Long-term effect and prognostic factors of a low-dose radiotherapy of painful plantar calcaneal spurs : A retrospective unicenter study.

PURPOSE: To estimate the long-term effect of low-dose radiotherapy of painful plantar calcaneal spurs, and to verify possible prognostic factors. PATIENTS AND METHODS: In this retrospective unicenter study, electronic patient files of patients with painful plantar calcaneal spurs treated with low-dose radiotherapy between July 2009 and February 2020 were reviewed. The low-dose radiotherapy consisted of a total dose of 3.0 Gy given with a fraction dose of 0.5 Gy three times a week. The pain reduction was estimated using a patient questionnaire with a visual analogue scale. Kaplan-Meier statistics and Cox regression analysis were used for the statistical analysis. RESULTS: Altogether, 864 heels of 666 patients were reviewed. The probability of an insufficient pain control 10 years after low-dose radiotherapy was 45.9% (95% confidence interval 39.4-52.4%) in the subset of patients with a minimum follow-up of 3 months (582 heels of 467 patients). Patients with an unsatisfactory pain reduction 3 months after low-dose radiotherapy were offered a re-irradiation. Forty percent of the patients who received a re-irradiation developed good pain reduction. Occurrence of an initial aggravation of pain during or within 3 months after low-dose radiotherapy (p = 0.005), and treatment of bilateral painful plantar calcaneal spurs (p = 0.008) were identified as significant unfavorable prognostic factors on univariate analysis. On multivariate analysis, the initial aggravation of pain remained as independent significant prognostic factor (p = 0.01). No clear radiation toxicity was observed. CONCLUSIONS: Low-dose radiotherapy is a safe and effective treatment option for patients with painful plantar calcaneal spurs. An initial aggravation of pain during or within 3 months after radiotherapy was identified as unfavorable prognostic factor for the treatment outcome. Re-irradiation of patients with an unsatisfactory pain reduction after low-dose radiotherapy is effective and should be offered to patients.

Dietary fibre-rich oat-based products affect serum lipids, microbiota, formation of short-chain fatty acids and steroids in rats.

Wistar rats (ten per group) were fed either an oat-free control diet or a dietary fibre-rich test diet containing 500 g oat-based products/kg for 6 weeks. The oat-based products, containing 4-128 g/kg resistant starch, 30-92 g/kg beta-glucan and 122-304 g/kg total dietary fibre, were oat flour extrudate, flour/Novelose (commercial resistant starch) extrudate (80:20 w/w), oat bran, bran/Novelose extrudate (80:20 w/w) and autoclaved oat flour. Serum total cholesterol decreased in the groups fed flour, flour/Novelose and bran/Novelose (P<0.05). In most of the test groups, count numbers of bifidobacteria were higher (P<0.001) and of coliforms were lower (P<0.05). The mass of the caecum walls and contents was greater in groups fed Novelose- and bran-containing diets (P<0.005). In all the test groups, pH values were lower in the intestinal contents (P<0.001), and caecal concentrations of acetate (P<0.001), propionate (P<0.05), butyrate (P<0.005) and total SCFA (P<0.001) were higher. The lowest concentrations of steroids were found in rats fed the autoclaved flour. In the other test groups, more bile acids appeared in the caecal (P<0.001) and colonic contents (P<0.005), as well as in the faeces, at week 6 (P<0.001). The highest bile acid excretion was found after feeding bran-containing diets. In the intestinal contents of all the test groups, more primary bile acids (P<0.001) appeared than in the control group. The excretion of steroids increased within the experimental period. Using extrusion technology, dietary fibre-rich oat-based products, which have beneficial physiological effects in rats, can be produced. Oat flour and bran are excellent sources for the preparation of directly edible oat products. Their nutritional properties can be further improved by the addition of resistant starch.

Steroids in the intestinal tract of rats are affected by dietary-fibre-rich barley-based diets.

The aim of the present study was to investigate the influence of dietary-fibre (DF)-rich barley-based diets on bile acids (BA) and neutral sterols (NS) in the intestinal tract of rats. For this purpose, young male Wistar rats (n 50; ten per group) weighing about 67 g were fed either a barley-free diet (control group) or diets containing 500 g barley meal extrudates/kg or a barley meal-Novelose mixture (groups A-D) for 6 weeks. These barley products contained 7-24 g resistant starch/100 g and 7-12 g (1 --> 3),(1 --> 4)-beta-glucan/100 g. More steroids were transported towards the lower parts of the intestinal tract when higher concentrations of macromolecular DF were present in the diets (P < 0.001). Tauroconjugated and primary BA dominated in the contents of the small intestine. Intense enzymic conversion of BA occurred in the caecum and colon. The fermentation of DF affected indirectly the amount of formed secondary BA. The main BA present in the caecal contents were muricholic acids, hyodeoxycholic acid and cholic acid. The BA spectrum in the colonic contents was different from that in the caecum. A higher concentration of NS appeared in the intestinal contents of the groups fed the barley-based diets than in the controls (P < 0.005). The microbial conversion of cholesterol to coprostanol, cholestanone and coprostanone was influenced by the amount and composition of the DF in the gut. DF in the diet may affect the concentration and spectrum of steroids in the intestinal tract. The results are relevant for the discussion of mechanisms behind the cholesterol-lowering effects of DF.

Dietary fiber-rich barley products beneficially affect the intestinal tract of rats.

The objective of this study was to investigate the effects of barley-rich diets in the intestinal tract of rats. Four test groups (A-D) of 10 young male Wistar rats were fed diets containing 50 g/100 g barley extrudates (A, B and D) or mixtures (C) for 6 wk; the control diet contained no barley. The barley-containing supplements in the test diets were: A = cultivar "HiAmi"; B = "HiAmi" and "Prowashonupana" (50:50); C = "Prowashonupana" and Novelose (50:50); D = "Prowashonupana" and amylose from maize (60:40). These supplements contained 7-12 g/100 g beta-glucan and 7-24 g/100 g resistant starch. Additionally, 5 g microcrystalline cellulose/100 g was present in all diets. Carbohydrate utilization (indirect calorimetry) was lower (P < 0.05) in rats fed the barley-containing diets C or D than in the controls. In the test groups, the following differences from the controls were found: greater food intake in the last 2 wk (P < 0.05); increased weight gain in wk 6 (P < 0.05); greater mass of the ceca (groups B-D; P < 0.05) and colons (P < 0.001) as well as masses of cecal (groups C and D; P < 0.01) and colon contents (P < 0.001); greater concentrations of resistant starch in cecal and most of the colon contents (P < 0.05); and more beta-glucan in the small intestine, cecum and colon (P < 0.05). The numbers of coliforms and Bacteroides were lower than in the controls in groups B-D and those of Lactobacillus were greater in all test groups (P < 0.05). Short-chain fatty acids (SCFA) were higher in the cecal contents of the test groups (> or = 800 micro mol/g DM; P < 0.001) compared with the controls ( approximately 200 micro mol/g DM). Similarly, SCFA were higher in colon and feces of the test groups. The concentrations of excreted bile acids increased up to 30% during the feeding period. The proportions of secondary bile acids were lower and the amounts of neutral sterols (P < 0.001) were greater in feces of rats fed the barley-containing diets for 6 wk than in the controls. Diets containing more soluble macromolecular dietary fibers such as beta-glucans affected the excretion of bile acids and neutral sterols the most, whereas the fermentation of dietary fiber, including resistant starch, influenced the steroids in feces. These results suggest that dietary fiber-rich barley-containing diets have beneficial physiologic effects.