Structural differences between rye and wheat breads but not total fiber content may explain the lower postprandial insulin response to rye bread

BACKGROUND: Rye bread has a beneficial effect on the postprandial insulin response in healthy subjects. The role of rye fiber in insulin and glucose metabolism is not known. OBJECTIVE: The aim of the study was to determine the effect of the content of rye fiber in rye breads on postprandial insulin and glucose responses. DESIGN: Nineteen healthy postmenopausal women aged 61 +/- 1 y, with a body mass index (in kg/m(2)) of 26.0 +/- 0.6, and with normal glucose tolerance participated in the study. The test products were refined wheat bread (control), endosperm rye bread, traditional rye bread, and high-fiber rye bread; each bread provided 50 g available carbohydrate and was served with breakfast. Plasma glucose, insulin, glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, and serum C-peptide were measured in fasting and 8 postprandial blood samples. In vitro starch hydrolysis and the microscopic structure of the breads were also determined. RESULTS: Postprandial insulin, glucose-dependent insulinotropic polypeptide, and C-peptide responses to the rye breads were significantly lower than the response to the control; no significant differences in insulin and C-peptide responses to the rye breads were found. Glucose and glucagon-like peptide 1 responses to the rye breads were not significantly different from those to the control, except at 150 and 180 min. In vitro starch hydrolysis was slower in all rye breads than in the control, and the structure of continuous matrix and starch granules differed between the rye and control breads. CONCLUSION: Total fiber content does not explain the lower postprandial insulin response to rye bread than to wheat bread, but structural differences between rye and wheat breads might.     

Cholesterol metabolism and non-cholesterol sterol distribution in lipoproteins of type 1 diabetes: the effect of improved glycemic control

In type 1 diabetes, the ratios to cholesterol of serum absorption markers, e.g., cholestanol, are elevated and those of synthesis markers, e.g., lathosterol, are reduced suggesting perturbed cholesterol metabolism. We studied 17 subjects with type 1 diabetes in poor glycemic control at baseline to assess whether improvement of glycemic control affects lathosterol and cholestanol ratios to cholesterol and their distribution in lipoproteins. Cholesterol and the non-cholesterol sterols were assayed directly from serum, and free and ester fractions after thin-layer chromatographic separation of lipoprotein sterols with gas-liquid chromatography. After the 2-6 months follow-up, the mean value of HbA1(c) decreased from 10.8% to 8.6% (p=0.001). Even though the concentrations of serum and lipoprotein cholesterol remained unchanged, the serum lathosterol to cholesterol ratio increased by 28% (p<0.05) and the lathosterol/cholestanol proportion by 23% (p<0.05). The ratios of total and esterified lathosterol to cholesterol in serum, chylomicrons and LDL, and free lathosterol to cholesterol in serum and IDL, were negatively associated with HbA1(c) at baseline and after follow-up, suggesting that the better glycemic control, the higher was cholesterol synthesis. The absorption markers were less consistently associated with HbA1(c). About half of the serum lathosterol and cholestanol was carried in LDL and one-fourth to one-fifth in HDL, but the lathosterol ratios were roughly similar in all lipoproteins. In contrast, cholestanol accumulated in chylomicrons and HDL. Glycemic control did not affect the distributions of lathosterol and cholestanol. In conclusion, improvement in glycemic control increased cholesterol synthesis, but had no effect on cholesterol absorption as measured by the serum or lipoprotein cholestanol to cholesterol ratio. From a clinical point of view, the better the glycemic control, the more antiatherogenic cholesterol metabolism may be in type 1 diabetes.     

Human myeloid precursors forming colonies in diffusion chambers expresses the Ia-like antigen.

Normal human bone marrow contains cells capable of forming myeloid colonies (CFU-DG) in fibrin clots in diffusion chambers placed in the peritoneal cavity of cyclophosphamide-treated mice. Evidence has accumulated indicating that these colony-forming cells represent an earlier stem cell than the granulocyte-monocyte precursor cell (CFU-C) assayed in soft agar. We provide data showing that these stem cells express the "Ia-like" or DR antigen. In the presence of rabbit Ia antiserum at a titer of 1:300, all CFU-DG were inhibited. Cytotoxicity was complement-dependent. Data are also presented that suggest that the megakaryocyte stem cell also expresses the Ia antigen.     

An outbreak of Bacillus cereus food-poisoning in Finland associated with boiled rice.

A food-poisoning outbreak caused by Bacillus cereus occurred in a Finnish industrial plant in January 1975. Eighteen of the 36 persons who ate a lunch including boiled rice, meat and vegetables became ill. The disease pattern was similar to previously reported short incubation time B. cereus food-poisonings associated with cooked rice. The median incubation time was two hours, the main symptoms being nausea, abdominal pain and vomiting. Rice and certain seasonings were the contaminated raw materials. Gas chromatographic fatty acid analysis of a bacterial cell was used as a diagnostic method as well as to identify a certain strain of B. cereus.     

Use of resources and postoperative outcome.

OBJECTIVE: To characterise those surgical patients who consume one half of all hospital patient days, and to compare their outcome with that of low consumers. DESIGN: A retrospective cohort study. SETTING: Tertiary referral centre, Finland. PATIENTS: 13025 surgical patients who were admitted to a university hospital in Kuopio, Finland, during 1997. INTERVENTIONS: The length of stay below which half of all patient days fell was chosen as a cut-off value to divide patients into low and high consumers. MAIN OUTCOME MEASURES: Hospital and 12-month mortality and standardised mortality ratios (SMR: observed deaths/expected deaths based on the corresponding general population). RESULTS: The 2239 patients (17%) whose length of stay exceeded 9 days (high consumers) took up one half of all patient days. The pattern of resource use varied between operative specialities. At 12 months the SMRs showed excess mortality among high consumers (5.0, 95% confidence interval 4.4 to 5.7) compared with low consumers (2.1, 95% CI 1.9 to 2.3). CONCLUSIONS: Relating the length of stay to the proportion of resources consumed may provide a feasible tool for the recognition of different patterns of use of resources. SMRs may be more relevant measures of outcome than hospital mortality when assessing the efficacy of operative treatment.     

Alvik's glenoplasty for humeroscapular dislocation. 6-year follow-up of 52 shoulders

In Alvik's modification of the Eden-Hybbinette operation, an iliac crest bone graft is inserted in a groove in the glenoid rim of the scapula. In this retrospective study, 52 shoulders in 46 patients operated on using the modified Alvik's method were reviewed. The mean age of the patients at the time of the operation was 32 years, and the average follow-up time was 6 years. There were no operative complications, and two thirds of the patients were satisfied with the operation. Spontaneous redislocation occurred postoperatively in only one shoulder. In addition, there were 10 traumatic redislocations. Postoperative arthrosis was found in nine shoulders; the arthrosis had more correlation with the patient's age at the time of the operation than with the follow-up time. In 41 shoulders, there was bony healing of the transplant.     

Intra-institutional prediction of outcome after cardiac surgery: comparison between a locally derived model and the EuroSCORE

Objective: To construct models for predicting mortality, morbidity and length of intensive care unit (ICU) stay after cardiac surgery and to compare the performance of these models with that of the EuroSCORE in two independent validation databases. Methods: Clinical data on 4592 cardiac surgery patients operated between 1992 and 1996 were retrospectively collected. In order to derive predictive models and to validate them, the patient population was randomly divided into a derivation database (n=3061) and a validation database (n=1531). Variables that were significant in univariate analyses were entered into a backward stepwise logistic regression model. The outcome was defined as mortality within 30 days after surgery, predefined morbidity, and the length of ICU stay lasting >2 days. In addition to the retrospective database, the models were validated also in a prospectively collected database of cardiac surgical patients operated in 1998–1999 (n=821). The EuroSCORE was tested in two validation databases, i.e. the retrospective and prospective one. Hosmer–Lemeshow goodness-of-fit was used to study the calibration of the predictive models. Area under the receiver operating characteristic (ROC) curve was used to study the discrimination ability of the models. Results: The overall mortality in the retrospective and the prospective data was 2 and 1%, and morbidity 22 and 18%, respectively. The created predictive models fitted well in the validation databases. Our models and the EuroSCORE were equally good in discriminating patients. Thus, in the prospective validation database, the mean areas under the ROC curve for our models and for the EuroSCORE were similar, i.e. 0.84 and 0.77 for mortality, 0.74 and 0.74 for morbidity, and 0.81 and 0.79 for the length of intensive care unit stay lasting for 2 days or more, respectively. Conclusions: Our models and the EuroSCORE were equally good in discriminating the patients in respect to outcome. However, our model provided also well calibrated estimation of the probability of prolonged ICU stay for each patient. As was originally suggested, the EuroSCORE may be an appropriate tool in categorizing cardiac surgical patients into various subgroups in interinstitutional comparisons. Our models may have additive value especially in resource allocation and quality assurance purposes for local use.     

The use of resorbable polyglycolic acid mesh in the treatment of splenic injuries--a report of two cases

The use of resorbable polyglycolic acid mesh in the treatment of splenic injuries offers an alternative in conservative splenic surgery. We report on two patients who were successfully treated with polyglycolic acid mesh for Grade III splenic injuries and discuss the difficulties in surgical techniques when trying to avoid splenectomy in splenic injuries.     

Delayed diagnosis of rupture of the main bronchus

A case of a bronchus rupture with delayed diagnosis is reported. The symptoms of tracheobronchial lesions are discussed. With this case report the authors wish to bring attention to a rare but increasingly common injury in patients with multiple trauma.