Gastrointestinal Symptoms are Still Prevalent and Negatively Impact Health-Related Quality of Life: A Large Cross-Sectional Population Based Study in The Netherlands

Background

Over the last decades important risk factors for gastrointestinal symptoms have shifted, which may have changed its population prevalence. The aim of this study was to assess the current prevalence of gastrointestinal symptoms, appraise associated factors and assess health-related quality of life in the general population.

Methods

A total of 51,869 questionnaires were sent to a representative sample of the Dutch adult general population in December 2008. Demographic characteristics, gastrointestinal symptoms, health-related quality of life, medication use and co-morbidity were reported. We used multivariable logistic regression analysis to determine factors associated with gastrointestinal symptoms.

Results

A total of 18,317 questionnaires were returned, and 16,758 were eligible for analysis. Prevalence of gastrointestinal symptoms was 26%. Most frequent symptoms were bloating (63%), borborygmi (60%) and flatulence (71%). Female gender (adjusted OR (aOR) 1.59, 95% CI 1.43–1.77), asthma/COPD (aOR 1.47, 95% CI 1.21–1.79), use of paracetamol (aOR 1.33, 95% CI 1.20–1.47), antidepressants (aOR 1.56, 95% CI 1.22–2.00) and acid-suppressive medication were independently associated with presence of gastrointestinal symptoms. Age over 65 years (aOR 0.75, 95% CI 0.65–0.87), and use of statins (aOR 0.75, 95% CI 0.61–0.93) were associated with a lower prevalence of gastrointestinal symptoms. Respondents with gastrointestinal symptoms had a lower mean health-related quality of life of 0.81 (SD = 0.21) compared to 0.92 (SD = 0.14) for persons without gastrointestinal symptoms (P<0.01).

Conclusions

Prevalence of gastrointestinal symptoms in the Dutch community is high and associated with decreased health-related quality of life.     

Mesenterical lymphangiomatosis causing volvulus and intestinal obstruction

Lymphangiomas are benign tumors consisting of lymphatic vasculature that generally occur in the skin and soft tissues. Rarely, lymphangiomas occur in the gastrointestinal tract. Here, we report a case of a 13-year-old girl presenting with an intestinal obstruction. Upon laparotomy, multiple cystic masses in the mesentery causing a volvulus were resected and histologically identified as multiple lymphangiomas, or lymphangiomatosis. Mesenteric lymphangioma is a rare entity, but should be considered as cause of bowel obstruction without other known abdominal disease. As the etiology of lymphangiomas remains elusive, further research is directed at unravelling the mechanistic and molecular factors contributing to this disease.     

Seed yield of near-isogenic soybean lines with introgressed quantitative trait loci conditioning resistance to corn earworm (Lepidoptera: Noctuidae) and soybean looper (Lepidoptera: Noctuidae) from PI 229358

The development of superior soybean, Glycine max (L.) Merr., cultivars exhibiting resistance to insects has been hindered due to linkage drag, a common phenomenon when introgressing alleles from exotic germplasm. Simple-sequence repeat (SSR) markers were used previously to map soybean insect resistance (SIR) quantitative trait loci (QTLs) in a'Cobb' X PI 229358 population, and subsequently used to create near-isogenic lines (NILs) with SIR QTL i n a 'Benning' genetic background. SIR QTLs were mapped on linkage groups (LGs) M (SIRQTL-M), G (SIRQTL-G), and H (SIRQTL-H). The objectives of this study were to 1) evaluate linkage drag for seed yield by using Benning-derived NILs selected for SIRQTL-M, SIRQTL-H, and SIRQTL-G; 2) assess the amount of PI 229358 genome surrounding the SIR QTL in each Benning NIL; and 3) evaluate the individual effects these three QTLs on antibiosis and antixenosis to corn earworm, Helicoverpa zea (Boddie), and soybean looper, Pseudoplusia includens (Walker). Yield data collected in five environments indicated that a significant yield reduction is associated with SIRQTL-G compared with NILs without SIR QTL. Overall, there was no yield reduction associated with SIRQTL-M or SIRQTL-H. A significant antixenosis and antibiosis effect was detected for SIRQTL-M in insect feeding assays, with no effect detected in antixenosis or antibiosis assays for SIRQTL-G or SIRQTL-H without the presence of PI 229358 alleles at SIRQTL-M. These results support recent findings concerning these loci.     

Physiological comparisons of two soybean cultivars differing in canopy photosynthesis. I. Variation in vertical 14CO2 labelling and dry weight partitioning

Differences in canopy apparent photosynthesis (CAP) among soybean [Glycine max (L.) Merr.] genotypes have been shown to be correlated to seed yields. Since the physiological basis for such differences in CAP is unknown, two cultivars known to differ in CAP, Tracy and Davis, were studied during the 1978–1980 growing seasons. The CAP and dry weights of component plant parts were determined. In 1978 and 1979, ¹⁴CO₂ uptake by vertical leaf strata was determined and specific leaf weight (SLW) and leaf area index (LAI) were determined for corresponding strata in 1979 and 1980. Measurements were taken on several dates during reproductive growth. With the exception of CAP, all measurements (¹⁴C uptake, dry weights) were made in layers within the canopy. CAP on some dates were significantly higher in Tracy than in Davis and integrated CAP values from a certain growth period, labeled as R5 to R7, averaged 16 percent higher in Tracy for the three years studied. No differences in the relative recovery of ¹⁴C from different layers of leaves in the canopy were found. This indicates that variations in canopy structure or leaf orientation did not play a major role in the CAP differences between cultivars. The differences seem related to variations in leaf dry weights. Overall, Tracy exhibited 13.5, 19.2, and 13.2 percent greater leaf dry weights than Davis during 1978, 1979, and 1980, respectively. These differences in leaf dry weight seem largely due to a differences in the SLW. Data from these experiments indicate that differences in soybean CAP values were associated with differences in SLW.Abbreviations CAP Canopy Apparent Photosynthesis - CER Carbondioxide Exchange Rates - EST Eastern Standard Time - LAI Leaf Area Index - LSD Least Significant Difference - POPOP 1,4-bis-[2(5-phenyloxazdyl)]-benzene - PPO 2,5-diphenyloxazole - SLW Specific Leaf Weight     

Mapping of quantitative trait loci for canopy-wilting trait in soybean (Glycine max L. Merr)

Drought stress adversely affects [Glycine max (L.) Merr] soybean at most developmental stages, which collectively results in yield reduction. Little information is available on relative contribution and chromosomal locations of quantitative trait loci (QTL) conditioning drought tolerance in soybean. A Japanese germplasm accession, PI 416937, was found to possess drought resistance. Under moisture-deficit conditions, PI 416937 wilted more slowly in the field than elite cultivars and has been used as a parent in breeding programs to improve soybean productivity. A recombinant inbred line (RIL) population was derived from a cross between PI 416937 and Benning, and the population was phenotyped for canopy wilting under rain-fed field conditions in five distinct environments to identify the QTL associated with the canopy-wilting trait. In a combined analysis over environments, seven QTL that explained 75?% of the variation in canopy-wilting trait were identified on different chromosomes, implying the complexity of this trait. Five QTL inherited their positive alleles from PI 416937. Surprisingly, the other two QTL inherited their positive alleles from Benning. These putative QTL were co-localized with other QTL previously identified as related to plant abiotic stresses in soybean, suggesting that canopy-wilting QTL may be associated with additional morpho-physiological traits in soybean. A locus on chromosome 12 (Gm12) from PI 416937 was detected in the combined analysis as well as in each individual environment, and explained 27?% of the variation in canopy-wilting. QTL identified in PI 416937 could provide an efficient means to augment field-oriented development of drought-tolerant soybean cultivars.     

Glutathione-S-transferase pi as a model protein for the characterisation of chemically reactive metabolites

Chemically reactive metabolites (CRMs) are thought to be responsible for a number of adverse drug reactions through modification of critical proteins. Methods that defined the chemistry of protein modification at an early stage would provide invaluable tools for drug safety assessment. Here, human GST pi (GSTP) was exploited as a model target protein to determine the chemical, biochemical and functional consequences of exposure to the hepatotoxic CRM of paracetamol (APAP), N-acetyl-p-benzoquinoneimine (NAPQI). Site-specific, dose-dependent modification of Cys47 in native and His-tagged GSTP was revealed by MS, and correlated with inhibition of glutathione (GSH) conjugating activity. In addition, the adaptation of iTRAQ labelling technology to define precisely the quantitative relationship between covalent modification and protein function is described. Multiple reaction monitoring (MRM)-MS of GSTP allowed high sensitivity detection of modified peptides at physiological levels of exposure. Finally, a bioengineered mutant cytochrome P450 with a broad spectrum of substrate specificities was used in an in vitro reaction system to bioactivate APAP: in this model, GSTP trapped the CRM and exhibited both reduced enzyme activity and site-specific modification of the protein. These studies provide the foundation for the development of novel test systems to predict the toxicological potential of CRMs produced by new therapeutic agents.     

Fine mapping and identification of candidate genes controlling the resistance to southern root-knot nematode in PI 96354

Meloidogyne incognita (Kofoid and White) Chitwood (Mi) is the most economically damaging species of the root-knot nematode to soybean and other crops in the southern USA. PI 96354 was identified to carry a high level of resistance to galling and Mi egg production. Two Quantitative Trait Locus (QTLs) were found to condition the resistance in PI 96354 including a major QTL and a minor QTL on chromosome 10 and chromosome 18, respectively. To fine map the major QTL on chromosome 10, F_5:6 recombinant inbred lines from the cross between PI 96354 and susceptible genotype Bossier were genotyped with Simple Sequence Repeats (SSR) markers to identify recombinational events. Analysis of lines carrying key recombination events placed the Mi-resistant allele on chromosome 10 to a 235-kb region of the ‘Williams 82’ genome sequence with 30 annotated genes. Candidate gene analysis identified four genes with cell wall modification function that have several mutations in promoter, exon, 5′, and 3′UTR regions. qPCR analysis showed significant difference in expression levels of these four genes in Bossier compared to PI 96354 in the presence of Mi. Thirty Mi-resistant soybean lines were found to have same SNPs in these 4 candidate genes as PI 96354 while 12 Mi-susceptible lines possess the ‘Bossier’ genotype. The mutant SNPs were used to develop KASP assays to detect the resistant allele on chromosome 10. The four candidate genes identified in this study can be used in further studies to investigate the role of cell wall modification genes in conferring Mi resistance in PI 96354.     

Regional Differences in Intervention Coverage and Health System Strength in Tanzania

Background

Assessments of subnational progress and performance coverage within countries should be an integral part of health sector reviews, using recent data from multiple sources on health system strength and coverage.

Method

As part of the midterm review of the national health sector strategic plan of Tanzania mainland, summary measures of health system strength and coverage of interventions were developed for all 21 regions, focusing on the priority indicators of the national plan. Household surveys, health facility data and administrative databases were used to compute the regional scores.

Findings

Regional Millennium Development Goal (MDG) intervention coverage, based on 19 indicators, ranged from 47% in Shinyanga in the northwest to 71% in Dar es Salaam region. Regions in the eastern half of the country have higher coverage than in the western half of mainland. The MDG coverage score is strongly positively correlated with health systems strength (r = 0.84). Controlling for socioeconomic status in a multivariate analysis has no impact on the association between the MDG coverage score and health system strength. During 1991–2010 intervention coverage improved considerably in all regions, but the absolute gap between the regions did not change during the past two decades, with a gap of 22% between the top and bottom three regions.

Interpretation

The assessment of regional progress and performance in 21 regions of mainland Tanzania showed considerable inequalities in coverage and health system strength and allowed the identification of high and low-performing regions. Using summary measures derived from administrative, health facility and survey data, a subnational picture of progress and performance can be obtained for use in regular health sector reviews.