Controlled Portions of Presweetened Cereals Present no Glycemic Penalty in Persons with Insulin-Dependent Diabetes Mellitus

Objective to determine metabolic responses to commercially sweetened flaked corn cereal, unsweetened flaked corn cereal, glucose, and sucrose in teenagers and young adults with insulin-dependent diabetes mellitus (IDDM).Design A crossover design in which each subject consumed test meals in random order on 4 separate days at least 72 hours apart.Setting The inpatient setting of the General Clinical Research Center of the Indiana University Medical Center Hospital.Subjects Sixteen males and eight females, aged 14 to 25 years, with IDDM.Interventions After fasting overnight, each subject underwent challenge tests with 50 g carbohydrate per 1.73 m² of body surface area from sweetened flaked corn cereal, unsweetened flaked corn cereal, sucrose, and glucose. All subjects were maintained on continuous intravenous infusion of insulin overnight (euglycemic goal=3.9 to 6.7 mmol/L), with a constant basal insulin dose infused before and throughout a 3-hour postprandial period.Main outcome measures Plasma glucose, free insulin, triglycerides, and free fatty acid levels measured at baseline and 15, 30, 45, 60, 90, 120, 150, and 180 minutes after meals.Statistical analyses performed Comparisons among the four meals were made using two-way repeated measures analyses of variance followed by the Newman-Keuls multiple comparison procedure to identify specific differences among meals. The areas under the response curves were compared using one-way repeated measures analysis of covariance, adjusted for baseline values.Results The response to glucose for the area under the 3-hour blood glucose response curve was significantly greater than the response to sucrose (P=.006 by repeated measures analysis of variance); the areas for the two cereals (not significantly different from one another) were between the glucose and sucrose areas. At 3 hours, glycemia differed significantly among three of the meals: unsweetened flaked corn cereal>sweetened flaked corn cereal>sucrose (P<.001). Glucose at 3 hours was greater than sucrose (P<.001). There were no significant differences for free insulin, triglycerides, or free fatty acids.Applications Equivalent gram amounts of carbohydrate as presweetened breakfast cereals are not detrimental to persons with IDDM compared with unsweetened cereals. Therefore, presweetened cereals can be used in the correct portion sizes and based on the number of carbohydrate or starch servings in a person's diabetic meal plan. J Am Diet Assoc. 1996; 96:458-463.     

Apoptosis occurs early in the basal layer of the oral mucosa following cancer chemotherapy

Background: Oral mucositis, a debilitating side‐effect of chemotherapy, is difficult to prevent or treat. The aim of this study was to characterize the histological and ultrastructural change in the human oral mucosa following cytotoxic chemotherapy. Methods: Oral buccal mucosa biopsies were taken from four volunteers and 20 cancer patients. Each patient had one biopsy prior to chemotherapy and a second biopsy at varying intervals after chemotherapy. Biopsies were assessed histologically and ultrastructurally. Results: Apoptosis increased in the basal layer in the first 3 days after chemotherapy, began to decline at 6 days, but never returned to levels of volunteers by 11 days after treatment. Ultrastructural changes included increased intercellular fibres in basal layer cells, cytoplasmic vacuolation, loss of membrane contact with neighboring cells, multinucleation of suprabasal cells and loss of cellular cytoplasm. These changes persisted in prechemotherapy biopsies in patients who had prior chemotherapy. Conclusions: Apoptosis occurs early, and persists in the basal layer of the buccal mucosa after chemotherapy. Ultrastructural changes were present and remained up to 11 days after chemotherapy.     

EFFECT OF ETOMIDATE ON INTRACRANIAL PRESSURE AND CEREBRAL PERFUSION PRESSURE

Ten patients with intracranial lesions, anaesthetized with thiopentoneand nitrous oxide (70%) in oxygen (30%) received etomidate 0.2mg kg^–1 i.v. Ventilation was controlled in each patient.Intracranial pressure (i.c.p.) and mean arterial pressure (m.a.p.)were recorded. I.c.p. decreased significantly in all patients(0.01>P> 0.001). Although Pa_CO2 decreased during the periodof measurement, the extent and time-course of this change suggestedthat it was not mainly responsible for changes in i.c.p. M.a.p.decreased in most patients, but the decrease was statisticallysignificant only at 3 and 4 min after the administration ofetomidate (0.05 > P > 0.02). The changes in cerebral perfusionpressure (c.p.p.) and heart rate were not clinically or statisticallysignificant. We conclude that etomidate can be used for theinduction of anaesthesia in patients with intracranial space-occupyinglesions without increasing i.c.p. or seriously reducing c.p.p.     

Toxicity and Teratogenicity Studies with the Hypolipidemic Drug RMI 14,514 in Rats

Toxicity and Teratogenicity Studies with the Hypolipidemic DrugRMI 14,514 in Rats. Gibson, J.P., Larson, E.J.^A, Yarrington,J.T., Hook, R.H., Kariya, T. and Blohm, T.R. (1981 ).Fundam.Appl.Toxicol. 1:19–25. The hypolipidemic drug RMI 14,514 (5-tetradecyloxy-2-furoicacid) has an oral LD50 of over 5000 mg/kg in rats. In a chronictoxicity study (6 months drug diet) doses of 30,100, or 300mg/kg/day produced no obvious signs of toxicity or abnormalclinical pathology parameters, other than prominent growth retardationat 300 mg/ kg, which was somewhat alleviated when the dose wasreduced to 200 mg/kg after 6 weeks. Hepatic change in the formof mild lipid accumulation was noted histopathologically after6 months of treatment at 100 or 300 mg/kg/day, but was not presentat 3 months or after 4 weeks off drug. The administration ofRMI 14,514 in the diet to pregnant rats at 30, 100, or 150 mg/kg/dayon Days 7 thru 21 of pregnancy (day 1 = day sperm detected)did not induce any teratogenic effects. When rats were exposedto the drug from implantation thru sexual maturity (126 daysof age) at the same dosage, it produced no adverse developmentalor behavioral effects, except for slight reduction in weightgain from birth to sexual maturity at 150 mg/kg/day. The drugcaused reductions in plasma cholesterol and total fatty acids,but no distinct changes in various tissue lipids, except inthe erythrocyte where fatty acids and phospholipids were reduced.These differences did not affect membrane integrity of the erythrocyteas far as osmotic or mechanical fragility tests could determine.The drug, which bears a structural resemblance to long-chainfatty acids, was incorporated into tissue lipids in detectableamounts, but tended to disappear from tissues at a rate similarto that of expected lipid turnover after treatment was stopped.