Antioxidant Activity, Glycemic Response, and Functional Properties of Rice Cooked with Red Palm Oil.

High rice consumption levels accompanied by a lifestyle lacking in physical activity leads to obesity and diabetes due to the rice consumed generally has high digestibility and high glycemic index. Red palm oil (RPO) is a vegetable oil suggested to have the potential to reduce starch digestibility and increase the bioactive compounds of rice. This research aimed to find out the best cooking method to produce rice with a sensory quality similar to regular rice and to study the effect of the best cooking method on the glycemic response and physicochemical properties of rice. The results showed that RPO addition increased the antioxidant activities and total carotenoid levels of rice. The addition of RPO after cooking has better antioxidant activity and total carotenoid than before cooking. Adding 2% RPO before or after cooking produced rice with similar or better sensory quality than regular rice. Rice cooked with 2% RPO added before cooking had a lower glycemic response than regular rice, which was suggested to be caused by the increasing formation of the amylose lipid complex and the triglycerides that protected the starch from amylase enzyme. The formation of the amylose lipid complex and triglyceride layers protecting rice starch was confirmed by the new peaks of the FTIR spectra, the appearance of oil-coated starch morphology, and the changes in the proportion of C and O atoms. In conclusion, the addition of 2% RPO before the cooking process can be considered as a cooking method to produce rice for diabetic patients.

Chemical Components, Antioxidant Activity, and Glycemic Response Values of Purple Sweet Potato Products.

Purple sweet potato is a source of starch with high potential to be developed as a functional food. It can be boiled and consumed as a snack or processed into intermediate goods such as flour. The flour can then be modified through partial gelatinization and followed by a retrogradation process to produce resistant starch-rich purple sweet potato flour. The study was aimed at obtaining the glycemic response values of purple sweet potato products, namely, boiled purple sweet potatoes (BSP), purple sweet potato noodles (SPN), and resistant starch-rich purple sweet potato noodles (RSPN). SPN was prepared from conventional purple sweet potato flour, whereas RSPN was made from resistant starch-rich purple sweet potato flour. Moreover, water, ash, protein, fat, and carbohydrate; total phenolic, anthocyanin, and resistant starch contents; and the rate of hydrolysis of starch were evaluated. Ten subjects were involved in the estimation of glycemic response determined by the area under the curve (AUC) of the blood glucose after consuming products. Glucose syrup was used as a reference. The glycemic response data were processed using ANOVA and further tested using LSD at p < 0.05. The results showed RSPN had the lowest glycemic index value if compared to BSP and SPN (58.7, 63.5, and 83.7) and fell under food with medium GI, but the differences were not statistically significant. RSPN and SPN were classified as medium GI; however, the process of partial gelatinization followed by retrogradation during the preparation of flour used for raw material in making RSPN has successfully maintained the total phenol and anthocyanin and increased resistant starch content of the noodle Processing of purple sweet potato flour into noodle lowered the GI category, and when the flour was partially gelatinized and retrograded, the noodle had more potentiality as a functional food due to their high total phenolic and anthocyanin content.

The Effectiveness of Right- vs Left-lateral Starting Position in Unsedated Diagnostic Colonoscopy with Modified-water Immersion Method: A Randomized Controlled Trial Study.

OBJECTIVE: A colonoscopy study in sedated patients with air insufflation showed that right-lateral starting position (RLP) improved abdominal discomfort and reduced cecal intubation time. The aim of this study was to determine if RLP vs left-lateral starting position (LLP) may produce similar results in unsedated patients examined with a modified-water immersion (m-WI) method. METHODS: Consecutive patients for diagnostic colonoscopy meeting the inclusion criteria were randomized. Patients and colonoscopist were unblinded. The m-WI method entailed suction during insertion not only for fecal debris evacuation but also to facilitate passage through difficult or angulated colonic flexures. Water was infused as needed when any difficulty was encountered during insertion. A bowel visualization scale (BVS) (0=totally blurred visualization; 1=blurred lumen visualization; 2=small fecal debris with clear mucosa visualization; 3= clear visualization) was used to evaluate the interference of fecal debris with cecal intubation rate and time. RESULTS: A total of 142 patients (72 in RLP and 70 in LLP) were enrolled. The respective pain score, visual analog scale, (VAS) and cecal intubation rate were not significantly different. The cecal intubation time was nearly significantly different (13.4±4.5 min vs 11.7±5.4 min; p=0.054) and was significantly different in the constipation subgroup (16.0±3.5 min vs 8.6±3.8 min; p=0.001). The cecal intubation time based on BVS showed significant difference between RLP and LLP in Scale 2 (13.9±4.6 min vs 10.3±4.2 min; p=0.003) and Scale 2 and 3 combined (13.2±4.3 min vs 10.6±4.8 min; p=0.01), respectively. CONCLUSION: RLP did not improve the pain score, and LLP showed better performance in unsedated m-WI colonoscopy patients (ClinicalTrial.gov, NCT03489824).

Endoscope-connected water pump with high flow rates improves the unsedated colonoscopy performance by water immersion method.

OBJECTIVES: The aim of this study was to determine if different water pump flow rates influence the insertion time of water immersion method in unsedated patients. We tested the hypothesis that high flow rate (HFR) is more effective than low flow rate (LFR) in facilitating insertion. Clinical registration number: NCT01869296. METHODS: Consecutive symptomatic patients without prior abdominal surgery were consented and enrolled. They were randomized to an HFR (10.4 mL/s) or LFR (1.7 mL/s) group. The patients were not informed about the flow rate of the water pump (single blinded). Patients underwent unsedated colonoscopy examination with standard colonoscope. Demographic and procedural parameters were recorded. Data were analyzed with Student's t-test or Chi-square test as appropriate. RESULTS: A total of 132 patients (66 in HFR and 66 in LFR group) were recruited. The HFR group showed significantly shorter cecal intubation time (12.5±6.2 min in HFR vs 16.3±7.3 min in LFR, p=0.004), shorter time to pass rectosigmoid (3.6±2.2 min in HFR vs 6.2±4.6 min in LFR, p<0.001), and lower pain score (4.2±2.8 in HFR vs 5.3±2.6 in LFR, p=0.024). The cecal intubation rate was not significantly different (87.9% in HFR vs 80.3% in LFR, p=0.34), and 29 (14 in HFR and 15 in LFR) patients with signs of colon redundancy were successfully intubated to the cecum after repeated loop reduction and position changes. CONCLUSION: Compared to LFR, HFR of the water infusion pump significantly reduced colonoscopy insertion time and pain score in unsedated patients. Significantly shorter time to pass the rectosigmoid appeared to play a contributory role.

Difference of polymorphism VEGF-gene rs699947 in Indonesian chronic liver disease population.

BACKGROUND: The VEGF gene polymorphism rs699947 related to clinical pathology, mortality, and recurrence of HCC. Few studies mentioned an association between VEGF gene polymorphisms with illness progression in chronic liver disease. We aimed to explore differences of VEGF gene polymorphism rs699947 in chronic hepatitis, liver cirrhosis and hepatocellular carcinoma patients in Indonesian population. METHODS: A cross-sectional study with consecutive sampling and without matching was performed during a 3 years period (2011-2014) at Dr. Sardjito General Hospital Yogyakarta, Indonesia. Blood DNA was sequenced from 123 subjects with chronic liver diseases [39 chronic hepatitis (CH), 39 liver cirrhosis (LC), and 45 hepatocellular carcinoma (HCC)]. 59 healthy subjects also participated. Using isolated VEGF genes for specific primers for rs699947, blood samples were examined by targeting DNA sequences with Applied Bio systems. All data were analyzed using STATA version 11.0 with significance level at P<0.05. RESULTS: The mean of age in HCC and LC subjects were older than in CH and healthy (P value <0.05); there were more males in LC, HCC and the healthy groups but not in CH (P>0.05). HBV was the dominant etiology in HCC, LC, and CH besides HCV and non HBV-HCV (P<0.05). There were significant differences in the SNP -2578 distributions of allele C compared to allele A in all subjects (healthy vs. LC, and HCC; LC vs. CH (P<0.05), but no significant difference A>C vs. C>C, and genotypes distribution. Proportion of SNP -2578 A>C vs. C>C CH 1.8:1; HCC 1.4:1; healthy 1.7:1; but its proportion in LC was inversed (1:1.2). Genotype A was low in all subjects (5%-11%). Significant difference of allele distribution was found in healthy vs. LC, and HCC; CH vs. LC. Based on HWE analyses, distribution of allele C was dominant. There were not significant differences in deletion, insertion-deletion at -2547 until -2526, and haplotype (Ht) CCGACCCC (P>0.05). The OR analyses of allele and SNP showed that allele A can be a predictor of disease progression in LC to HCC (OR 2.26) and healthy to LC (OR 1.65); and SNP A>C also can be a predictor in healthy to HCC (OR 1.41) and CH (OR 1.14). CONCLUSION: The occurrence of allele A and SNP A>C VEGF gene (-2578) might predict illness progression from healthy to CH, LC or HCC and LC to HCC.

The role of vascular endothelial growth factor -634 G/C and its soluble receptor on chronic liver disease and hepatocellular carcinoma.

BACKGROUND AND STUDY AIMS: The single nucleotide polymorphism (SNP) of the vascular endothelial growth factor (VEGF) gene -634 G/C (rs2010963) influences the progression of hepatocellular carcinoma (HCC). There have been no studies on the role of VEGF SNP -634 G/C in chronic liver disease (CLD). The aim of the present study was to analyse the correlation between VEGF SNP -634 and the clinical severity of CLD and HCC. PATIENTS AND METHODS: A cross sectional study was conducted on 182 subjects (46 HCC, 39 liver cirrhotic/LC, 38 chronic hepatitis/CH; and 57 healthy subjects). The study was conducted from 2010 to 2014 at the Dr. Sardjito Hospital Yogyakarta, Indonesia. All subjects submitted blood serum for DNA sequencing examination using primer. The clinical data of CLD and HCC were assessed, and sVEGFR-2 was examined in 149 subjects. All data were analysed using STATA programme 11.0. RESULTS: Significant differences were observed in genotypic frequency (GG/GC/CC) between HCC, LC, CH and healthy subjects (p=0.004), but though no significant differences were observed between the G>G and C>G genotypic frequencies (p=0.337). The frequency of genotype GG was significantly higher than genotype GC or CC in HCC and was associated with declining of clinical conditions (p<0.05). No significant difference in the distribution genotypes was observed with respect to the level of sVEGFR-2 in the serum. However, we observed a significant correlation between sVEGFR-2 and clinical characteristics in LC and CH (p<0.05). CONCLUSION: Genotype GG of the VEGF SNP -634 is the dominant genotype in severe CLD and HCC. sVEGFR-2 correlates with the disease severity but is not directly associated with the SNP -634 genotype.

Are Mucosa CD4+/CD8+ T-Cells Expressions Correlated with the Endoscopic Appearance of Chronic Gastritis Related with Helicobacter pylori Infection?

Local inflammatory processes in the gastric mucosa are followed by extensive immune cell infiltration, resulting in chronic active gastritis characterized by a marked infiltration of T(h)1 cytokine-producing CD4+ and CD8+T-cells Objective. To investigate the correlation between CD4+/CD8+ T-cells in gastric mucosa with endoscopic appearance in chronic gastritis with or without H.pylori infection. Prospective, cross sectional study is performed in a chronic dyspepsia population in July-November 2009 at Dr. Sardjito General Hospital Yogyakarta, Indonesia. The update Sydney system was used to analyze the gastroscopy appearance. Biopsy specimens were stained with HE-stain and IHC-stain. Data were analyzed by t-test, Mann-Whitney and Spearman correlation test. Number of 88 consecutive subjects are enrolled the study (50% male; 50% female), age 46±15 years; 25% H.pylori positive. The expression of CD4+ and CD8+ were higher in H.pylori negative subjects, but only the CD4+ was significant (P=0.011). A significant correlation was found between CD4+ and CD8+ in both subjects (r(Hp+)=0.62 and r(Hp-)=0.68; P<0.05). The expression of CD4+ and CD8+ in H.pylori positive showed a significant correlation with gastric lesions (r(CD4+)=-0.60; r(CD8+)=-0.42 ; P<0.05), only erosion showed a significant difference in both subjects. A positive correlation was found between CD4+ and CD8+ infiltration in both subjects with or without H.pylori infection, and a negative correlation was only found between gastric lesion with CD4+ and CD8+ infiltration in H.pylori subject.

Soluble Vascular Endothelial Growth Factor Receptor-2 as a Predictive Factor for Progression of Illness in Chronic Liver Diseases and Hepatocellular Carcinoma.

Angiogenesis is generally induced in the process of necro-inflammation and regeneration in chronic liver diseases (CLD). Whereas VEGF is a major humoral factor in relation to neo-vascularization, the receptor, VEGFR-2, is located in hepatocytes and sinusoid endothelial cells. The aim in this study is to investigate the significance of soluble form of VEGFR-2 (sVEGFR-2) in various CLDs. A cross sectional study was conducted from 2010 to 2013 at Dr. Sardjito Hospital Yogyakarta, Indonesia. 149 patients with chronic hepatitis (CH), liver cirrhosis (LC) or hepatocellular carcinoma (HCC) were enrolled in this study. sVEGFR-2 serum was examined using Quantikine®HS kit human immunoassay. Data were analyses by STATA (P value <0.05). The median of sVEGFR-2 was decreased according to the disease progression (LC: 7014.95 pg/mL; CH: 8805.15 pg/mL; healthy subject: 9785.2 pg/mL). However, sVEGFR-2 in HCC (8043.73 pg/mL) was significantly higher than that in LC (P= 0.0059). Based on AUROC analyses, the clinical cut-off point of sVEGFR-2 with >80% sensitivity was used (CH-LC ≤7236.7, LC-HCC ≥7215). The odds ratio (OR) LC to HCC was 5.87 and CH to LC was 4.63. The significant correlations were showed significantly between sVEGFR-2 with MELD and ALT in LC, and with APRI and FIB-4 in CH. In conclusion, the serum sVEGFR-2 could be used as a predictive factor progressing CH to LC, but not HCC.

Mutations within enhancer II and BCP regions of hepatitis B virus in relation to advanced liver diseases in patients infected with subgenotype B3 in Indonesia.

Studies on the characteristics of mutations within the hepatitis B virus (HBV) genome, their roles in the pathogenesis of advanced liver diseases, and the involvement of host properties of HBV-infected individuals have not been conducted in subgenotype B3-infected populations. For addressing this issue, 40 cases with HBV surface antigen (HBsAg)-positive advanced liver diseases, including advanced liver cancer and cirrhosis (male 31, female 9, age 54.4 ± 11.6-year-old), were collected and compared with 109 cases with chronic hepatitis B (male 71, female 38, age 38.0 ± 13.4-year-old). Mutations in enhancer II (Enh II) and basal core promoter (BCP)/precore regions were analyzed by PCR-direct sequencing method. HBV viral load was examined by real-time PCR. For all examined regions, the prevalence of mutation was significantly higher in cases with advanced liver diseases. Multivariate analysis showed that, in patients older than 45 years, C1638T and T1753V mutations constituted independent risk factors for the advancement of liver diseases. The presence of C1638T and T1753V mutations may serve as predictive markers for the progression of liver diseases in Indonesia and other countries, where subgenotype B3 infection is prevalent.

Abdominal malignant fibrous histiocytoma infiltrating stomach with Chilaiditi's sign manifestation (a rare case report).

The incidence and mortality rate of gastric cancer are decreasing within last 60 years. Approximately 85% of gastric cancer is carcinoma where as the rest 15% is lymphoma and sarcoma. Leiomyosarcoma is the most frequently encountered sarcoma in stomach and represents 1-3% gastric cancer. This tumor is frequently located in the anterior and posterior wall of gastric fundus accompanied by ulceration and bleeding. Malignant fibrous histiocytoma (MFH) is a soft tissue tumor with poor prognosis, rarely found in stomach. This tumor is most frequently originated from inner fascia or skeletal muscle (58-75%) and most frequently happen in the peritoneal cavity and abdomen (9-16 %). We reported a 45-year-old woman with abdominal MFH which infiltrated to the lesser curvature of stomach with Chilaiditi sign. Chilaiditi sign is a condition of intestine disposition (usually at the hepatic flexure of colon) which lies between liver and diagfragma, found in 0.1 ? 0.25% cases which is diagnosed by chest X Ray. This case is a very rare case.