three agroecological zones (high, mid and low altitude). RESULTS: Several fungal genera were recovered among which Aspergillus flavus, A. niger, Fusarium verticillioides, F. solani, Rhizopus stolonifer and Penicillium spp. were prevalent. The weevil Sitophilus zeamais and the larger grain borer Prostephanus truncatus were the most damaging. Enzyme-linked immunosorbent assay (ELISA) tests yielded fumonisins and aflatoxins ranging between 0.02 and 21.44 ppm, and 0.7 and 108.39 ppb in 96.4% and 21.4% of samples, respectively. Fumonisin was more pronounced in villages in forest areas whereas aflatoxin was highest in valley and forest areas in Zone II. CONCLUSION: Strategic interventions to curtail fungal, mycotoxin and insect contamination should be directed towards improved agronomic and post-harvest practices of maize from fields to consumers. Copyright © 2009 Society of Chemical Industry

AIM Inter- and intraobserver reliability and learning curve using Graf's ultrasonographic hip examination were assessed. MATERIAL AND METHODS 189 participants of the basic, advanced and final courses on hip ultrasound using the Graf method (DEGUM) were asked to answer a questionnaire and to measure 34 normal and pathological sonographic hip examinations. Measurement differences and the learning curve during the different courses were evaluated. RESULTS There was a significant (p = 0.001) improvement of the average angle between the basic (6.74 degrees [+/- 1.46 degrees ]) and the advanced course (6.22 degrees [+/- 1.17 degrees ]). However, there were no better results in the final course and no additional improvement. Participants had higher variations when measuring the beta-angle than the alpha-angle. A significant improvement was seen if the participants performed a large number of hip ultrasounds between the courses. Higher measurement differences were seen in pathological hip ultrasounds and in ultrasonographic examinations of poorer quality. CONCLUSIONS During the educational courses on hip ultrasound using the Graf method, a high intra- and interobserver variability was seen. These findings were most prominent in measurement of the beta-angle, in pathological hip ultrasounds and in ultrasonographic hip examinations of poorer quality. The best results were achieved by participants who had performed a large number of examinations between courses. For the improvement of ultrasonographic measurements, a large number of self-performed examinations and a training in potential mistakes seem to be of great importance.

The presence of fungi, aflatoxins and fumonisin B1 in cassava and yam chips (during 28 processing and storage) were evaluated during two consecutive seasons in two agroecological zones of Benin (Northern Guinea Savannah, NGS and Sudan Savannah, SS). The Benin samples were assessed for moisture content, fungal infestation and total aflatoxin and fumonisin B1 contamination. During the two seasons, samples collected from the NGS, had moisture contents ranging from 10.0 to 14.7% in cassava chips and from 11.4 to 15.3% in yam chips. In samples from the SS, moisture content ranged from 10.1 to 14.5% and 11.1 to 14.5% in cassava and yam chips, respectively. A. flavus was the predominant fungal species. The maximum cfu/g in cassava and yam chips was 8950 and 6030, respectively. Other fungal species isolated included P. chrysogenum, M. piriformis, Phoma sorghina, F. verticillioides, R. oryzae and Nigrospora oryzae. High performance liquid chromatography analysis of both cassava and yam chips showed no contamination by either aflatoxins or fumonisin B1.

Consecutive outbreaks of acute aflatoxicosis in Kenya in 2004 and 2005 caused > 150 deaths. In response, the Centers for Disease Control and Prevention and the World Health Organization convened a workgroup of international experts and health officials in Geneva, Switzerland, in July 2005. After discussions concerning what is known about aflatoxins, the workgroup identified gaps in current knowledge about acute and chronic human health effects of aflatoxins, surveillance and food monitoring, analytic methods, and the efficacy of intervention strategies. The workgroup also identified public health strategies that could be integrated with current agricultural approaches to resolve gaps in current knowledge and ultimately reduce morbidity and mortality associated with the consumption of aflatoxin-contaminated food in the developing world. Four issues that warrant immediate attention were identified: a) quantify the human health impacts and the burden of disease due to aflatoxin exposure; b) compile an inventory, evaluate the efficacy, and disseminate results of ongoing intervention strategies; c) develop and augment the disease surveillance, food monitoring, laboratory, and public health response capacity of affected regions; and d) develop a response protocol that can be used in the event of an outbreak of acute aflatoxicosis. This report expands on the workgroup’s discussions concerning aflatoxin in developing countries and summarizes the findings.

A trial was set up in northern Benin to evaluate the potential of Teretrius nigrescens to reduce the infestation and damage to cassava chips caused by storage insects. Cassava chips were stored for 5 months in mud silos and 50 adults of T. nigrescens were added when the stores were first filled. Stores where no predator was released were monitored as controls. The main storage insects observed were Prostephanus truncatus and Dinoderus spp. Initial chip weight varied between 102 and 246 g with no difference between treatments. Chip weight and number of holes on chips initially differed between treatments after 2 months of storage. After 3 months of storage, losses reached 40–50% without T. nigrescens and 30–40% when cassava chips were stored with T. nigrescens. A farmer can increase his profit by 1437 Fcfa/100 kg (1$=560 Fcfa, 1£=968 Fcfa; 1€=656 Fcfa, as on 2 December 2005) through the use of T. nigrescens because losses are reduced by 11%. Data analysis showed that there were significant differences ( P 0.0 0 0 1 ) between the two treatments for the number of holes, number of insects, weight of each chip as well as damage. There were twice as many P. truncatus and holes on chips in stores where T. nigrescens was not released. The addition of the predator to farmers’ stores is an economic option for controlling losses due to insects in cassava chips.

Die Epiphyseolysis capitis femoris (ECF) wird definiert als nichttraumatische Epiphysenlosung in der Schenkelhalsepiphysenfuge wahrend des pubertaren Wachstumsschubes. Abhangig von der Anamnesedauer wird die akute von der chronischen und der akut auf chronischen Form unterschieden. Die Atiologie der Erkrankung ist bis heute nicht endgultig geklart, wobei von einem multifaktoriellen Geschehen ausgegangen wird. Die typische, in der Pubertat auftretende Form, wird von der atypischen ECF unterschieden. Letztere ist haufig mit endokrinologischen Erkrankungen oder Therapien assoziiert. Pradisponierende Faktoren fur die typische ECF in der Pubertat sind das mannliche Geschlecht, Hochwuchs und v. a. Ubergewicht. Wahrscheinlich findet haufig vor dem Abrutsch ein Wachstumsschub statt. Die Adipositas der Patienten ist mit einer verminderten femoralen Antetorsion assoziiert, welche zusatzlich durch Scherkrafte eine ungunstige mechanische Auswirkung auf die Epiphysenfuge hat. Die Therapie der ECF ist operativ und richtet sich nach der Erkrankungsform. Die akute ECF ist wegen der moglichen Gefahrdung der Huftkopfdurchblutung ein Notfall. Als Komplikationen sind nach ECF v. a. die Huftkopfnekrose und Chondrolyse gefurchtet.

The natural occurrence of Fusarium and fumonisin contamination was evaluated from 1999 to 2003 in both preharvest and stored maize produced by small-scale farmers in four agroecological zones of Benin. Mycological analyses revealed a predominance of both Fusarium and Aspergillus in maize samples compared to other genera. The two Fusarium species most commonly isolated from maize were Fusarium verticillioides (68%) and Fusarium proliferatum (31%). Atypical isolates of F. verticillioides with some characteristics of Fusarium andiyazi but apparently closer to F. verticillioides, because the isolates were all high fumonisin producers, were also found only on preharvest maize. Study of F. verticillioides strains showed the presence of extremely high fumonisin producers in Benin with total fumonisin levels ranging from 8240 to 16,690 mg/kg. Apart from 2002-2003, Fusarium occurrence was not significantly different from one zone to another, although a slight decrease was observed from south, humid, to north, drier. Fusarium occurrence varied somewhat from one season to another. It significantly decreased over the 6 months of storage. Widespread fumonisin occurrence in maize was observed. Most of the maize samples collected were found positive for fumonisin with levels ranging from not detected to 12 mg/kg in 1999-2000, 6.7 mg/kg in 2000-2001 and 6.1 mg/kg in 2002-2003. Fumonisin levels in maize were found to be significantly higher in the two southern zones during all the surveys. The highest mean total fumonisin level was detected in 1999-2000 in maize samples from the southern Guinea Savannah (SGS) (12 mg/kg), whereas in both 2000-2001 and 2002-2003, it was in samples from the forest mosaic savannah (FMS) (6.7 and 6.1 mg/kg, respectively). Fumonisin levels varied from one season to another and, throughout the storage time, showing a decreasing trend in each zone. However, this decrease was not significant every season. An increasing trend was observed during some seasons in the SGS and northern Guinea Savannah (NGS) zones. The results of this study emphasise that farmers and consumers, not only in Benin but also in other West African countries, should be alerted to the danger of fumonisin contamination in maize.

Twelve indigenous and exotic isolates of Beauveria bassiana and Metarhizium anisopliae were evaluated for their virulence and their ability to suppress populations of Callosobruchus maculatus in stored cowpea. LT 50 values ranged from 3.11 to 6.12 days following immersion in aqueous suspensions containing 1×10 8 conidia ml −1 . Indigenous isolates that had been recovered from C. maculatus were more virulent in laboratory bioassays than exotic isolates from other insects. The two isolates with the shortest LT 50 values were compared in dose–response assays by immersion and by exposure to cowpea grains treated with dry conidia. In both assays B. bassiana 0362 was consistently more virulent than M. anisopliae 0351. By immersion, LC 50 values on day 6 post-treatment were 9.10×10 4 and 7.10×10 5 conidia ml −1 for B. bassiana 0362 and M. anisopliae 0351, respectively. Exposure to treated grains gave LC 50 values of 1.15×10 7 and 4.44×10 7 conidia g −1 grain for B. bassiana 0362 and M. anisopliae 0351, respectively. In 1 kg batches of cowpea stocked with 50 adult C. maculatus , B. bassiana 0362 at both 1×10 7 and 1×10 8 conidia g −1 grain led to significant adult mortality and reduced F 1 emergence relative to untreated populations. At 1×10 8 conidia g −1 the effect of the fungus persisted into the F 1 generation. The net reproductive rates, R 0 , measured 26 days after insects were released were 5.16 and 7.32 for the high and low doses compared to 9.52 for the untreated control.

A survey of the sanitary quality, particularly concerning aflatoxin contamination and practices of the dried yam chips food sub-sector was carried out in Benin. Producers and intermediaries of the yam chips food production sub-sector were interviewed and samples collected. Aflatoxin content was assessed by a biochemo-luminescence method on a total of 107 samples. Twenty-three per cent of the samples had aflatoxin contents over the 15 μg kg−1 CODEX standard value for total aflatoxin. Moisture content of whole tuber chips was around 20% when producers stopped drying after 3–6 days. Drying was thus not accomplished, but most producers were unaware of this problem. After storage for 7 months, mean moisture content was around 14%, but 41% of the samples stored in rooms had a moisture content over 15%, levels that are still favourable for mould growth. Most producers, wholesalers and retailers complained about storage problems and particularly about insect proliferation, but less than 15% mentioned mould growth as a problem. Mouldy chips are generally washed and dried again. Very rarely are mouldy chips discarded and lack of moulds is not a quality attribute for dried yam chips. Therefore, there is a risk of chronic exposure to aflatoxin for Beninese yam chips consumers.

This study relates preharvest and harvest practises to postharvest quality of maize in Benin, West Africa. Fungal infection and aflatoxin levels were evaluated in 300 farmers' stores in four agro-ecological zones over 2 years (1993-1995), at the beginning of storage (sample A) and 6 months later (sample B). Aspergillus flavus infected 10-20% of the kernels in sample A (1993-1994). In sample B, 54-79% of the kernels were infected with A. flavus. In 1994-1995, A. flavus infection was higher in sample A (27-47%) than B (8-26%). Fusarium species were found in 38-58% of the kernels in sample A in both years, but decreased slightly to 29-51% in sample B. Significant agroecozonal effects existed within sampling, but were not consistent between samplings and years. Of the total number of samples collected (744), 38.8% were found to be aflatoxin-positive, with an average of 105 parts per billion (ppb) and 60% of the aflatoxin-positive samples having a contamination approximately 20 ppb, the intervention level recommended by the World Health Organization. Factors associated with increased aflatoxin were: planting local maize varieties in southern Benin, intercropping with cowpea, groundnut, or cassava, use of urea-fertilizer, damage to maize in the field, prolonged harvesting, long drying periods in the field, and winnowing. Practices that reduced aflatoxin contamination were: planting improved varieties in northern Benin, mixed cropping with vegetables, use of NPK-fertilizer, drying of harvested cobs for 60-90 days, drying ears without the husk, sorting out of poor quality ears.

Smac/Diablo and HtrA2/Omi promote apoptosis by binding to and antagonizing IAP proteins, including the 'X chromosome-linked inhibitor of apoptosis' (XIAP). Here we show that caspase-mediated proteolysis of a limited subset of cell death substrates exposes functional Smac/Diablo-like N-termini after cleavage, which are able to bind to and antagonize XIAP. We propose that this mechanism may establish a feedforward sensitization of the apoptotic pathway and contribute to the functional redundancy of IAP antagonism. In addition, this may be particularly relevant in Alzheimer's disease since the caspase-generated C31 peptide, an established cytotoxin, acquires Smac/Diablo-like properties after apoptotic processing.

A storage experiment was conducted in Bante, central Benin between autumn 1994 and spring 1995. The maize was harvested 1, 3, and 7 weeks after physiological maturity and stored for up to eight months. The main results were: (a) Leaving the maize in the field for extended periods after physiological maturity resulted in severe grain losses after eight months of storage; (b) Most of the grain losses were attributed to Prostephanus truncatus; (c) Early harvested maize had a higher proportion of mouldy grain; (d) Harvest date had no consistent effect on the level of aflatoxin contamination; (e) Based on a participatory evaluation of maize quality by local farmers, the economic value of maize stored for eight months was highest in maize harvested three weeks after physiological maturity.

Maize infection by Aspergillus flavus Link and subsequent aflatoxin contamination as affected by insect damage to maize ears before harvest was studied with surveys in farmers' fields and in a field trial in the Republic of Benin, West Africa. The most important pest species was the lepidopteran earborer Mussidia nigrivenella Ragonot. Percentage of grain infected by A. flavus and of samples contaminated with aflatoxin, as well as the mean aflatoxin content of samples, increased with increasing borer damage. Ears with 10% damage) had an average aflatoxin of 514.6 and 388.2 ppb in 1994 and 1995, respectively. In 1994 only, coleopteran species such as Sitophilus zeamais Motschulsky and Carpophilus sp. significantly increased levels of aflatoxin in grain samples. In a field trial using M. nigrivenella infestation and A. Flavus inoculation treatments, the presence of the insect feeding resulted in increased kernel infection and aflatoxin contamination. Artificial infestation with M. nigrivenella larvae increased aflatoxin content of maize by an average of 45 ppb, whereas inoculation with A. flavus spores increased the toxin level by 517 ppb. The significant interaction between infestation and inoculation indicated that higher levels of aflatoxin B1 were found when the fungus was associated with borers than with the fungus alone. M. nigrivenlla was the major field pest connected with A. flavus infection and subsequent aflatoxin production in preharvest maize in Benin.

After insects, mites are the major arthropod pests that inhabit stored agricultural products worldwide. To determine the acarofauna that infests cowpea, maize, paddy rice and sorghum in Benin (West Africa), surveys were conducted in some principal markets (Dantokpa, Glazoue and Parakou) of this country. A total of 555 samples of grains and debris were collected in May and September 2011. More than 56 species belonging to 24 mite families were recorded in the four products. These mite species included predators, parasites, fungivorous, phytophagous and other groups whose feeding habits are not well known. The family Cheyletidae was the most prevalent and the most diverse predatory mite family encountered, in which Cheyletus malaccensis Oudemans was the most abundant species. Several families of mite pests and mites responsible for allergies (Acaridae, Glycyphagidae, Pyroglyphidae, Pyemotidae and Saproglyphidae) were also detected. The three most dominant and frequent species were C. malaccensis, Suidasia nesbitti (Hughes) and Suidasia sp. Statistical analysis showed that densities of these three mite species were higher in Parakou than in Glazoue and Dantokpa, on one hand, and higher in debris than in grains, on the other hand. The densities of S. nesbitti and Suidasia sp. decreased significantly during the dry season, whereas C. malaccensis remained stable throughout the two samplings. Of all grains, sorghum was the least infested with mites. This study shows that in Benin mites are present in stored agricultural products to which they cause serious damage, and may cause various allergies to people.

Es wird uber eine vergleichende bakteriologische Untersuchung wahrend Scheinoperationen sowohl im konventionell belufteten Operationsraum, als auch in einer stromungstechnisch analysierten Sterilboxe mit Luftbakterienfiltern berichtet, und zwar einerseits bei Tragen eines geschlossenen Helmes mit Atemabluftabsaugung und andererseits mit und ohne Mundschutz. In der Sterilboxe zeigte sich im Vergleich zum konventionell belufteten Operationsraum eine statistisch gesicherte Verringerung des Keimpegels im Operationsbereiche, die durch eine Atemabluftabsaugung nicht mehr signifikant verbessert werden konnte. Es kann festgehalten werden: 1. das die Keimverminderung pro Zeiteinheit sicher bedeutungsvoll sein kann, das aber die Verminderung des eigentlichen Infektionsrisikos fur den Patienten lediglich die 10% der Infekte betreffen, welche durch Luftkeime verursacht sind. 2. Das Tragen von Helm und Absaugevorrichtung scheint die Prophylaxe nicht wesentlich zu verbessern, so das vor allem bei Operationen mit kleinem Operationsgebiet auf diese Masnahme verzichtet werden darf.

Die beste Katastrophenorganisation bleibt ein Papiertiger, wenn die entsprechende breitbasige Ausbildung fehlt. Ein Grundunterricht in Erster Hilfe mus von der Schule aus die ganze Bevolkerung erfassen, und er setzt sich in der Samariterbewegung fort. Die aktive Mitarbeit der Arzte, unabhangig ihrer Fachrichtung, in grosen wie in kleinen Ortschaften, im Zivil- wie im Militardienst ist unabdingbare Voraussetzung zur wirkungsvollen Katastrophenhilfe. Im heutigen Zeitalter der Spezialisierung werden viele Kollegen Grundsatze und Praxis der Katastrophenmedizin bald vergessen, wenn eine entsprechende Ausbildung im Studium nicht eingeplant und spater kontinuierlich erganzt wird. Auch ein gut vorbereiteter Arzt vermag in der Katastrophensituation allein wenig auszurichten, wenn er nicht personell und materiell massivst unterstutzt wird. Die Hilfe insgesamt wird nur optimal wirksam, falls eine entsprechende leitende Hilfsorganisation vorhanden ist und Plane fur alle Eventualitaten jederzeit abrufbar sind. Dabei ist eine Koordination aller beteiligten Helfer und aller umliegenden Spitaler anzustreben. Auch jedes Krankenhaus sollte innerbetrieblich entsprechende Vorsorgemasnahmen treffen und ein Alarmsystem besitzen. Nur mittels solcher prophylaktischer Masnahmen kann die Tragik einer Katastrophe fur die Allgemeinheit gelindert und die Uberlebenschance fur alle Betroffenen entscheidend gunstig beeinflust werden.

A primary resection and reanastomosis of the colon is often the procedure of choice, even in the presence of a significant stenotic element, provided there are no mayor disturbances of water-electrolyte homeostasis. In a series of 100 consecutive colonic resections (23 complicated by perforation, 9 by ileus, and 2 by bleeding), 97 patients were treated by primary resection (92 without a protective colostomy). No untoward effects were noted specifically due to this technique. The overall mortality rate was 4%, a favorable result when compared with the cumulative risk of a multiple stage procedure.

Fundoplication, using an abdominal approach, is advocated to create an adequate substitute for the insufficient sphincter in gastroesophageal reflux associated with hiatus hernia. To achieve success, correct indications for surgical treatment are important. Based on experience with approximately 1,400 patients over the past 20 years, these include: (a) a retrosternal burning sensation (in 90% of our cases); (b) objective confirmation of reflux by means of x-ray and endoscopic examination, together with biopsy examination of the esophageal mucosa and gastric acid evaluation; and (c) evidence of organic complications such as endobrachyesophagus with ulcerostenotic changes at the junction between the esophageal and gastric mucosa. Long-term follow-up of 590 patients with simple reflux esophagitis who underwent fundoplication showed that 87.5% were symptom free. In 44 patients with complicated gastroesophageal reflux disease, fundoplication produced clinical healing in 84.1%.

A historical survey based on the most important literature is presented as a starting point for further discussion on the significance of possible adverse reactions reported after prescription of cotrimoxazole. The often changing and contradictory assessments made of the situation in different countries and at different times are outlined, and the difficulty of making a balanced and just evaluation of long established drugs is shown, particularly if the available data are derived primarily from spontaneous reports which, besides being almost impossible to verify, are often incomplete.