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Introduction: To evaluate the recovery rate of loss of smell (LOS) with objective olfactory testing in COVID-19 patients. Methods: Adults with confirmed COVID-19 and self-reported sudden LOS were prospectively recruited through a public call from the University of Mons (Belgium). Epidemiological and clinical data were collected using online patient-reported outcome questionnaires. Patients benefited from objective olfactory evaluation (Sniffin-Sticks-test) and were invited to attend for repeated evaluation until scores returned to normal levels. Results: From March 22 to May 22, 2020, 88 patients with sudden-onset LOS completed the evaluations. LOS developed after general symptoms in 44.6% of cases. Regarding objective evaluation, 22 patients (25.0%) recovered olfaction within 14 days following the onset of LOS. The smell function recovered between the 16th and the 70th day post-LOS in 48 patients (54.5%). At the time of final assessment at 2 months, 20.5% of patients ( N = 18) had not achieved normal levels of olfactory function. Higher baseline severity of olfactory loss measured using Sniffin-Sticks was strongly predictive of persistent loss ( p < 0.001). Conclusion: In the first 2 months, 79.5% of patients may expect to have complete recovery of their olfactory function. The severity of olfactory loss, as detected at the first Sniffin-Sticks-test, may predict the lack of mid-term recovery., (Copyright © 2020 Lechien, Journe, Hans, Chiesa-Estomba, Mustin, Beckers, Vaira, De Riu, Hopkins and Saussez.)

Objectives: To test the psychometric properties of the United Kingdom's Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure (CQRA-PREM) in patients with spondyloarthritis (SpA) and rheumatoid arthritis (RA) and to implement this questionnaire in daily practice in the Netherlands., Methods: After a forward-backward translation procedure into Dutch, the CQRA-PREM was tested into two quality registries in daily practice. Face validity was assessed with focus group interviews. Feasibility was evaluated through completion times and interpretability of domain scores through floor and ceiling effects. Internal consistency (Cronbach's α coefficients) and homogeneity (corrected item-total correlations) were determined. Divergent validity was assessed by Spearman's rank correlation coefficients (r s ) between the average scores of domains and outcome measures. The CQRA-PREM was implemented in daily practice, and the results were used in quality improvement cycles., Results: Face validity of the CQRA-PREM was good. The CQRA-PREM was completed by 282 patients with SpA and 376 with RA. Median time to complete the CQRA-PREM was 4.7 min. Ceiling effects were found in three out of seven domains. Internal consistency of nearly all domains was considered good (0.65 ≤ α ≤ 0.95). Thresholds for homogeneity were exceeded within three domains (r p  > 0.7), suggesting item redundancy. Divergent validity showed that nearly all domains of the CQRA-PREM were at most weakly correlated with outcomes measures (- 0.3 ≤ r s  ≤ 0.3). The CQRA-PREM could identify areas of improvement for providing patient-centered care., Conclusion: The CQRA-PREM has acceptable psychometric properties and has shown to be a useful tool in evaluating quality of care from the patients' perspective in the Netherlands., Trial Registration: SpA-Net is registered in the Netherlands Trial Registry (NTR6740)., Key Points: • The Commissioning for Quality in Rheumatoid Arthritis Patient-Reported Experience Measure (CQRA-PREM) is a valid measure for assessing patient-centeredness of rheumatology care. • The Dutch version of the CQRA-PREM shows acceptable psychometric properties. • The CQRA-PREM shows to be a useful tool in Plan-Do-Check-Act quality improvement cycles in the Netherlands. • The CQRA-PREM can be used for benchmarking and quality improvement of rheumatology services.

Background/Purpose: Hypopharyngeal squamous cell carcinomas (SCC) are generally diagnosed in an advanced disease stage. A total laryngopharyngoesophagectomy with gastric pull-up reconstruction is a time tested surgical treatment in our centre for resectable failures or recurrences after primary treatment with organ preservation protocols (radiotherapy or chemoradiation), or as a primary surgical treatment for very advanced hypopharyngeal tumors. We present the results of our approach in terms of success rate, postoperative complications and functional and oncologic outcomes. Methods: We retrospectively reviewed the charts of all patients with hypopharyngeal SCC, who underwent laryngopharyngoesophagectomy with gastric pull-up reconstruction during the period 1989-2015. Results: The cohort included 60 patients. Mean follow-up was 32 months. Stage III and stage IV disease was present in 35 and 60% of patients, respectively. Successful reconstruction by intended gastric transposition was possible in 98.3% of cases. The in-hospital mortality rate was 8.3%. Two-year and five-year actuarial overall survival were 39.5 and 21.1%, respectively. Two-year and five-year actuarial disease specific survival were 58.5 and 46.6%, respectively. Two-year and five-year actuarial locoregional recurrence free survival were both 49.5%. A significantly lower locoregional recurrence free survival was observed in patients with pN+ disease compared to pN0 (Log rank, p <0.05). Complete oral intake was achieved in 82.7% of patients. Speech rehabilitation by means of Provox® puncture or electrolarynx was achieved in 66% of patients. Discussion/Conclusion: Total laryngopharyngoesophagectomy with gastric pull-up reconstruction for advanced stage hypopharyngeal SCC combines relatively good oncologic and functional outcomes in a prognostically unfavorable patient group.

Objective: To develop and test the usability and acceptability of a disease-specific integrated electronic health (eHealth) system for spondyloarthritis (SpA) in the Netherlands ('SpA-Net')., Methods: SpA-Net was developed in four phases. First, content and design were discussed with experts on SpA and patients. Second, the database, electronic medical record (EMR) and quality management system were developed. Third, multiple rounds of testing were performed. Fourth, the eHealth system was implemented in practice and feasibility was tested among patients through semistructured focus interviews (n=16 patients) and among care providers through feedback meetings (n=11 rheumatologists/fellows and 5 nurses)., Results: After completion of the first three steps of development in 2015, SpA-Net was implemented in 2016. All patients included have a clinical diagnosis of SpA. Information on domains relevant to clinical record-keeping is prospectively collected at routine outpatient consultations and readily available to care providers, presented in a clear dashboard. Patients complete online questionnaires prior to outpatient visits. In February 2019, 1069 patients were enrolled (mean [SD] age 54.9 [14.1] years, 52.4% men). Patients interviewed (n=16) considered SpA-Net an accessible system that was beneficial to disease insight and patient-physician communication, and had additional value to current care. Care providers appreciated the additional information for (preparing) consultations. Barriers were the initial time required to adopt the EMR and the quantity of data entry., Conclusion: SpA-Net enables monitoring of patients with SpA and real-life data collection, and could help improve knowledge and optimise communication between patients and care providers. Both considered SpA-Net a valuable addition to current care., Trial Registration Number: NTR6740., Competing Interests: Competing interests: CW, EB, YvE-H, HV, MvdL: none declared. AvT: served on advisory board for Novartis. AB: received departmental research grants from AbbVie and Celgene, and served on advisory boards and/or received speaking fees from Janssen-Cilag, UCB, Lilly and Novartis.

Recently, secreted microRNAs (miRNAs) have received a lot of attention since they may act as autocrine factors. However, how secreted miRNAs influence embryonic development is still poorly understood. We identified 294 miRNAs, 114 known, and 180 novel, in the conditioned medium of individually cultured bovine embryos. Of these miRNAs, miR-30c and miR-10b were much more abundant in conditioned medium of slow cleaving embryos compared to intermediate cleaving ones. MiR-10b, miR-novel-44, and miR-novel-45 were higher expressed in the conditioned medium of degenerate embryos compared to blastocysts, while the reverse was observed for miR-novel-113 and miR-novel-139. Supplementation of miR-30c mimics into the culture medium confirmed the uptake of miR-30c mimics by embryos and resulted in increased cell apoptosis, as also shown after delivery of miR-30c mimics in Madin-Darby bovine kidney cells (MDBKs). We also demonstrated that miR-30c directly targets Cyclin-dependent kinase 12 ( CDK12 ) through its 3' untranslated region (3'-UTR) and inhibits its expression. Overexpression and downregulation of CDK12 revealed the opposite results of the delivery of miRNA-30c mimics and inhibitor. The significant down-regulation of several tested DNA damage response (DDR) genes, after increasing miR-30c or reducing CDK12 expression, suggests a possible role for miR-30c in regulating embryo development through DDR pathways.

In cancer patients, antithrombotic medications (i.e. anticoagulation or antiplatelet therapy) are frequently prescribed for prior or new indications such as venous thromboembolism or stoke prevention in atrial fibrillation. Balancing the risks of bleeding and thrombosis during periods of thrombocytopenia represents a significant challenge. Management is informed mainly by expert opinion and several recent retrospective studies on venous thromboembolism. The main management options include no change, temporarily withholding antithrombotic therapy, reducing dose, changing the regimen, and increasing the platelet transfusion threshold. Important recent advances in knowledge include the prognostic importance and apparent safety of aspirin in acute myocardial infarction and thrombocytopenia and data suggesting a low risk of recurrent venous thromboembolism in autologous stem cell transplantation patients who had anticoagulation withheld. This paper will review the literature on antithrombotic medication in thrombocytopenic patients with cancer. The significant knowledge gaps will be summarized and considerations for practice and research will be provided., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Haemolytic anaemia is the result of an abnormal breakdown of red blood cells. The direct antiglobulin test (DAT), also known as the direct Coombs test, can be used to determine the cause of the haemolysis. The DAT distinguishes between immune and non-immune causes of haemolysis. However, the DAT should not be used in screening for haemolysis. When the DAT is performed without an indication for in vivo haemolysis, there is a high risk of false-positive results. To increase the specificity of the DAT, the eluate can be tested to determine the specificity of the autoantibodies. In this article we present two cases of haemolytic anaemia in which the DAT gives further indication of the cause of haemolysis.

Purpose: The aim was to evaluate stereotactic body radiation therapy (SBRT) treatment planning variability for early stage nonsmall cell lung cancer (NSCLC) with respect to the published guidelines of the Stereotactic Radiotherapy Working Group of the German Society for Radiation Oncology (DEGRO)., Materials and Methods: Planning computed tomography (CT) scan and the structure sets (planning target volume, PTV; organs at risk, OARs) of 3 patients with early stage NSCLC were sent to 22 radiotherapy departments with SBRT experience: each department was asked to prepare a treatment plan according to the DEGRO guidelines. The prescription dose was 3 fractions of 15 Gy to the 65% isodose., Results: In all, 87 plans were generated: 36 used intensity-modulated arc therapy (IMAT), 21 used three-dimensional conformal radiation therapy (3DCRT), 6 used static field intensity-modulated radiation therapy (SF-IMRT), 9 used helical radiotherapy and 15 used robotic radiosurgery. PTV dose coverage and simultaneously kept OARs doses were within the clinical limits published in the DEGRO guidelines. However, mean PTV dose (mean 58.0 Gy, range 52.8-66.4 Gy) and dose conformity indices (mean 0.75, range 0.60-1.00) varied between institutions and techniques (p ≤ 0.02). OARs doses varied substantially between institutions, but appeared to be technique independent (p = 0.21)., Conclusion: All studied treatment techniques are well suited for SBRT of early stage NSCLC according to the DEGRO guidelines. Homogenization of SBRT practice in Germany is possible through the guidelines; however, detailed treatment plan characteristics varied between techniques and institutions and further homogenization is warranted in future studies and recommendations. Optimized treatment planning should always follow the ALARA (as low as reasonably achievable) principle.

Introduction: Severe thrombocytopenia (≤50×10(9) platelets/L) is often the consequence of hematological malignancies and intensive chemotherapy. The risk of clinically significant bleeding is increased in these patients, despite the use of prophylactic platelet transfusions. The fact that there is no clear correlation between the platelet count and the risk of hemorrhage, suggests that there are other contributing factors. The contribution of impairments in platelet and coagulant function remains poorly understood., Aim: In patients with chemotherapy-induced thrombocytopenia due to hematological malignancies, we evaluate platelet and coagulant functions and determine the effects of platelet transfusion. Ultimately, we can identify specific hemostatic factors that aid in the prediction of bleeding., Materials and Methods: In total 58 patients were included and blood was collected before and, if indicated (≤10×10(9) platelets/L), 1 hour after transfusion with platelet concentrate. Platelet function was assessed using flow cytometry by determining: 1) integrin αIIbβ3 activation (PAC-1 antibody), 2) P-selectin expression (anti-P-selectin antibody), 3) phosphatidylserine exposure (Annexin-V) and 4) intracellular calcium (Fluo-4 AM). Factor levels were determined in plasma. Thrombus and fibrin formation was assessed by perfusion of whole blood over a collagen-tissue factor surface at a shear rate of 1,000 s-1., Results: Platelets from the thrombocytopenic patients before transfusion showed markedly reduced integrin αIIbβ3 activation and P-selectin expression in response to thrombin, collagen-related peptide and ADP, compared to healthy donor platelets. Also, agonist-induced intracellular calcium fluxes were greatly reduced. However, calcium fluxes with thapsigargin, a SERCA pump inhibitor, were similar in patient and control platelets, suggesting a normal calcium store content in the patient platelets. Furthermore, phosphatidylserine exposure was increased in unstimulated patient platelets compared to control platelets (8.2 vs. 1.8%, p<0.0001). Coagulation factor levels were within the normal range, with the exception of von Willebrand factor and fibrinogen levels, which were elevated. Platelet transfusion partly recovered the platelet integrin αIIbβ3 activation and P-selectin expression induced by agonists. Platelet deposition (6.7 vs. 1.7%, p<0.0001) and fibrin formation (7.6 vs. 0.9%, p=0.0005) under flow conditions were substantially improved after platelet transfusion., Conclusions: Platelets from cancer patients undergoing chemotherapy appear to display impaired functional responses to activating stimuli. Platelet transfusion partly restores these functional defects, resulting in improved thrombus and fibrin formation., (© 2016 Elsevier Ltd. All rights reserved.)

Background: Serologic determination of the Vel- phenotype is challenging due to variable Vel expression levels. In this study we investigated the genetic basis for weak Vel expression levels and developed a high-throughput genotyping assay to detect Vel- donors., Study Design and Methods: In 548 random Caucasian and 107 Vel+(w) donors genetic variation in the SMIM1 gene was studied and correlated to Vel expression levels. A total of 3366 Caucasian, 621 black, and 333 Chinese donors were screened with a high-throughput genotyping assay targeting the SMIM1*64&#95;80del allele., Results: The Vel+(w) phenotype is in most cases caused by the presence of one SMIM1 allele carrying the major allele of the rs1175550 SNP in combination with a SMIM1*64&#95;80del allele or in few cases caused by the presence of the SMIM1*152T>A or SMIM1*152T>G allele. In approximately 6% of Vel+(w) donors genetic factors in SMIM1 could not explain the weak expression. We excluded the possibility that lack of expression of another blood group system was correlated with weak Vel expression levels. Furthermore, using a high-throughput Vel genotyping assay we detected two Caucasian Vel- donors., Conclusion: Weak Vel expression levels are caused by multiple genetic factors in SMIM1 and probably also by other genetic or environmental factors. Due to the variation in Vel expression levels, serologic determination of the Vel- phenotype is difficult and a genotyping assay targeting the c.64&#95;80del deletion in SMIM1 should be used to screen donors for the Vel- phenotype., (© 2015 AABB.)

Background: Ge-imogolites are short aluminogermanate tubular nanomaterials with attractive prospected industrial applications. In view of their nano-scale dimensions and high aspect ratio, they should be examined for their potential to cause respiratory toxicity. Here, we evaluated the respiratory biopersistence and lung toxicity of 2 samples of nanometer-long Ge-imogolites., Methods: Rats were intra-tracheally instilled with single wall (SW, 70 nm length) or double wall (DW, 62 nm length) Ge-imogolites (0.02-2 mg/rat), as well as with crocidolite and the hard metal particles WC-Co, as positive controls. The biopersistence of Ge-imogolites and their localization in the lung were assessed by ICP-MS, X-ray fluorescence, absorption spectroscopy and computed micro-tomography. Acute inflammation and genotoxicity (micronuclei in isolated type II pneumocytes) was assessed 3 d post-exposure; chronic inflammation and fibrosis after 2 m., Results: Cytotoxic and inflammatory responses were shown in bronchoalveolar lavage 3 d after instillation with Ge-imogolites. Sixty days after exposure, a persistent dose-dependent inflammation was still observed. Total lung collagen, reflected by hydroxyproline lung content, was increased after SW and DW Ge-imogolites. Histology revealed lung fibre reorganization and accumulation in granulomas with epithelioid cells and foamy macrophages and thickening of the alveolar walls. Overall, the inflammatory and fibrotic responses induced by SW and DW Ge-imogolites were more severe (on a mass dose basis) than those induced by crocidolite. A persistent fraction of Ge-imogolites (15% of initial dose) was mostly detected as intact structures in rat lungs 2 m after instillation and was localized in fibrotic alveolar areas. In vivo induction of micronuclei was significantly increased 3 d after SW and DW Ge-imogolite instillation at non-inflammatory doses, indicating the contribution of primary genotoxicity., Conclusions: We showed that nm-long Ge-imogolites persist in the lung and promote genotoxicity, sustained inflammation and fibrosis, indicating that short high aspect ratio nanomaterials should not be considered as innocuous materials. Our data also suggest that Ge-imogolite structure and external surface determine their toxic activity.

The treatment of mid-gestational uterine incarceration remains a challenge. The success rate of manual reduction decreases with gestational age, and an operative procedure may carry important fetal, next to possible maternal morbidities. We will present four cases of uterine incarceration between the 15th and 25th week of pregnancy of which three colonoscopy-assisted manual repositions proved successful. It illustrates that conservative treatment of uterine incarceration is feasible, even during the late second trimester. That is why a review of the conservative approach of this rare condition is also presented., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Transfusion-related acute lung injury (TRALI) is hypothesized to be a "two-hit" entity, in which an inflammatory condition (e.g., sepsis) predisposes to TRALI. TRALI is a clinical diagnosis. Disciplines involved in managing TRALI may differ in decision-making on the reporting of TRALI., Study Design and Methods: A survey was conducted among critical care physicians, hematologists, hemovigilance workers, and transfusion medicine physicians, using case vignettes and a questionnaire. The vignettes varied in patient- and blood product-related factors that may influence the decision to report a TRALI case. Multiple linear regression analysis was performed. A positive beta-coefficient is in favor of reporting., Results: Ninety-two questionnaires were returned (response rate, 68%). For all disciplines, preferences in favor of reporting TRALI were onset of symptoms within 1 hour (beta = 0.4), after transfusion of a single unit of FFP (beta = 0.5), and in the absence of acute lung injury before transfusion (beta = 1.3). An admission diagnosis of sepsis was a negative preference (beta = -0.3). Massive transfusion (6 RBC plus 4 FFP units) was a negative preference for transfusion medicine physicians (beta = -0.3), but a positive preference for the other disciplines. The questionnaire revealed that massive transfusion and the age of blood products were considered relatively more important reasons to report TRALI by critical care physicians compared to the other disciplines (p < 0.05)., Conclusion: A pretransfusion inflammatory condition is a reason to withhold from reporting of a suspected TRALI case. Disciplines involved in managing TRALI differ in decision-making of reporting TRALI, which may contribute to variance in incidence.

Objective: To determine the number of reported cases of transfusion-related acute lung injury (TRALI) in the Netherlands in 2002-2005 and to determine how many cases were associated with incompatibility between leukocyte-reactive antibodies in the donor plasma and leukocytes or antigens in the recipient., Design: Retrospective national case review., Method: Cases of TRALI reported in 2002-2005 were assessed according to the national clinical definition of TRALI, and the relationship between TRALI and transfusion was assessed. Additional clinical details were requested from the treating hospital as necessary. The results of leukocyte serological tests from donors and recipients were linked to clinical cases. For cases with positive leukocyte serological tests, the relevant blood components and the sex of the donor were recorded., Results: Of the 46 cases reported, 6 had insufficient information. 8 cases did not meet the definition or had another more likely diagnosis. There was a trend toward an increase in the number of reports: 12 cases were reported in 2005, corresponding with 1:60,000 blood components. Of the 40 evaluable cases, 32 (80%) met the definition of TRALI and were deemed to be definitely (n = 16), probably (n = 5) or possibly (n = 11) related to transfusion. Severity ranged from moderate to life-threatening, and there was one TRALI-related death. Leukocyte serology was fully investigated in 18 cases: 13 (72%) had leukocyte incompatibility and in 5 cases exclusively fresh frozen plasma from a female donor was implicated.

Stereotactic body radiotherapy (SBRT) is a high dose radiotherapy, the radiation dose is applicated one-time or in a few fractions exactly to the tumor or metastases under maximal separation from the normal tissue. Because of this a major expenditure of medical and technical efforts are necessary, a detailed description of the proceedings is following in the methodic part of this article. Indications of SBRT are especially medical irresectable lung tumors of early stages, primary liver/biliary tumors and pulmonary or liver metastases if there is an oncological benefit for the patients. The side effects are moderate, the local tumor control rate is between 78 to 100 %. Depending on the primary tumor the overall survival is prolonged statistically significant. In the Klinikum Krefeld indications of SBRT vs chemotherapy, LITT or resection are discussed by an interdisciplinary conference of gastroenterologists/oncologists, radiologists, radiooncologists and surgeons. An example of LITT will be shown also.

Objective: Itemize blood transfusion incidents in the South-West Netherlands region (about 3.5 million inhabitants), where a regional reporting system for transfusion incidents was introduced in January 2001., Design: Prospective, descriptive., Method: In the period 1 January 2001-31 December 2001, 22 hospitals voluntarily reported transfusion incidents in patients to the blood bank. All incidents were anonymously recorded in a standardised report and registered in 14 categories., Results: A total of 119 transfusion incidents were reported and categorised as: incorrect blood component transfused (n = 8), mild fever 1-2 degrees C (n = 14), non-haemolytic fever > 2 degrees C (n = 36), acute haemolytic transfusion reactions (n = 3). delayed haemolytic transfusion reactions (n = 18), allergic reactions (n = 11), bacterial contamination (n = 3), transfusion-related acute lung injury (n = 1), near accidents (n = 6) and product recalls (n = 19). There were no reports in the categories anaphylactic shock, post-transfusion purpura, transfusion-acquired viral infection, and transfusion-related graft versus host disease. In the same year of haemovigilance, the blood bank issued a total of 158,000 blood products. A complication rate of 1:700 blood products was calculated. It is estimated that 53% of all incidents were reported., Conclusion: Despite all of the safety measures taken, severe adverse events still occurred. A well-run system for haemovigilance can contribute to the knowledge of transfusion incidents. The safety and quality of blood transfusions can be improved if this knowledge is incorporated into ongoing education about blood transfusions and in the prevention and treatment of transfusion reactions.

The highly polymorphic Rh (Rhesus) system is encoded by two homologous genes, one encoding the D polypeptide and the other the CcEe polypeptides. Partial D antigens may be caused by gene rearrangements, deletions or point mutations. In this study the molecular basis of R0Har RH:33, a Rh phenotype of low frequency, is described. The R0Har RH:33 phenotype is characterized by partial expression of D, altered expression of e, absence of G and the presence of two antigens of low frequency: Rh33 and FPTT. Southern blot analysis, RHD typing by PCR and sequence analysis of Rh transcripts revealed that the RHD gene is absent in subjects with this phenotype. Apart from the expected RHCE transcripts, a new Rh transcript, RHc(D)(e), was identified in three unrelated individuals expressing R0Har Rh:33. The RHc(D)(e) transcript showed the same sequence as the RHce transcript, with the exception of exon 5, which was substituted by the corresponding exon of the RHD gene. A method for PCR-based genotyping was developed to determine specifically the c(D)(e) haplotype. The c(D)(e) PCR proved to be a reliable alternative method for R0Har RH:33 typing.

Background: The objective of this study was to determine the effect of either carbohydrate content or osmolarity on gastric emptying rate in normal healthy subjects., Methods: In total 12 test drinks were ingested as a single 8 mL/kg per body weight bolus on an empty stomach. Six of these drinks had a different carbohydrate content, increasing stepwise from 45 to 90 g/L, but all with the same osmolarity (330 mOsm/kg). The other six drinks all contained 60 g carbohydrate/L but differed stepwise in osmolarity because of the use of maltodextrins with a difference in chain length (243 to 374 mOsm/kg)., Results: The results show a significant negative relation between carbohydrate content and gastric emptying in the six drinks with a uniform osmolarity but progressively increasing carbohydrate content. The six drinks, which had the same carbohydrate-energy content but different osmolarities, emptied all at the same rate from the stomach. The delivery of carbohydrate-energy per minute from the stomach to the small intestine was the same for all drinks., Conclusions: From these data we conclude that the rate of gastric emptying of carbohydrate-containing solutions is triggered by the carbohydrate-energy drink content or by the delivery rate of carbohydrate-energy to the gut. Osmolarity in the range studied here had no effect.

Objective: To evaluate the anti-HCV (hepatitic C virus) reactivity for the development of an individual donor counseling strategy which would prevent unnecessary donor deferment without compromising the safety of blood products., Design: All donors, who were repeatedly reactive in the Ortho HCV ELISA as well as the Abbott HCV EIA screening tests were selected for follow-up testing. At follow-up three screening tests (Ortho, Abbott, and UBI HCV EIA) and two confirmation tests (Riba 4 and PCR HCV RNA) were performed. During the counseling interview risk factors and medical history were recorded., Setting: Blood bank Zuid-Limburg, Maastricht, the Netherlands; estimated donor population 17,500., Participants: A total of 54 donors could be completely evaluated., Results: The participants could be divided into five different categories, requiring specific donor information and different blood bank policies. The donors in categories 1 and 2 (n = 11) had false-positive reactions and were kept active. Category 3 and 4 donors (n = 28) showed indeterminate results and were permanently or temporarily excluded. Finally, in category 5 donors (n = 15) a HCV infection could be diagnosed on the basis of either Riba-positive or PCR-positive results., Conclusions: An anti-HCV screening policy should include a careful evaluation and confirmation of antibody reactivity. A strategy is suggested which allows an individual donor counseling, prevents unnecessary donor deferment, and avoids unnecessary fear of seropositivity.

Digestion is a process which takes place in resting conditions. Exercise is characterised by a shift in blood flow away from the gastrointestinal (GI) tract towards the active muscle and the lungs. Changes in nervous activity, in circulating hormones, peptides and metabolic end products lead to changes in GI motility, blood flow, absorption and secretion. In exhausting endurance events, 30 to 50% of participants may suffer from 1 or more GI symptoms, which have often been interpreted as being a result of maldigestion, malabsorption, changes in small intestinal transit, and improper food and fluid intake. Results of field and laboratory studies show that pre-exercise ingestion of foods rich in dietary fibre, fat and protein, as well as strongly hypertonic drinks, may cause upper GI symptoms such as stomach ache, vomiting and reflux or heartburn. There is no evidence that the ingestion of nonhypertonic drinks during exercise induces GI distress and diarrhoea. In contrast, dehydration because of insufficient fluid replacement has been shown to increase the frequency of GI symptoms. Lower GI symptoms, such as intestinal cramps, diarrhoea--sometimes bloody--and urge to defecate seem to be more related to changes in gut motility and tone, as well as a secretion. These symptoms are to a large extent induced by the degree of decrease in GI blood flow and the secretion of secretory substances such as vasoactive intestinal peptide, secretin and peptide-histidine-methionine. Intensive exercise causes considerable reflux, delays small intestinal transit, reduces absorption and tends to increase colonic transit. The latter may reduce whole gut transit time. The gut is not an athletic organ in the sense that it adapts to increased exercise-induced physiological stress. However, adequate training leads to a less dramatic decrease of GI blood flow at submaximal exercise intensities and is important in the prevention of GI symptoms.

Intensive exercise affects digestion and absorption. Nevertheless, athletes involved in intensive endurance exercise are advised to ingest fluid and energy supplying nutrients, to compensate for the losses and to delay fatigue. The present review describes the effects of exercise on the gastrointestinal tract and the aspects which determine optimal fluid and nutrient delivery during exercise in different climatological and exercise conditions.

It is not known whether the presence of Herpes simplex virus in the throat of elderly patients with severe gastroenteritis and pulmonary implications is of clinical relevance. We cultured throat swabs and faeces of elderly patients with (n = 11) and without (n = 12) severe Salmonella gastroenteritis for viruses and bacteria to study the aetiology of respiratory complications. Complement fixation titers for anti-Herpes simplex antibodies in paired sera were also ascertained. Throat swabs of 6 out of 11 elderly patients with severe Salmonella enteritidis gastroenteritis were positive for Herpes simplex virus type 1. However, a four-fold increase of anti-Herpes simplex antibody titers in paired sera could not be demonstrated. None of the 12 throat swabs of elderly patients without gastro enteritis grew Herpes simplex virus. No other pathogens causing pulmonary complications could be demonstrated in throat swabs of the elderly patients. Herpes simplex virus present in the throat of the elderly patients was very probably not the agent responsible for the pulmonary complications and consequently treatment with acyclovir was not indicated. Weakness caused by severe gastroenteritis and the relative T-lymphocyte immunodeficiency state in the elderly probably enhanced the shedding of Herpes simplex virus in the throat of the elderly patients, without clinical relevance.

The purpose of this study was to establish the intra-individual variation in the rate of gastric emptying (GE) by using the double sampling technique of George. Eight healthy male volunteers, all familiar with gastric intubation and testing, participated in four GE tests, using an isotonic fluid as a test meal. Conditions were kept constant during all four tests, and each test was separated by at least 48 h. The within-subjects coefficient of variation proved to be 29%. The findings demonstrate that, given standard conditions, GE is reproducible from day to day.

Sustained exhausting exercise is thought to depress appetite and food intake. The aim of the present investigation was to study the effect of intensive cycling exercise, with an energy expenditure comparable to values derived from the Tour de France, on food and fluid intake, energy balance, nitrogen balance, and nutrient oxidation. Thirteen highly trained cyclists consuming a normal carbohydrate (CHO)-rich diet (60 En%) were studied during a 7-day stay in a respiration chamber. Two preparation days were followed by a standardized resting day (3), after which the subjects completed two exhausting exercise days (4-5). On day 6 the standardized resting day was repeated. Food and fluid intake were measured by weighed procedure. Energy expenditure was calculated from continuous gas analysis. Energy and nitrogen losses were calculated from all measured excretes. The results showed that energy balance (EB) and nitrogen balance (NB) were positive on the first resting day and became negative on the exercise days. EB was positive again on the recovery day whereas NB remained negative. Nitrogen losses almost balanced N intakes (1.7 g.kg-1) indicating an increased protein requirement. CHO oxidation exceeded CHO intake indicating endogenous CHO depletion. Contribution of CHO to energy exchange decreased from 51.4% +/- 3.1% on day 4 to 40.6% +/- 3.4% on day 5; this decrease was compensated by an increased fat oxidation. The food consumption pattern during days 4 and 5 was not different from days 2 and 6. In-between meal consumption accounted for 30.5%-34.3% of total energy intake. Fluid consumption was adequate to compensate for the losses.(ABSTRACT TRUNCATED AT 250 WORDS)

A review is presented about the morphological findings of malformations of the kidneys, ureters and urinary bladder.