Influence of roasting conditions on health-related compounds in different nuts.

Due to their health-beneficial ingredients the consumption of nuts can contribute to a healthy diet. The composition of hazelnuts, almonds, macadamia nuts, pistachios and walnuts regarding health-promoting and potentially harmful compounds was examined before and after roasting under different time and temperature conditions. Fatty acid compositions were not affected by roasting. Malondialdehyde increased with higher roasting temperatures (17-fold in walnuts). Levels of tocopherol isomers were reduced after roasting (α-T: 38%, ß-T: 40%, γ-T: 70%) and hydrophilic antioxidant capacity decreased significantly in hazelnuts (1.4-fold), macadamia nuts (1.7-fold) and walnuts (3.7-fold). Increasing roasting temperatures supported the formation of significant amounts of acrylamide only in almonds (1220 µg kg(-1)). In general, nuts roasted at low/middle temperatures (120-160°C) exhibited best sensory properties. Therefore, desired sensory quality along with a favourable healthy nut composition may be achieved by roasting over a low to medium temperature range.

Lycopene modulation of molecular targets affected by smoking exposure.

Increasing evidence indicates that tomato lycopene may be an ideal candidate in protecting from cancer risk related to smoking exposure. The carotenoid shows potent redox-properties by which it decreases the reactive oxygen species (ROS) generated by smoke and modulates redox-sensitive cell targets, including protein tyrosine phosphatases, protein kinases, MAPKs and transcription factors. Moreover, it counteracts the effects of smoke on carcinogen-bioactivating enzymes and on molecular pathways involved in cell proliferation, apoptosis and inflammation. Lycopene also inhibits smoke-stimulated IGF-signalling and smoke-induced DNA adducts. Some of these actions may be mediated by its oxidative metabolites and may be synergistically enhanced by the presence of other antioxidant nutrients. This review summarizes the background information about the interactions of lycopene with smoke in experimental models and presents the most current knowledge with respect to lycopene role in smoke-related diseases.

Lycopene and cardiovascular diseases: an update.

Cardiovascular disease (CVD) is the leading cause of death in Western societies and accounts for up to a third of all deaths worldwide. In comparison to the Northern European or other Western countries, the Mediterranean area has lower rates of mortality from cardiovascular diseases and cancer, and this is attributed, at least in part, to the so-called Mediterranean diet, which is rich in plantderived bioactive phytochemicals. Identification of the active constituents of the Mediterranean diet is therefore crucial to the formulation of appropriate dietary guidelines. Lycopene is a natural carotenoid found in tomato, an essential component of the Mediterranean diet, which, although belonging to the carotenoid family, does not have pro-vitamin A activity but many other biochemical functions as an antioxidant scavenger, hypolipaemic agent, inhibitor of pro-inflammatory and pro-thrombotic factors, thus potentially of benefit in CVD. In particular, the review intends to conduct a systematic analysis of the literature (epidemiological studies and interventional trials) in order to critically evaluate the association between lycopene (or tomato products) supplementation and cardiovascular diseases and/or cardiovascular disease risk factors progression, and to prepare provision of evidence-based guidelines for patients and clinicians. Several reports have appeared in support of the role of lycopene in the prevention of CVD, mostly based on epidemiological studies showing a dose-response relationship between lycopene and CVD. A less clear and more complex picture emerges from the interventional trials, where several works have reported conflicting results. Although many aspects of lycopene in vivo metabolism, functions and clinical indications remain to be clarified, supplementation of low doses of lycopene has been already suggested as a preventive measure for contrasting and ameliorating many aspects of CVD.

What constitutes high quality of care for adults with epilepsy?

BACKGROUND: Providers are increasingly being held accountable for the quality of care provided. While quality indicators have been used to benchmark the quality of care for a number of other disease states, no such measures are available for evaluating the quality of care provided to adults with epilepsy. In order to assess and improve quality of care, it is critical to develop valid quality indicators. Our objective is to describe the development of quality indicators for evaluating care of adults with epilepsy. As most care is provided in primary and general neurology care, we focused our assessment of quality on care within primary care and general neurology clinics. METHODS: We reviewed existing national clinical guidelines and systematic reviews of the literature to develop an initial list of quality indicators; supplemented the list with indicators derived from patient focus groups; and convened a 10-member expert panel to rate the appropriateness, reliability, and necessity of each quality indicator. RESULTS: From the original 37 evidence-based and 10 patient-based quality indicators, the panel identified 24 evidence-based and 5 patient-based indicators as appropriate indicators of quality. Of these, the panel identified 9 that were not necessary for high quality care. CONCLUSION: There is, at best, a poor understanding of the quality of care provided for adults with epilepsy. These indicators, developed based on published evidence, expert opinion, and patient perceptions, provide a basis to assess and improve the quality of care for this population.

[Surgery for fractures of the lower extremities in cases of chronic spinal cord injury]. / Operative Therapie von Frakturen der unteren Extremitäten bei chronischen Querschnittlähmungen.

According to the literature, the need for surgical treatment of fractures of the lower extremity in patients with chronic spinal cord injury (SCI) is very limited. Conservative management is usually presented as the treatment of choice. We present the results of a retrospective review of 55 fractures in 44 patients from 1996 to 2000 which were managed surgically. Rating of the outcome was based on basic clinical and radiological criteria. The results of the radiological investigation on bone remodeling and bone positioning after healing were rated as good or excellent in 43 and fair in five limbs. In five cases, the treatment failed. For 53 of the 55 fractures, the patients regained their normal level of independence. Comparing our results to those presented in the literature, we clearly had fewer complications as well as better clinical and radiological results. We therefore advocate surgical treatment as an appropriate choice of treatment for lower extremity fractures of patients with chronic SCI.

[Analysis of FIM-values during the hospital treatment of patients with acute spinal cord injury]. / Analyse von FIM-Werten während der stationären Behandlung nach akuter Querschnittlähmung.

The cost pressures in the German health care system continue to rise. In the context of the introduction of the DRG system, adequate treatment of paraplegic and tetraplegic patients within the financial limits will become even more difficult. In dispute with health care insurance companies, scientifically sound studies have been lacking to justify a treatment lasting up to six months as an in-patient of individuals with acute spinal cord injury or disease. The FIM (Functional Independence Measurement), established as a reliable tool in the evaluation of the functional development of patients presenting with acute spinal cord lesions, has been used as the basic tool in our study. Under the conditions of a specialized spinal cord injury centre the FIM showed a statistically highly significant increase of functional independence during the entire course of treatment. No therapeutic standstill could be detected in order to determine a point of discharge. Even in the last six weeks of treatment significant progress in functional independence can be observed.

Initial in vitro toxicity testing of functional foods rich in catechins and anthocyanins in human cells.

Functional foods need to be assessed for beneficial effects to support claims, but also for toxic effects. This report describes two examples of how complex food samples are initially characterized in human cells in vitro. Water extracts of green tea (GT) and black carrots (BC) were analyzed for key ingredients (catechins and anthocyanidins, respectively). Extracts, reconstituted mixtures of the major ingredients or individual compounds [(-)-epigallocatechin gallate or cyanidin, respectively] were evaluated in parallel using human colon cells (HT29 clone 19A). End points of cytotoxicity included determination of membrane integrity, proliferation inhibition, and genetic damage. Cells were pretreated with plant compounds at sub-toxic concentrations, and their resistance to toxicity of H2O2 was evaluated as a parameter of protection. The extracts reduced cell viability (BC) and cell growth (BC, GT) and caused DNA damage (BC, GT). They were more toxic than their key ingredients. Neither GT-samples nor BC protected against H2O2-induced DNA damage, whereas cyanidin did. In vitro analysis of extracts from functional foods firstly aims at defining the sub-toxic concentrations at which protective activities are then further characterized. It also allows comparing responses of complex samples and individual compounds, which is important since effects from protective food ingredients can be masked by accompanying toxic components.

Assessment of antioxidant activity by using different in vitro methods.

In this study, six common tests for measuring antioxidant activity were evaluated by comparing four antioxidants and applying them to beverages (tea and juices): Trolox equivalent antioxidant capacity assay (TEAC I-III assay), Total radical-trapping antioxidant parameter assay (TRAP assay), 2,2-diphenyl-l-picrylhydrazyl assay (DPPH assay), N,N-dimethyl-p-phenylendiamine assay (DMPD assay), Photochemiluminescence assay (PCL assay) and Ferric reducing ability of plasma assay (FRAP assay). The antioxidants included gallic acid representing the group of polyphenols, uric acid as the main antioxidant in human plasma, ascorbic acid as a vitamin widely spread in fruits and Trolox as water soluble vitamin E analogue. The six methods presented can be divided into two groups depending on the oxidising reagent. Five methods use organic radical producers (TEAC I-III, TRAP, DPPH, DMPD, PCL) and one method works with metal ions for oxidation (FRAP). Another difference between these tests is the reaction procedure. Three assays use the delay in oxidation and determine the lag phase as parameter for the antioxidant activity (TEAC I, TRAP, PCL). They determine the delay of radical generation as well as the ability to scavenge the radical. In contrast, the assays TEAC II and III, DPPH, DMPD and FRAP analyse the ability to reduce the radical cation (TEAC II and III, DPPH, DMPD) or the ferric ion (FRAP). The three tests acting by radical reduction use preformed radicals and determine the decrease in absorbance while the FRAP assay measures the formed ferrous ions by increased absorbance. Gallic acid was the strongest antioxidant in all tests with exception of the DMPD assay. In contrast, uric acid and ascorbic acid showed low activity in some assays. Most of the assays determine the antioxidant activity in the micromolar range needing minutes to hours. Only one assay (PCL) is able to analyse the antioxidant activity in the nanomolar range. Black currant juice showed highest antioxidant activity in all tests compared to tea, apple juice and tomato juice. Despite these differences, results of these in vitro assays give an idea of the protective efficacy of secondary plant products. It is strongly recommended to use at least two methods due to the differences between the test systems investigated.

Mechanism of the Heck reaction using a phosphapalladacycle as the catalyst: classical versus palladium(IV) intermediates.

The mechanism of the (Mizoroki-)Heck vinylation of aryl bromides catalyzed by the phosphapalladacycle [[PdCH2C6H4P(o-Tol)2(OAc)]2] (1) was investigated in order to determine whether palladium(IV) intermediates play a significant role in the catalytic cycle. The phosphapalladacycle 1 was compared to the related palladium(0) catalyst [Pd[P(o-Tol)3]2] (2) and an intermediate of the classical catalytic cycle [[PdAr[P(o-Tol)3]Br]2] (3) obtained by oxidative addition of an aryl bromide to 2. Small, yet measurable deviations of the phosphapalladacycle 1 from the other catalysts 2 and 3 in the product distribution of styrene, in competition experiments of styrene and n-butyl acrylate, in the isotope effect on styrene, and the Hammett correlation on aryl bromides led to the conclusion that a different catalytic cycle is operative. Nevertheless, due to only small differences in these competition experiments a modified classical catalytic cycle with a novel, cyclometallated, anionic palladium(0) species 6 is proposed rather than palladium(IV) intermediates. Species 6 accounts for the observed high activity and stability of palladacycle catalysts in the Heck reaction. Palladium(IV) intermediates can be ruled out by taking into account the experiments performed here and recently published by others.

Postpartum thiamine deficiency in a Karen displaced population.

BACKGROUND: Before its recognition, infantile beriberi was the leading cause of infant death in camps for displaced persons of the Karen ethnic minority on Thailand's western border. OBJECTIVE: This study aimed to document thiamine status in the peripartum period to examine the current supplementation program and the correlation between the clinical manifestations of thiamine deficiency and a biochemical measure of thiamine status. DESIGN: Women were enrolled prospectively at 30 wk of gestation and were followed up weekly until delivery and at 3 mo postpartum. Thiamine supplementation during pregnancy was based on patient symptoms. RESULTS: At 3 mo postpartum, thiamine deficiency reflected by an erythrocyte transketolase activity (ETKA) > or = 1.20% was found in 57.7% (15/26) of mothers, 26.9% (7/26) of whom had severe deficiency (ETKA > 1.25%). No significant associations between ETKA and putative maternal symptoms or use of thiamine supplements were found. CONCLUSIONS: Biochemical postpartum thiamine deficiency is still common in Karen refugee women. This situation may be improved by educating lactating women to reduce their consumption of thiaminase-containing foods and by implementing an effective thiamine supplementation program.

[Amputation of the lower extremity in paraplegic patients. Etiology, sequelae and patient management]. / Amputation der unteren Extremitäten bei Querschnittgelähmten. Ursache, Folgen und Versorgung.

Up to now, there are not many reports about indications and guidelines for prosthetic fitting in amputated paraplegics and tetraplegics. In a review of 35 spinal cord patients with 42 amputations of the lower extremity, data on the neurological level, cause of injury, level of amputation, long-term complications, prosthetic fitting, and usage of the prostheses in daily life are presented. Everyday usage of the prostheses is reported for 15 patients.

[Pressure distribution measurements during use of wheelchairs]. / Druckverteilungsmessungen bei Rollstuhlversorgungen.

There is a growing number of mobility-impaired and wheelchair-dependent patients caused by diseases and injuries of the central nervous system. The risk is high for pressure sores to develop due to disturbances of the motor, sensory, and autonomic nervous system. Numerous seating systems for prophylaxis and treatment of decubitus ulcer are available. To identify risk parameters, the literature on animal experiments regarding pressure ulcers was reviewed. A study on the reproducibility of the analysis method with capacitive sensors tested in ten paraplegics with 470 measurements is presented. It shows the reliability of the procedure.

Intestinal absorption of lycopene from different matrices and interactions to other carotenoids, the lipid status, and the antioxidant capacity of human plasma.

BACKGROUND: The bioavailability of carotenoids has been investigated in animal studies as well as in human studies, so far mostly for beta-carotene. Only few results exist for lycopene. In recent studies, lycopene was significantly better available from processed tomatoes compared to raw tomatoes, when using daily intakes between 16.5 mg and 75 mg lycopene. AIM OF THE STUDY: In a comparative study the availability of a low oral lycopene dosage of 5 mg/d from different food matrices versus soft gel capsules containing tomato oleoresin was assessed. In addition to the plasma carotenoid content, the effect of lycopene ingestion on other plasma carotenoids, the lipid status parameters, and the antioxidant activity was estimated. METHODS: Twenty-two female adults (20-27 y) were randomized in three groups and were advised to minimize their carotenoid intake for two weeks. After this initial period, two groups received a portion of tomatoes or tomato juice adjusted to a lycopene dose of 5 mg/d, the third group ingested the same dose comprised in soft gel capsules containing tomato oleoresin. During the test period of 6 weeks, the participants continued reducing the intake of carotenoids from food. Fasting blood samples were withdrawn prior to the study, before supplementation started, and then weekly while supplemented. Seven-day dietary records were prepared before the study started and after one week of supplementation. Carotenoids were analyzed by reversed phase HPLC with diode array detection. Dietary records were evaluated using the computer software EBIS 2.1. The plasma total cholesterol, HDL cholesterol, and triglycerides were determined enzymatically. In addition, the antioxidant activity of plasma was estimated by using the TEAC and the TRAP assays. RESULTS: The basal levels of lycopene in plasma were comparable for all groups (0.2-0.3 mumol/l) and decreased significantly during the two weeks of depletion to approximately 50% of the basal values. Other plasma carotenoids such as beta-carotene and beta-cryptoxanthin decreased significantly, too, whereas lutein and zeaxanthin remained unchanged. After supplementation with tomato oleoresin capsules or tomato juice, the plasma lycopene increased significantly, while it remained unchanged during intake of tomatoes. Normal dietary habits were practised of all volunteers before and during the study except vitamin C whose intake was significantly lower during the study period, because the probands were recommended to reduce the intake of fruits and vegetables. Lycopene supplementation did not affect the lipid status parameters of the three groups. After ingestion of lycopene the antioxidant activity of the plasma was not altered. Mean TEAC values were estimated to 0.33 +/- 0.05 mmol/l and TRAP values to 1.0 +/- 0.1 mmol/l and showed no significant differences in all groups during the whole study period. CONCLUSIONS: The bioavailability of lycopene varied significantly depending on the administered matrix. Lycopene from tomato oleoresin capsules and tomato juice (processed tomatoes) was better absorbed from the intestine than lycopene from raw tomatoes. The daily intake of 5 mg lycopene, an intake comparable to the usual daily carotenoid intake, did not affect cholesterol and triglycerides in plasma or its antioxidant capacity.

Resection of heterotopic ossification of the hip in spinal cord injured patients.

Twenty nine spinal cord injury patients were treated by resection of heterotopic ossification in 41 hips. The average follow-up period after surgery was 4.2 years. The mean time to surgery after injury was 82.1 months. The indications for surgery were seating problems, loss of function, pressure sores and pain. The average preoperative motion in flexion and extension was 21.95 degrees, the average intraoperative motion was 94.51 degrees. The average motion at follow-up evaluation was 82.68 degrees. Clinical relevant recurrence occurred in three patients. Complications excluding recurrence occurred in 10 hips, including deep and superficial wound infections, fracture, aneurysm and pressure ulcer. The operation was followed by a specific regime of physiotherapy and radiation therapy.

Vitamin C status of patients with chronic renal failure, dialysis patients and patients after renal transplantation.

The vitamin C status of patients with chronic renal failure (CRF), dialysis patients (DP) and patients after renal transplantation (RT) was the object of this investigation. Levels of vitamin C intake from dietary records were estimated at mean values of 93.5 mg/d (CRF), 65.5 mg/d (DP) and 163.9 mg/d (RT). Compared to the recommendation of the German Society of Nutrition (75 mg/d), this indicated a normal range of supply for all groups except the group of DP. The corresponding mean plasma concentrations were 62.2 mumol/l (CRF), 80.3 mumol/l (DP) and 68.8 mumol/l (RT). Supplements of 60 or 100 mg vitamin C given to patients of the DP-group after each dialysis session showed slightly, but not significantly higher concentrations of vitamin C in plasma. During dialysis treatment, plasma vitamin C concentrations dropped to approximately 50% of the basal value, but almost reached initial levels again 44 hours later, both with and without supplementation. During one treatment period, vitamin C loss in the dialysate of three patients ranged between 92.5 and 333.6 mg. The amount of vitamin C in plasma, however, dropped to approximately 50% of the basal value for these patients, too.

[Vitamin B1, B2, A and E and beta-carotene content in transitional breast milk and comparative studies in maternal and umbilical cord blood]. / Gehalte der Vitamine B1, B2, A und E sowie beta-Carotin in transitorischer Frauenmilch und Vergleichsuntersuchungen im Blut der Mütter und im Nabelschnurblut.

The contents of the vitamins B1 (27 ng/ml), B2 (57 ng/ml), A (1.3 micrograms/ml), and E (9.7 micrograms/ml) as well as beta-carotene (0.2 microgram/ml) in transitional human milk were determined for up to 35 women aged between 19 and 31 years. Additionally, the vitamin content in maternal and cord plasma as well as the erythrocytic transketolase- and glutathione-reductase activities of the water soluble vitamins were measured. Dietary recalls were evaluated for the nutritional intake of vitamins. Concerning the fat soluble vitamins, the breast fed newborns received the recommended amounts of the German Society of Nutrition (DGE) for this group. In contrast to this, the supply of the water soluble vitamins (B1: 13.5 micrograms/500 ml; B2: 28.5 micrograms/500 ml) attained only 5 to 10% of the recommendations for newborns during the first two weeks after parturition with breast feeding. Vitamin content of maternal plasma (B1: 6.1 +/- 2.8 ng/ml) and erythrocytic enzyme activities (alpha ETK: 0.86-1.62; alpha EGR: 1.08-1.75) indicated a low or sufficient intake, while the values in cord blood (B1: 19.8 +/- 6.5 ng/ml; alpha ETK: 0.62-1.62; alpha EGR: 1.01-1.47) were in accordance with a satisfactory supply.

Integrated development of a knowledge-based CPR system for quality assurance in diabetes outpatient clinics.

Many approaches for the development of computer-based patient record (CPR) systems consider only implicitly the inferences a user wants to accomplish in using the system. However, the integration of knowledge-based support into the routine work flow requires an explicit model of the inferences during routine work. Such a model helps to structure the interface of the system and to identify those inference steps which could benefit from knowledge-based support. This paper describes the approach used in developing a CPR system taking into account its future role as a platform for the integration of knowledge bases into routine work.

Polychlorinated biphenyl residues in food and human milk: determination of co-planar and mono-ortho substituted congeners.

An analytical method is described for determining the residues of coplanar as well as mono-ortho substituted PCB congeners both exhibiting toxicological relevance, in foods of animal origin and in human milk. The unsophisticated procedure, convenient for routine analyses, includes the extraction of lipids, clean-up steps using liquid/liquid partition and column chromatography, fractionation of the congeners using HPLC on a special carbon column with an optimal gradient elution, and capillary column gas chromatography with electron capture or mass spectrometric detection. As preliminary results indicate, the low-chlorinated PCB technical products contribute more to the actual contamination of environment and foods than has been estimated so far. Obviously the co-planar congeners are accumulated during the food chain in a portion different from that found for the other congeners.

Determination of coplanar polychlorinated biphenyl congener residues in food using HPLC fractionation.

An analytical method is described for determining the residues of coplanar PCB congeners exhibiting toxicological relevance, in foods of animal origin and human milk. The unsophisticated procedure, convenient for routine analyses, includes extraction and saponification of lipids, isolation of the unsaponifiable matter and its cleanup on a small silica gel column, fractionation using HPLC on a special carbon column and gas-chromatographic analysis with capillary columns and electron capture detection (ECD).