The Effect of Dietary Carbohydrate and Fat Manipulation on the Metabolome and Markers of Glucose and Insulin Metabolism: A Randomised Parallel Trial

High carbohydrate, lower fat (HCLF) diets are recommended to reduce cardiometabolic disease (CMD) but low carbohydrate high fat (LCHF) diets can be just as effective. The effect of LCHF on novel insulin resistance biomarkers and the metabolome has not been fully explored. The aim of this study was to investigate the impact of an ad libitum 8-week LCHF diet compared with a HCLF diet on CMD markers, the metabolome, and insulin resistance markers. n = 16 adults were randomly assigned to either LCHF (n = 8, <50 g CHO p/day) or HCLF diet (n = 8) for 8 weeks. At weeks 0, 4 and 8, participants provided fasted blood samples, measures of body composition, blood pressure and dietary intake. Samples were analysed for markers of cardiometabolic disease and underwent non-targeted metabolomic profiling. Both a LCHF and HCLF diet significantly (p < 0.01) improved fasting insulin, HOMA IR, rQUICKI and leptin/adiponectin ratio (p < 0.05) levels. Metabolomic profiling detected 3489 metabolites with 78 metabolites being differentially regulated, for example, an upregulation in lipid metabolites following the LCHF diet may indicate an increase in lipid transport and oxidation, improving insulin sensitivity. In conclusion, both diets may reduce type 2 diabetes risk albeit, a LCHF diet may enhance insulin sensitivity by increasing lipid oxidation.     

Central auditory processing and word discrimination in patients with multiple sclerosis

Many multiple sclerosis (MS) patients with normal pure tone threshold suffer from difficulties in their hearing especially speech perception in background noise, which is possibly because of incompetence of central auditory processing in this group. Three audiologic tests including gap in noise test (GIN), duration pattern sequence test (DPST) and word discrimination score (WDS) were used for comparing a number of aspects of central auditory processing between patients with MS and normal subjects. Approximate threshold and percent of correct answers in GIN test, percent of correct answers in DPST test and monosyllabic discrimination in WDS test were obtained through cross-sectional non-invasive study conducted on 26 subjects with relapsing-remitting multiple sclerosis who had mean age of 28.9 (SD 4.1) years, and 26 18–40-year-old ones with normal hearing and mean age of 27.7 (SD 5.2). Results of this study demonstrate increased approximate threshold and reduction of percent of correct answers obtained from GIN test in patients with multiple sclerosis (Pv = 0.0001). Furthermore in patients with MS, the average of correct answers in DPST was lower than normal subjects and finally performance of MS subjects in WDS test in quiet environment was correlated with GIN threshold (r = ?/624, Pr = /003). Results of the present study showed that patients with MS had defect in aspects of central auditory processing consisting of temporal resolution, auditory pattern and the memory for auditory task and difficulty in discrimination of speech in noisy environment that are related to the involvement of central nervous system.     

Trauma care system in Iran

Objective

The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function.

Methods

The current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers.

Results

Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance, financial resources), it is not yet established in our system of trauma care.

Conclusions

It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.     

Mikrochirurgischer transkonjunktivaler Zugang zur Orbita Erste retrospektive Erfahrungsanalyse mit dem transkonjunktivalen Zugang bei 15 Patienten Klinische und chirurgische Aspekte

Die Autoren berichten über ihre 4j?hrigen Ergebnisse und Erfahrungen mit den ersten 15 Patienten, bei denen durch einen transkonjunktivalen Zugang Orbitatumoren verschiedener Art ohne Augenmuskeldissektion entfernt wurden. Die klinische Symptomatik, der Verlauf pr?- und postoperativ sowie die Langzeitergebnisse und ein Rückblick auf den transkonjunktivalen Zugang, seine Indikationen, seine Risiken und seine Grenzen werden diskutiert. Bei Follow-up-Untersuchungen zeigten 93% der Patienten ein sehr gutes kosmetisches und funktionelles Ergebnis. Unsere Erfahrungen mit diesem Zugang w?hrend der letzten 4 Jahre zeigen, da? dieser sich bei richtiger Indikationsstellung intraoperativ durch eine sehr gute und relativ risikoarme Freilegungsm?glichkeit der Orbital?sionen im einzelnen und postoperativ durch eine minimale Narbenbildung und somit sehr gute kosmetische Ergebnisse auszeichnet. Lokalisatorisch bieten sich für diesen Zugang insbesondere ausgew?hlte intrakonal lokalisierte Orbitaprozesse, mediobasal und lateral. Nicht geeignet ist der transkonjunktivale Zugang dagegen für Orbitaprozesse, die nahe der Orbitaspitze, weit retrobulb?r extrakonal lokalisiert sind oder eine extraorbitale intrakranielle Ausdehnung aufweisen.      

Hypocholesterolemia in patients treated with recombinant interleukin-2: appearance of remnant-like lipoproteins

Reversible acute hypocholesterolemia was observed during treatment of metastatic cancer with high-dose intravenous recombinant interleukin-2 (IL-2). Further analysis revealed virtual disappearance of high-density lipoproteins (HDLs) and marked reduction in the concentration of low-density lipoproteins (LDL); the remaining LDL and intermediate-density lipoproteins (IDL) were enriched in triglyceride relative to cholesterol and had broad-beta electrophoretic mobility, properties reminiscent of remnant lipoproteins. These changes differ qualitatively and quantitatively from those previously reported for other cytokines such as tumor necrosis factor (TNF) or the interferons (IFNs).     

Heterogeneity in the smoking behavior of African American women

OBJECTIVE: To assess the association between sociodemographic variables and smoking behavior patterns of African American women. METHODS: Six years of data (N=14,903) from the National Health Interview Surveys were analyzed using multiple logistic regression. RESULTS: African American women in the South were more likely to never smoke and to start smoking later than women in the Northeast. Positive smoking outcomes (never smoking, initiating smoking at later ages, and quitting) were associated with higher education, higher income, and being married. CONCLUSIONS: Variations among African American women suggest the need for targeting specific subgroups at greater risks to reduce disparities in smoking and smoking-related diseases.     

Vertical Mammaplasty Marking Using the Key Hole Pattern

Many modifications of the vertical mammaplasty procedure used to shorten the learning curve have been described. The authors advocate marking the breasts for the vertical mammaplasty operation according to the key hole pattern. They have used inverted T techniques on the upper breast and Lejour’s vertical mammaplasty on the lower breast. A total of 14 patients who had breast hypertrophy and ptosis underwent operations with this marking modification. The amount of removed breast ranged from 285 to 875 g per breast. Hematoma, skin necrosis, skin dehiscence, loss of nipple–areola sensitivity, and distortion were not observed in these cases.     

A comparison of laser-ultrasound detection system sensitivity with a broad-band ultrasonic source for biomedical applications

BACKGROUND: Laser ultrasound detection systems are used for noninvasive imaging of internal structures and function of soft tissues. The detection systems with a high sensitivity can be used for detecting small tumors located deeply in human tissues, such as the breast. In this study, the sensitivity of existing ultrasonic detection systems has been compared experimentally by using thermoelastic waves as a broadband ultrasonic source. METHODS: For the comparison, an optical stress transducer, a polyvinylidene difluoride (PVDF) sheet and a calibrated PVDF needle hydrophone were used. To ensure that all detection systems were interrogated by the same ultrasonic field, a small optical instrument was constructed to fix the generating laser head. The sensitivity was evaluated by measuring signal-to-noise ratios (SNRs) and noise equivalent pressures (NEPs). RESULTS: The PVDF system, with a 4 kPa NEP, has a 22-dB better performance than the optical stress transducer. The optical stress transducer showed nearly the same sensitivity as the hydrophone for detecting ultrasound waves at a 1-cm distance. CONCLUSIONS: PVDF detection system provides a useful tool for imaging of soft tissues because of its high sensitivity and broadband detection range.     

Clinical echinococcosis.

In 221 patients (0.48% of hospital admissions) with hydatid disease (122 female and 99 males), 81% had single and 19% multiple organs involved. Lungs, liver and spleen as single sites of echinococcosis together represented 83.24% of cases and the liver alone represented 95.24% of instances with multiple organ involvement. One hundred seventy-nine single and 74 multiple cysts (ratio of 2.42/1) represented a total of 363 cysts (1.64 cysts/patient). The incidence of intact cysts was 51.52% and 48.48% had ruptured. Ruptures numbered highest in the lungs (73.44%) and greater in multiple (79.66%) than in single cysts (68.12%). In the liver, 27.14% of single and 54.55% of multiple cysts (40.44% of all liver cysts) had ruptured. Cysts varied in size from 0.8 to 35 cm diameter. Single cysts averaged significantly higher (14.16 cm) and multiple ones lower (5.71 cm) as did intact (6.75 cm) versus reptured cysts (4.33 cm). Except for 10 silent and 15 symptomatic cysts treated medically, all the rest were treated surgically by removal of the endocyst or resection of both endo and exocysts including 205 first, 31 second and 5 third procedures (1.75% of all major operations). Complications occurred in 28.57%. Surgical mortality (3.57%) was markedly lower than with conservative treatment (60%) and significantly less than that of the whole group (14.48%).