Effects of potato resistant starch intake on insulin sensitivity, related metabolic markers and appetite ratings in men and women at risk for type 2 diabetes: a pilot cross-over randomised controlled trial.

BACKGROUND: The intake of certain types of resistant starch (RS) has been associated in some studies with increased whole-body insulin sensitivity. This randomised, cross-over pilot trial evaluated the effect of consuming cooked, then chilled potatoes, a source of RS, compared to isoenergetic, carbohydrate (CHO)-containing control foods, on insulin sensitivity and related markers. METHODS: Nineteen adults with body mass index 27.0-39.9 kg m-2 consumed 300 g day-1 RS-enriched potatoes (approximately two potatoes; ~18 g RS) or CHO-based control foods, as part of lunch, evening and snack meals, over a 24-h period. After an overnight fast, insulin sensitivity, CHO metabolism markers, free fatty acids, breath hydrogen levels and appetite were assessed for up to 5 h after the intake of a standard breakfast. The primary endpoint was insulin sensitivity, assessed with the Matsuda index. P < 0.05 (one-sided) was considered statistically significant. RESULTS: Insulin sensitivity was not significantly different between the potato and control conditions. The potato intervention resulted in higher postprandial breath hydrogen (P = 0.037), lower postprandial free fatty acid concentrations (P = 0.039) and lower fasting plasma glucose (P = 0.043) compared to the control condition. Fullness ratings were significantly lower after potato versus control (P = 0.002). No other significant effects were observed; however, there was a trend toward lower fasting insulin (P = 0.077) in the potato versus the control condition. CONCLUSIONS: The results of this pilot study suggest RS-enriched potatoes may have a favourable impact on carbohydrate metabolism and support the view that additional research in a larger study sample is warranted.

Effects of low- and high-intensity physical exercise on physical and cognitive function in older persons with dementia: a randomized controlled trial.

BACKGROUND: Potential moderators such as exercise intensity or apolipoprotein-E4 (ApoE4) carriership may determine the magnitude of exercise effects on physical and cognitive functions in patients with dementia (PwD). We determined the effects of a 24-week aerobic and strength training program with a low- and high-intensity phase on physical and cognitive function. METHODS: In an assessor-blinded randomized trial, 91 PwD (all-cause dementia, recruited from daycare and residential care facilities, age 82.3 ± 7.0 years, 59 women, Mini-Mental State Examination 20.2 ± 4.4) were allocated to the exercise or control group. In the exercise group, PwD participated in a walking and lower limb strength training program with 12 weeks low- and 12 weeks high-intensity training offered three times/week. Attention-matched control participants performed flexibility exercises and recreational activities. We assessed adherence, compliance, and exercise intensity for each session. We assessed physical (endurance, gait speed, mobility, balance, leg strength) and cognitive (verbal memory, visual memory, executive function, inhibitory control, psychomotor speed) functions with performance-based tests at baseline and after 6, 12, 18, 24, and 36 weeks (follow-up). ApoE4 carriership was determined post-intervention. RESULTS: Sixty-nine PwD were analyzed. Their mean attendance was ~ 60% during the study period. There were no significant effects of the exercise vs. control intervention on endurance, mobility, balance, and leg strength in favor of the exercise group (Cohen's d = 0.13-0.18). Gait speed significantly improved with ~ 0.05 m/s after the high-intensity phase for exercise participants (Cohen's d = 0.41) but declined at follow-up. There were no significant effects of the exercise vs. control intervention on any of the cognitive measures (Cohen's d ~ - 0.04). ApoE4 carriership did not significantly moderate exercise effects on physical or cognitive function. CONCLUSIONS: Exercise was superior to control activities for gait speed in our sample of PwD. However, the training effect provided no protection for mobility loss after detraining (follow-up). There were no beneficial effects of the exercise vs. control group on cognitive function. Exercise intensity moderated the effects of exercise on gait speed. ApoE4 carriership moderated the effect of exercise on global cognition only (trend level). TRIAL REGISTRATION: Netherlands Trial Register, NTR5035. Registered on 2 March 2015.

Investigating the effect of germanium on the structure of SiO2-ZnO-CaO-SrO-P2O5 glasses and the subsequent influence on glass polyalkenoate cement formation, solubility and bioactivity.

A series of germanium (Ge)-containing glasses were synthesized based on a starting glass composition of SiO2-ZnO-CaO-SrO-P2O5. Additions of GeO2 (6 and 12 mol%) were incorporated at the expense of SiO2, which retained the amorphous character, and each glass was processed to present similar particle size and surface area. Glass characterization using x-ray photoelectron spectroscopy (XPS) and magic angle spinning nuclear magnetic resonance (MAS-NMR) determined that the addition of GeO2 increased the fraction of lower Q-speciation and subsequently the concentration of non-bridging oxygens (NBO). Glass Polyalkenoate Cements (GPC) were formulated from each glass with 40, 50 and 60 wt% PAA, and presented time dependent solubility profiles (1, 10, 100, 1000 h) for the release of Si4+ (4-140 mg/l), Ca2+ (1-8 mg/l), Zn2+ (<6 mg/l), Sr2+ (2-37 mg/l), PO43- (2-43 mg/l) and Ge4+ (20-911 mg/l) and attained pH values close to 7.5 after 1000 h. Ge-GPCs containing 40 wt% polyacrylic acid (PAA) presented appropriate working time (Tw) and setting times (Ts), and the corresponding compressive strengths ranged from (14-30 MPa). The Ge-GPCs (40, 50 wt%) presented a linear increase (R2-0.99) with respect to time. Simulated Body Fluid (SBF) testing resulted in the Ge-GPCs encouraging the precipitation of crystalline hydroxyapatite on the GPC surface, more evidently after 100 and 1000 h incubation.

Relationship between drug burden and physical and cognitive functions in a sample of nursing home patients with dementia.

PURPOSE: The Drug Burden Index (DBI) is a tool to quantify the anticholinergic and sedative load of drugs. Establishing functional correlates of the DBI could optimize drug prescribing in patients with dementia. In this cross-sectional study, we determined the relationship between DBI and cognitive and physical functions in a sample of patients with dementia. METHODS: Using performance-based tests, we measured physical and cognitive functions in 140 nursing home patients aged over 70 with all-cause dementia. We also determined anticholinergic DBI (AChDBI) and sedative DBI (SDBI) separately and in combination as total drug burden (TDB). RESULTS: Nearly one half of patients (48%) used at least one DBI-contributing drug. In 33% of the patients, drug burden was moderate (0 < TDB < 1) whereas in 15%, drug burden was high (TDB ≥ 1). Multivariate models yielded no associations between TDB, AChDBI, and SDBI, and physical or cognitive function (all p > 0.05). CONCLUSIONS: A lack of association between drug burden and physical or cognitive function in this sample of patients with dementia could imply that drug prescribing is more optimal for patients with dementia compared with healthy older populations. However, such an interpretation of the data warrants scrutiny as several dementia-related factors may confound the results of the study.

Urogenital diseases and their effect on reproductive performance in high-parity sows.

UNLABELLED: In a Slowakian indoor pig production unit (2423 sows), from June to December 2002 all culled sows with excessive vulval discharge at culling, and with vulval discharge and periparturient disease in their previous history were subjected to retrospective lifetime production analysis. The sows were assigned to nine groups according to parity (parity 1-9). Average total litter size, average live-born litter size, average stillbirth rate, average mummy rate, and average litter weaning weight were evaluated retrospectively for all births. Non-culled sows represented the control animals. The percentage of animals with periparturient disease and vulval discharge in their history differed between parities. Parity 2, 3, and 4 sows had a significantly lower percentage of vulval discharge and periparturient disease in their history than sows of other parities. Compared to parity 1-6 sows, parity 7-9 sows had significantly lower (P < .001) conception rates, farrowing rates, and adjusted farrowing rates. Compared to parity 1-2 and 7-9 sows, parity 3-6 sows had a significantly larger (P < .001) lifetime average total born and live-born litter size. Compared to parity 1-3 and 7-9 sows, parity 4-6 sows had a significantly lower (P < .001) rate of stillbirths over all parities. No differences in mummy rates were detected between the sows of different parities. Compared to parity 1-2 and 7-9 sows, parity 3-6 sows had significantly higher (P < .001) weaning litter weights over all parities. Sows without a history of vulval discharge and periparturient disease had higher (P < .001) production levels in parity 7-9. IMPLICATIONS: The present results indicate that parity markedly influences the production level of sows that have a history of periparturient disease and vulval discharge.

Changing the diffusion mechanism of Ge-Si dimers on Si(001) using an electric field.

We change the diffusion mechanism of adsorbed Ge-Si dimers on Si(001) using the electric field of a scanning tunneling microscope tip. By comparing the measured field dependence with first-principles calculations we conclude that, in negative field, i.e., when electrons are attracted towards the vacuum, the dimer diffuses as a unit, rotating as it translates, whereas, in positive field the dimer bond is substantially stretched at the transition state as it slides along the substrate. Furthermore, the active mechanism in positive fields facilitates intermixing of Ge in the Si lattice, whereas intermixing is suppressed in negative fields.

Prescribing books for immigrant children: a pilot study to promote emergent literacy among the children of Hispanic immigrants.

OBJECTIVES: To assess book-sharing activities within first-generation Hispanic immigrant families, and to assess the effect of pediatricians giving books to their patients. DESIGN: Survey. PARTICIPANTS: Convenience sample of 122 predominantly Hispanic immigrant parents of children aged 2 months to 5 years. Of these parents, 56 had received children's books from the pediatrician, and 66 had not. SETTING: House staff continuity clinic at a university children's hospital. MAIN OUTCOME MEASURE: Frequent Book Sharing (FBS) was defined as a parent's reporting more than 3 days per week of sharing books with the child. Main independent variables included the following: (1) exposure to the Reach Out and Read program, defined as having received a children's book from the pediatrician; (2) socioeconomics, as measured by parents' years of education and Medicaid enrollment; (3) acculturation, as defined by 4 questions relating to parents' proficiency with the English language; (4) parent's country of origin; (5) parent literacy, as measured by a parent's reporting more than 3 days per week of reading alone; (6) parent's age; (7) marital status; (8) household size; (9) child's age; (10) child's sex. RESULTS: Ninety percent of the parents were born outside of the United States (71% in Mexico), 85% spoke Spanish in the home, and 63% had completed less than a high-school education. Seventy-five percent of children's medical insurance was provided by Medi-Cal (Medicaid), and 9% of children were uninsured. Sixty-seven percent spoke exclusively Spanish at home, and 84% of parents want their children to learn to read in both English and Spanish. High FBS was reported among parents whose children had received books from the physician when compared with parents whose children had received no books. The odds ratio (OR) was 3.62 (95% confidence interval [CI], 1.40-9.37; P<.05). Also associated with FBS were parents reading frequently to themselves (OR = 9.52; 95% CI, 2.09-43.27; P<.05) and national origin outside Mexico (OR = 5.54; 95% CI, 1.59-19.27; P<.05). These findings were independent of parent's educational level, parent's employment, parent's age, acculturation, and family size. CONCLUSIONS: Pediatricians can promote literacy development among Hispanic immigrant children through the provision of free books at well-child visits. Our findings also suggest the independent effects of adult literacy and child age. Further research is needed to understand the effect of pediatric literacy programs on Hispanic immigrant children, their bilingual environments, and their readiness for school entry. Arch Pediatr Adolesc Med. 2000;154:771-777

Initial experience with laparoscopic repair of incisional hernias.

BACKGROUND: Development of a safe, unobtrusive means to repair the large incisional hernia continues to represent a challenge to surgeons. METHODS: A retrospective analysis of the first 12 patients who underwent an attempt at laparoscopic repair of an incisional hernia at a single institution was carried out. RESULTS: Of the 12 attempts at laparoscopic repair, 11 were completed. No serious perioperative morbidity was encountered. During a mean follow-up of 12.5 months, one recurrence (due to a technical shortcoming that has since been overcome) was identified. CONCLUSIONS: The laparoscopic approach to incisional hernia repair is a safe alternative to open repair of abdominal wall defects.

Role-modeling healthy behavior: peer counseling for pregnant and postpartum women in recovery.

The utilization of paraprofessional peer counselors for pregnant and postpartum women in recovery represents a nonthreatening and innovative departure from conventional medical and social service models. However, it must be acknowledged that these are women in recovery confronting the same daily stresses as their clients. In essence, they require the same social support services as their clients. Therefore, program planners must be reminded to build in the necessary social support systems for them at the outset. The rewards in terms of the peer counselors' capacity to engage and retain women with whom they can identify and help is well worth the investment. As a consequence of extensive community outreach and supportive activities undertaken by peer counselors, barriers to client receptivity may be removed, greater compliance and service utilization will be achieved, and the potential for successful recovery will be enhanced.

Solitary scapula mass: atypical presentation of esophageal adenocarcinoma.

Adenocarcinoma of the esophagus is an aggressive malignancy that frequently occurs with lymph node involvement. Current management strategies may incorporate adjuvant therapeutic modalities in an attempt to improve the typical dismal outcome. There is frequent association of esophageal adenocarcinoma with Barret's metaplasia. Isolated bone and soft tissue metastases are rare and may present a diagnostic challenge in asymptomatic patients.

Ethics of fetal tissue transplantation.

Now that the Clinton Administration has overturned the ban on federal funding for fetal tissue transplantation, old ethical issues renew their relevance and new ethical issues arise. Is fetal tissue transplantation necessary and beneficial? Are fetal rights violated by the use of fetal tissue in research? Is there a moral danger that the potential of fetal tissue donation will encourage elective abortions? Should pregnant women be allowed to designate specific fetal transplant recipients? What criteria should be used to select fetal tissue transplants? Whose consent should be required for the use of fetal tissue for transplantation? We review the current state of clinical research with fetal tissue transplantation, the legal history of fetal tissue research, the major arguments against the use of fetal tissue for transplantation, and the new postmoratorium ethical dilemmas. We include recommendations for guidelines to govern the medical treatment of fetal tissue in transplantation.