Impact of different roasting conditions on sensory properties and health-related compounds of oat products.

Due to their high content of ß-glucan, the consumption of oat products can contribute to a healthy diet. Roasting may improve sensory properties but could also affect the nutritional value of oat products. Therefore, the aim of the present study was to analyse the impact of different roasting conditions (140-180 °C, approx. 20 min) on sensory quality, health-related compounds (e.g. acrylamide, ß-glucan) and viscosities of oat kernels and flakes. Roasting resulted in oat flakes with improved sensory properties. Acrylamide formation increased with higher roasting temperatures in kernels, thin and thick flakes. Contents of fat, protein, starch and ß-glucan were not affected by roasting, whereas dietary fibre fractions were marginally modulated. Viscosities were significantly reduced with increasing roasting temperatures. The results indicate that roasting up to 160 °C is a processing technique with potential to generate oat products with improved sensory quality and favourable nutritional composition.

Impact of different roasting conditions on chemical composition, sensory quality and physicochemical properties of waxy-barley products.

The consumption of ß-glucan-rich barley can contribute to a healthy diet. Sensory properties may be improved by roasting whereby the nutritional value should be preserved. The aim of the present study was to investigate the impact of different roasting conditions (160-200 °C, 20 minutes) on sensory quality, health-related compounds and viscosity in ß-glucan-rich barley kernels, thin and thick flakes. Sensory quality was improved by roasting. Acrylamide levels increased due to roasting to maximum values of 322 µg kg-1 (kernels), 586 µg kg-1 (thin flakes) and 804 µg kg-1 (thick flakes). No relevant impact of roasting on the contents of fat, protein, starch and ß-glucan was observed, whereas dietary fibre fractions were marginally modulated. Roasting significantly decreased viscosity 1.9-fold (kernels), 2.4-fold (thin flakes) and 2.7-fold (thick flakes), on average. In conclusion, improved sensory quality along with a favourable healthy composition of barley products may be achieved by roasting over a low to medium temperature range.

Effects of simulated sample sizes on mortality estimates-Protocol for a study in 3 randomised ICU trials.

BACKGROUND: An increasing number of trials are stopped earlier than originally planned. It has been suggested that trials stopped pre-maturely overestimate the treatment effect. With the outlined observational study, we aim to simulate the results of stopping trials before they reach their planned sample size to assess the effects on mortality estimates. METHODS AND STATISTICS: Based on 3 international, randomised clinical trials (RCTs) in critical care: Scandinavian Starch for Severe Sepsis and Septic Shock (6S) trial, the Transfusion Requirements in Septic Shock (TRISS) trial and the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) trial, we will estimate relative risks with 95% confidence intervals for the primary outcome 90-day mortality after the inclusion of each individual patient in each RCT. This will be presented graphically with the primary outcome as a function of the number of included patients. DISCUSSION: The outlined study will provide important knowledge about the effects of stopping critical care trials early. This may have important implications for patients, relatives, clinicians, researchers, guideline committee members and policy makers. ETHICS AND DISSEMINATION: We will use data from consenting patients enrolled in RCTs approved by the relevant ethical committees; this study requires no further permissions. We will report the results in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and submit the final approved manuscript to a peer-reviewed journal.

Pickering emulsifiers based on hydrophobically modified small granular starches Part II - Effects of modification on emulsifying capacity.

Small granular starches from rice, quinoa, and amaranth were modified with octenyl succinic anhydride (OSA) at 5 defined intervals (0-3.0%) and investigated with respect to emulsifying capacity and stability. Starch granule surfaces were characterized by Brunauer-Emmett-Teller and contact angle measurements. Emulsifying capacity was characterized by multiple light scattering (MLS) and particle size analysis. Stability towards environmental stress was characterized by centrifugation and MLS. Surface hydrophobicity and emulsifying capacity correlated with starch type and modification level. Quinoa stabilized emulsions had the smallest droplet size (e.g. 59.2 µm at 3.0% OSA) and superior stability, both before and after centrifugation, especially at the lowest modification levels. Rice and amaranth had larger droplets (99.8 and 84.1 µm at 3.0% OSA respectively). Amaranth, despite its small size showed poorer performance than quinoa, especially at lower modification levels. The higher emulsifying efficiency of quinoa starch granules attributed to the higher protein content.

Development and internal validation of the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU).

BACKGROUND: Intensive care unit (ICU) mortality prediction scores deteriorate over time, and their complexity decreases clinical applicability and commonly causes problems with missing data. We aimed to develop and internally validate a new and simple score that predicts 90-day mortality in adults upon acute admission to the ICU: the Simplified Mortality Score for the Intensive Care Unit (SMS-ICU). METHODS: We used data from an international cohort of 2139 patients acutely admitted to the ICU and 1947 ICU patients with severe sepsis/septic shock from 2009 to 2016. We performed multiple imputations for missing data and used binary logistic regression analysis with variable selection by backward elimination, followed by conversion to a simple point-based score. We assessed the apparent performance and validated the score internally using bootstrapping to present optimism-corrected performance estimates. RESULTS: The SMS-ICU comprises seven variables available in 99.5% of the patients: two numeric variables: age and lowest systolic blood pressure, and five dichotomous variables: haematologic malignancy/metastatic cancer, acute surgical admission and use of vasopressors/inotropes, respiratory support and renal replacement therapy. Discrimination (area under the receiver operating characteristic curve) was 0.72 (95% CI: 0.71-0.74), overall performance (Nagelkerke's R2 ) was 0.19 and calibration (intercept and slope) was 0.00 and 0.99, respectively. Optimism-corrected performance was similar to apparent performance. CONCLUSIONS: The SMS-ICU predicted 90-day mortality with reasonable and stable performance. If performance remains adequate after external validation, the SMS-ICU could prove a valuable tool for ICU clinicians and researchers because of its simplicity and expected very low number of missing values.

Pickering emulsifiers based on hydrophobically modified small granular starches - Part I: Manufacturing and physico-chemical characterization.

Small granular starches from rice, quinoa and amaranth were hydrophobized by esterification with octenyl succinic anhydride (OSA) in an aqueous alkaline slurry to obtain series of modified starches at defined intervals (i.e. 0.6, 1.2, 1.8, 2.4, 3.0%). The physical and the physico-chemical properties of the starch particles were characterized by proximate analysis including protein level, amylose level and dry matter. The shape and size of the starch granules were characterized by scanning electron microscopy and light scattering. The gelatinization properties were characterized by differential scanning calorimetry. The degree of modification was determined by titration with NaOH. With regard to the emulsion formulation and in order to assess the emulsifying capacity of the small granular starches, the effect of starch type, degree of modification and starch concentration on the resulting emulsion droplet size were evaluated by light scattering and optical microscopy. Emulsifying properties were found to depend on the degree of substitution, size of the granules and the starch to oil ratio of the formulation. Quinoa starch granules, in general, had the best emulsifying capacity followed by amaranth and rice. However, in higher starch concentrations (>400mg/mL oil) and adequate levels of OSA (3.0%) amaranth performed best, having the smallest size of starches studied.

Effects of hydroxyethyl starch 130/0.42 vs. Ringer's acetate on cytokine levels in severe sepsis.

BACKGROUND: The Scandinavian Starch for Severe Sepsis/Septic Shock (6S) trial showed increased 90-day mortality with hydroxyethyl starch (HES) 130/0.42 vs. Ringer's acetate. To explore the underlying pathophysiology, we compared early changes in plasma cytokine concentrations between patients resuscitated with HES vs. Ringer's acetate. METHODS: In a subgroup of 226 patients from the 6S trial, we calculated delta plasma concentrations of tumour necrosis factor alpha (TNF-α), interleukin (IL)-6 and IL-10 from randomization to day 2. We used multiple linear and logistic regression analyses to assess differences between the groups and associations between delta cytokine concentrations and 90-day mortality, respectively. RESULTS: Baseline characteristics and day 2 mortality were comparable between the groups. We observed similar delta cytokine concentrations in the HES vs. Ringer's group (mean difference in delta TNF-α: -1.5 pg/ml (95% CI, -4.9 to 1.9), P = 0.39; IL-6: 36.0 pg/ml (-24.1 to 96.1), P = 0.24; IL-10: -3.9 pg/ml (-21.1 to 28.9), P = 0.76). In all included patients, we observed a linear relationship between increases in TNF-α and 90-day mortality (P = 0.005). CONCLUSION: Resuscitation with HES 130/0.42 vs. Ringer's acetate did not appear to affect plasma concentrations of TNF-α, IL-6 or IL-10 differently during the first days after randomization into the 6S trial. In the overall cohort, increases in TNF-α were associated with increased 90-day mortality. Although interpretation should be done with caution, it seems unlikely that the increased mortality observed with the use HES in the 6S trial is signalled by early changes in three biomarkers of systemic inflammation.

Effects of fluid restriction on measures of circulatory efficacy in adults with septic shock.

BACKGROUND: The haemodynamic consequences of fluid resuscitation in septic shock have not been fully elucidated. Therefore, we assessed circulatory effects in the first 24 h of restriction of resuscitation fluid as compared to standard care in intensive care unit (ICU) patients with septic shock. METHODS: This was a post-hoc analysis of the multicentre CLASSIC randomised trial in which patients with septic shock, who had received the initial fluid resuscitation, were randomised to a protocol restricting resuscitation fluid or a standard care protocol in nine ICUs. The highest plasma lactate, highest dose of noradrenaline, and the urinary output were recorded in five time frames in the first 24 h after randomisation. We used multiple linear mixed effects models to compare the two groups. RESULTS: We included all 151 randomised patients; the cumulated fluid resuscitation volume in the first 24 h after randomisation was median 500 ml (Interquartile range (IQR) 0-1500) and 1250 ml (500-2500) in the fluid restriction group and standard care group, respectively. The estimated differences in the fluid restriction group vs. the standard care group were 0.1 mM (95% confidence interval -0.7 to 0.9; P = 0.86) for lactate, 0.01 µg/kg/min (-0.02 to 0.05; P = 0.48) for dose of noradrenaline, and -0.1 ml/kg/h (-0.3 to 0.2; P = 0.70) for urinary output during the first 24 h after randomisation. CONCLUSIONS: We observed no indications of worsening of measures of circulatory efficacy in the first 24 h of restriction of resuscitation fluid as compared with standard care in adults with septic shock who had received initial resuscitation.

Variability in targeted arterial oxygenation levels in patients with severe sepsis or septic shock.

BACKGROUND: Supplemental oxygen therapy is used for intensive care (ICU) patients with severe sepsis, but with no general guidelines and few safety data. The aim of this observational study was to describe the variability in oxygen administration as well as the association between partial pressure of arterial oxygen (PaO2 ) and mortality. METHODS: We extracted data from two Scandinavian clinical trials of ICU patients with severe sepsis or septic shock. We calculated average PaO2 and fraction of inspired oxygen (FiO2 ) from trial inclusion and the following 5 days, and assessed the association between PaO2 and 90-day mortality. RESULTS: The median PaO2 was 9.8 kPa [5-95% range 6.4-19.9] and FiO2 was 0.51 [5-95% range 0.27-1.00], respectively. Eight hundred and five of 1,770 patients (45%) died. The relative risk of mortality was 1.43 [95% CI: 1.19-1.65] in patients with average PaO2 < 8 kPa and 1.29 [95% CI: 0.84-1.68] in patients with average PaO2 ≥ 16 kPa, as compared to patients with average PaO2 10-12 kPa. The relative risk of mortality was 1.38 [95% CI: 1.17-1.58] in patients with an average FiO2 0.60-0.80 and 2.10 [95% CI: 1.88-2.23] in patients with an average FiO2  ≥ 0.80 as compared to patients with an average FiO2  ≤ 0.40. CONCLUSION: Administration of oxygen in patients with severe sepsis resulted in a wide range of PaO2 . Significantly higher mortality was observed in patients with an average PaO2 < 8 kPa and FiO2 ≥ 0.60. The results do not imply causation and the associations between average PaO2 and adverse outcomes have to be assessed further.

Predictive value of NGAL for use of renal replacement therapy in patients with severe sepsis.

BACKGROUND: The predictive value of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) for use of renal replacement therapy (RRT) and acute kidney injury (AKI) is not established in patients with severe sepsis. METHODS: This was a prospective observational study in three general intensive care units (ICUs) in adult ICU patients with severe sepsis needing fluid resuscitation and a sub-study of the 6S trial. Plasma and urine were sampled at baseline and NGAL was measured using particle-enhanced turbidimetric immunoassay (The NGAL Test). Outcome measures were use of RRT in ICU, development of AKI according to the Kidney Disease: Improving Global Outcomes plasma creatinine criteria within 48 h and 90-day mortality. RESULTS: Two-hundred- twenty-two patients had samples taken (211 had plasma and 162 urine sampled); simplified acute physiology score II was 54 (39-66). Forty patients (18%) had RRT in the ICU, 91 patients had AKI at enrollment; of the remaining 131 patients 24% developed AKI during the first 48 h, and 55% had died at 90 days. Areas under receiver-operating characteristics curve (AuROC) for predicting use of RRT in ICU were 0.70 (95% confidence interval 0.61-0.78) and 0.62 (0.51-0.73) for plasma and urine NGAL, respectively. AuROC of plasma and urine NGAL for AKI were 0.66 (0.54-0.77) and 0.71 (0.59-0.82), respectively, and for 90-day mortality 0.55 (0.47-0.63) and 0.61 (0.53-0.70), respectively. Combining NGAL values with plasma creatinine did not improve AuROCs. CONCLUSION: In ICU patients with severe sepsis, plasma and urine NGAL had low predictive power for use of RRT, AKI and 90-day mortality. These results were supported by sensitivity and exploratory analyses.

Acute kidney injury with hydroxyethyl starch 130/0.42 in severe sepsis.

BACKGROUND: We aimed to detail the effects of hydroxyethyl starch (HES) vs. Ringer's on kidney function including the interaction with mortality in post-hoc analyses as resuscitation with HES 130/0.42 increased mortality in the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) trial. METHODS: In all 798 randomised patients, we assessed the incidence and effect on mortality of acute kidney injury (AKI) in the HES vs. Ringer's acetate groups using the Kidney Disease: Improving Global Outcome criteria. We also assessed the intervention effect on time to and duration of renal replacement therapy (RRT). RESULTS: At baseline, the intervention groups were similar. The maximal AKI stage was higher in the HES vs. Ringer's group within the first 5 days after randomisation (P = 0.03), the average difference being 0.2 points (P < 0.01). An increase in AKI stage was associated with mortality (hazard ratio (HR) 1.35; 95% CI 1.22 to 1.49; P < 0.01). Significantly, more patients in the HES group received RRT within the first 5 days (P = 0.01), and the time to initiation of RRT was also shorter compared with the Ringer's group (HR 1.40; 95% CI 1.01-1.93; P = 0.04). The intervention effect of HES on mortality was reduced when adjusting for AKI stage as a time-dependent covariate (P = 0.15). CONCLUSION: In patients with severe sepsis, HES appeared to increase the rate of severe AKI and use of RRT within the first 5 days. The increased mortality observed with HES may have been partly mediated through acute kidney impairment.

Predicting fluid responsiveness with transthoracic echocardiography is not yet evidence based.

An essential part of intensive care is to accurately identify fluid responders among patients with circulatory failure. Over the past few years, new techniques have been assessed for rapid and non-invasive prediction of fluid responsiveness. As transthoracic echocardiography (TTE) is becoming an integrated tool in the intensive care unit, this systematic review examined studies evaluating the predictive value of TTE for fluid responsiveness. In October 2012, we searched Pubmed, EMBASE and Web of Science for studies evaluating the predictive value of TTE-derived variables for fluid responsiveness defined as change in thermodilution cardiac output or stroke volume after a fluid challenge or a passive leg raising test. The use of thermodilution was used as inclusion criterion because it is the only method validated to show the change in cardiac output or stroke volume, which defines fluid responsiveness. Of the 4294 evaluated citations, only one study fully met our inclusion criteria. In this study, the predictive value of variations in inferior vena cava diameter (> 16%) for fluid responsiveness was moderate with sensitivity of 71% [95% confidence interval (CI) 44-90], specificity of 100% (95% CI 73-100) and an area under the receiver operating curve of 0.90 (95% CI 0.73-0.98). Only one study of TTE-based methods fulfilled the criteria for valid assessment of fluid responsiveness. Before recommending the use of TTE in predicting fluid responsiveness, proper evaluation including thermodilution technique as the gold standard is needed.

Acrylamide formation and antioxidant level in biscuits related to recipe and baking.

Heated plant foods may contain compounds with adverse health effects (e.g. acrylamide). On the other hand, health-promoting compounds (e.g. antioxidants) have also been identified in such foods. Therefore, a baking experiment with biscuits was carried out to study the potential impact of both acrylamide and antioxidants in that food. Two different wheat flour types - wholemeal (WMF) and white flour type 550 (T550; 0.55% mineral content) - as well as recipe (fat and leavening agent) and thermal input (temperature × time) were changed. Furthermore, the effect of an enzymatic asparagine hydrolysation was tested. Antioxidants were determined with two independent procedures ABTS - (2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonate)) and FRAP-assay (ferric reducing ability of plasma). WMF samples resulted in an unchanged acrylamide level, but in a significantly higher antioxidant concentration when compared with T550 samples (149 and 141 µg kg(-1) acrylamide and 9.1 and 5.1 mmol TE kg(-1) FW ABTS for WMF and T550, respectively). A reduced fat content yielded in an increased volume. Raising agents had no effect on acrylamide levels, but antioxidants were higher in samples with sodium bicarbonate (SBC) than with ammonium bicarbonate (ABC). Thermal input (temperature × time; 150°C × 25 min to 240°C × 9 min) indicated an exponential acrylamide increase especially at higher temperatures (from 75 to 236 µg kg(-1)), whereas antioxidant increase was linear (from 7.0 to 7.7 mmol TE kg(-1) FW, ABTS). FRAP and ABTS values were correlated on a low level, whereas acrylamide content of biscuits was correlated with FRAP and lightness (R (2 )= 0.62 and 0.47, and 0.71 and 0.85 for WMF and T550, respectively). The enzyme asparaginase reduced acrylamide formation by about 50% for both raising agents (SBC and ABC, respectively), whereas antioxidant levels were not affected. An evaluation of recipe variants with low acrylamide and high antioxidants indicated the advantage of wholemeal biscuits.

[Extra-articular recurrent bleeding from the medial retinaculum]. / Extraartikuläre rezidivierende Blutungaus dem medialen Retinaculumbereich.

A young woman had subcutaneous bleeding at the retinaculum of the left knee after minor trauma. A small vein was attached to the scar and repeatedly ruptured after several other small traumas. Conservative therapy had no impact on the genesis of the bleeding. Having gone through severe bleeding situations with massive swelling of the knee five times in a row, the patient underwent surgical exploration.The source of recurrent bleeding, a small vein, could be identified and excised. After that no further bleeding episodes took place.

Central venous oxygen saturation for the diagnosis of low cardiac output in septic shock patients.

BACKGROUND: Simple diagnostic tests are needed to screen septic patients for low cardiac output because intervention is recommended in these patients. We assessed the diagnostic value of central venous oxygen saturation in the superior vena cava (ScvO(2)) for detecting low cardiac output in patients with septic shock. METHODS: We conducted a prospective observational study in three general intensive care units (ICUs) of adult patients with septic shock, who were to have a catheter inserted for thermodilution measurement of cardiac index (CI(TD)). Paired measurements of CI(TD) and central venous oximetry values were obtained when the clinician first measured CI(TD). RESULTS: We included 56 patients with septic shock and a mean sequential organ failure assessment score of 12 (range 3-20). Baseline CI(TD) was 3.5 l/min/m(2) (1.0-6.2) and ScvO(2) of 70% (33-87). The best cut-off of ScvO(2) for CI(TD)>2.5 l/min/m(2) (n=42) was a value >or=64% with positive and negative predictive values of 91% (95% confidence interval 79-98) and 91% (59-100), respectively. The diagnostic values were not improved by using instead central venous O(2) tension or the difference between arterial and central venous O(2) saturation. CONCLUSIONS: This prospective, observational study found that a ScvO(2) measurement of >or=64% indicated CI(TD)>2.5 l/min/m(2) in ICU patients with septic shock.

Acrylamide in fried and roasted potato products: a review on progress in mitigation.

The workshop of the European Commission and the Confederation of the Food and Drink Industries of the European Union (CIAA) held in March 2006 in Brussels, Belgium, discussed the key knowledge and achievements in the mitigation of acrylamide. This paper presents the progress made by the potato sector and identifies areas for future research. Because of the important contribution of potato products to acrylamide intake, it is an area that has received much attention. The discovery of the method of formation and the role of reducing sugars meant that long-standing knowledge in respect of sugar and fry colour could be used to identify methods of mitigation. Improvement in parameters such as (1) potato variety, (2) potato storage temperature, (3) process control (thermal input, pre-processing), (4) final preparation, and (5) colour have all contributed to a significant overall reduction in the average acrylamide content in French fries and potato crisps (termed 'chips' in the USA). There is evidence that the limit of reduction that these measures can offer for crisps has now been approached, but clearly more can be done for French fries and roasted potato products. The use of asparaginase offers potentially significant reduction in certain prefabricated potato products. More research is required into new potato varieties and the agronomical factors that influence the levels of asparagine and sugars in potatoes.

Influence of dough ingredients on 3-chloropropane-1,2-diol (3-MCPD) formation in toast.

The influence of different dough ingredients such as fat, salt, sourdough, emulsifiers, and sugar on the formation of 3-chloropropane-1,2-diol (3-MCPD) during toast preparation under domestic conditions was investigated. In comparison with a fat-free recipe, addition of 1% peanut fat considerably increased 3-MCPD formation, but varying the fat (2-5%) or salt (1.6-2.4%) contents within technological acceptable limits did not show any significant differences. A baking agent, which is usually commercially applied by many toast bakers or industrial toast manufacturers, increased 3-MCPD formation in toasted bread slices. Considerable evidence was found that the baking agent's main component sucrose had the major part in increasing 3-MCPD levels. Emulsifiers containing monoacylglycerols moderately increased 3-MCPD levels, but the addition of lecithin did not have any significant influence. 3-MCPD levels showed a good correlation with the lightness (L* value) of the bread slices; their 3-MCPD content increased exponentially towards dark coloured toasts. The relation between 3-MCPD and 2-MCPD was an average of 3:1 in all samples. Dichloropropanols such as, for example, 1,3-dichloropropanol could not be detected.

[Mobility of unstable fractures of the odontoid during helmet removal. A biomechanical study]. / Verhalten der instabilen Densfraktur bei Abnahme des Motorradhelms. Eine biomechanische Untersuchung.

In severe motorcyclist accidents unstable injuries of the cervical spine can usually not be excluded before an X-ray has been taken in the hospital. Despite this the helmet has to be taken off at the place of the accident in order to provide adequate treatment and airway management of the injured driver. There are no data in the current literature showing what happens to unstable lesions of the cervical spine during helmet removal. An experimental unstable lesion of the cervical spine was created by an osteotomy of the odontoid in 10 fresh frozen cadavers with intact soft tissues. All motions occurring in the segments C1-2 and C2-3 during helmet removal were recorded by fluoroscopy. The average motion in the unstable segment C1-2 was 23.7 degrees during a full range of extension-flexion movement of the cervical spine without any signs of dislocation of the segment. After application of the helmet there was one case of dislocation of C1-2 in neutral supine position already, and two further cases of dislocations during helmet removal. The average motion of C1-2 recorded during helmet removal was 19.0 degrees (2-25 degrees ), median 18.0 degrees. In order to avoid fracture dislocations and motion in the unstable upper cervical spine the helmet should better be cut in pieces at the place of the accident. There is a need for discussions with helmet producers to develop a new generation of helmets that can be removed easily without manipulating the head.