Impact of chickpea hummus on postprandial blood glucose, insulin and gut hormones in healthy humans combined with mechanistic studies of food structure, rheology and digestion kinetics.

Slowing the rate of carbohydrate digestion leads to low postprandial glucose and insulin responses, which are associated with reduced risk of type 2 diabetes. There is increasing evidence that food structure plays a crucial role in influencing the bioaccessibility and digestion kinetics of macronutrients. The aims of this study were to compare the effects of two hummus meals, with different degrees of cell wall integrity, on postprandial metabolic responses in relation to the microstructural and rheological characteristics of the meals. A randomised crossover trial in 15 healthy participants was designed to compare the acute effect of 27 g of starch, provided as hummus made from either intact chickpea cells (ICC) or ruptured chickpea cells (RCC), on postprandial metabolic responses. In vitro starch digestibility, microstructural and rheological experiments were also conducted to evaluate differences between the two chickpea hummus meals. Blood insulin and GIP concentrations were significantly lower (P < 0.02, P < 0.03) after the consumption of the ICC meal than the meal containing RCC. In vitro starch digestion for 90 min was slower in ICC than in RCC. Microscopic examination of hummus samples digested in vitro for 90 min revealed more intact chickpea cells in ICC compared to the RCC sample. Rheological experiments showed that fracture for ICC hummus samples occurred at smaller strains compared to RCC samples. However, the storage modulus for ICC was higher than RCC, which may be explained by the presence of intact cells in ICC. Food structure can affect the rate and extent of starch bioaccessibility and digestion and may explain the difference in the time course of metabolic responses between meals. The rheological properties were measured on the two types of meals before ingestion, showing significant differences that may point to different breakdown mechanisms during subsequent digestion. This trial was registered at clinicaltrial.gov as NCT03424187.

Defining the cardiovascular phenotype of adults with Alström syndrome.

BACKGROUND: >40% of infants with Alström Syndrome (AS) present with a transient, severe cardiomyopathy in the first months of life, with apparent recovery in survivors. One in five individuals then develop a later-onset cardiomyopathy but wide clinical variability is observed, even within the same family. The rationale for this study is to provide a comprehensive evaluation of the cardiovascular phenotype in adults with AS. METHODS: Adults attending the National Centre for AS in England were studied. All patients underwent biochemical, 12- lead electrocardiography, echocardiography, and cardiovascular magnetic resonance imaging. RESULTS: 47 adults with AS (64% male; mean age 33 years; 66% white British) were studied. Seven (15%) survived infantile cardiomyopathy and 23 (49%) developed adult-onset cardiomyopathy. Conventional risk factors for cardiovascular disease were present in 39 (83%). Abnormalities were present on biomarkers in 16 (34%), ECG 30 (64%), echocardiography 19 (40%) and CMR 31 (66%). Coronary artery imaging was performed in six (13%), with abnormalities in two. Cardiac, renal, and liver markers were more often impaired in older patients, with impaired left ventricular ejection fraction, reduced global longitudinal strain and late enhancement. 6 (13%) had severe pulmonary hypertension (mean pulmonary artery pressure 46 mmHg) due to left heart disease on invasive testing. CONCLUSION: Cardiomyopathy is common in adults with AS, complicated in a significant proportion by atherosclerotic coronary artery disease and restrictive cardiomyopathy, confirmed on CMR and invasive testing. With advancing age, cardiovascular complications are compounded by contemporaneous renal and liver disease.

Local anaesthetics in dermatological surgery: a review of adjuncts and pain reduction techniques.

A variety of adjuncts for local anaesthesia (LA) exists for dermatological surgery, along with many options to reduce the pain of LA. This review aims to summarize the evidence relating to such adjuncts and methods to reduce the pain of LA. Adjuncts to LA can be an important consideration to optimize anaesthetic effect. Current evidence suggests that buffering and warming of LA fluid, along with cooling, pinching and administering vibrations to the skin are effective at reducing pain during administration. In this review, no significant difference in pain reduction was found between cooling and administering vibrations to the skin. Studies demonstrate that, overall, LA injection into distal sites is safe. However, the evidence specific to dermatological surgery is limited with regard to ways to reduce pain during LA injection and in determining the safety of LA for distal sites with confidence. Further high-quality research in the form of multicentre randomized controlled trials is required.

A systematic review of the literature assessing operative blood loss and postoperative outcomes after colorectal surgery.

PURPOSE: There is no consensus in the literature regarding the association between operative blood loss and postoperative outcomes in colorectal surgery, despite evidence suggesting a link. Therefore, this systematic review assesses the association between operative blood loss, perioperative and long-term outcomes after colorectal surgery. METHODS: A literature search of MEDLINE, EMBASE, Science Citation Index Expanded and Cochrane was performed to identify studies reporting on operative blood loss in colorectal surgery. RESULTS: The review included forty-nine studies reporting on 61,312 participants, with a mean age ranging from 53.4 to 78.1 years. The included studies demonstrated that major operative blood loss was found to be a risk factor for mortality, anastomotic leak, presacral abscess, and postoperative ileus, leading to an increased duration of hospital stay. In the long term, the studies suggest that significant blood loss was an independent risk factor for future small bowel obstruction due to colorectal cancer recurrence and adhesions. Studies found that survival was significantly reduced, whilst the risk of colorectal cancer recurrence was increased. Reoperation and cancer-specific survival were not associated with major blood loss. CONCLUSION: The results of this systematic review suggest that major operative blood loss increases the risk of perioperative adverse events and has short and long-term repercussions on postoperative outcomes. Laparoscopic and robotic surgery, vessel ligation technology and anaesthetic considerations are essential for reducing blood loss and improving outcomes. This review highlights the need for further high quality, prospective, multicentre trials with a greater number of participants, and accurate and standardised methods of measuring operative blood loss.

A review of Mohs micrographic surgery for skin cancer. Part 1: Melanoma and rare skin cancers.

Mohs micrographic surgery (MMS) is a precise and effective method commonly used to treat high-risk basal cell carcinoma and squamous cell carcinoma on the head and neck. Although the majority of evidence for MMS relates to keratinocyte cancers, there is published evidence for other types of skin cancer. This review aims to discuss the evidence for using MMS to treat six different types of skin cancer [malignant melanoma, lentigo maligna, dermatofibrosarcoma protuberans, atypical fibroxanthoma (AFX), microcystic adnexal carcinoma and pleomorphic dermal sarcoma (PDS)] particularly in the context of survival rates and cancer recurrence. These cancers were chosen because there was sufficient literature for inclusion and because MMS is most useful when cancers are contiguous, rather than for cancers with marked metastatic potential such as angiosarcoma or Merkel cell carcinoma. We searched MEDLINE, PubMed and Embase using the keywords: 'melanoma', 'mohs micrographic surgery', 'lentigo maligna', 'dermatofibrosarcoma protuberans', 'atypical fibroxanthoma', 'microcystic adnexal carcinoma' and 'pleomorphic dermal sarcoma' along with their appropriate synonyms, to identify the relevant English-language articles from 2000 onwards, given that literature for MMS on nonkeratinocyte cancers is sparse prior to this year. AMSTAR (A MeaSurement Tool to Assess systematic Review) was used to assess the validity of systematic reviews. Further high-quality, multicentre randomized trials are necessary to establish the indications and efficacy of MMS for rarer cancers, particularly for AFX and PDS, for which only limited studies were identified.

Modelling Processes and Products in the Cereal Chain.

In recent years, modelling techniques have become more frequently adopted in the field of food processing, especially for cereal-based products, which are among the most consumed foods in the world. Predictive models and simulations make it possible to explore new approaches and optimize proceedings, potentially helping companies reduce costs and limit carbon emissions. Nevertheless, as the different phases of the food processing chain are highly specialized, advances in modelling are often unknown outside of a single domain, and models rarely take into account more than one step. This paper introduces the first high-level overview of modelling techniques employed in different parts of the cereal supply chain, from farming to storage, from drying to milling, from processing to consumption. This review, issued from a networking project including researchers from over 30 different countries, aims at presenting the current state of the art in each domain, showing common trends and synergies, to finally suggest promising future venues for research.

Measurement of molten chocolate friction under simulated tongue-palate kinematics: Effect of cocoa solids content and aeration.

The perception of some food attributes is related to mechanical stimulation and friction experienced in the tongue-palate contact during mastication. This paper reports a new bench test to measure friction in the simulated tongue-palate contact. The test consists of a flat PDMS disk, representing the tongue loaded and reciprocating against a stationary lower glass surface representing the palate. The test was applied to molten chocolate samples with and without artificial saliva. Friction was measured over the first few rubbing cycles, simulating mechanical degradation of chocolate in the tongue-palate region. The effects of chocolate composition (cocoa solids content ranging between 28 â€‹wt% and 85 â€‹wt%) and structure (micro-aeration/non-aeration 0-15 â€‹vol%) were studied. The bench test clearly differentiates between the various chocolate samples. The coefficient of friction increases with cocoa solids percentage and decreases with increasing micro-aeration level. The presence of artificial saliva in the contact reduced the friction for all chocolate samples, however the relative ranking remained the same.

Artificial intelligence and melanoma detection: friend or foe of dermatologists?

The significance of early diagnosis for melanoma prognosis and survival cannot be understated. The public health benefits of melanoma prevention and detection have driven advances in diagnostics for skin cancer, particularly in the field of artificial intelligence. Evaluating the benefits and limitations of artificial intelligence in dermatology is paramount to its future development and clinical application.

A natural mutation in Pisum sativum L. (pea) alters starch assembly and improves glucose homeostasis in humans.

Elevated postprandial glucose (PPG) is a significant risk factor for non-communicable diseases globally. Currently, there is a limited understanding of how starch structures within a carbohydrate-rich food matrix interact with the gut luminal environment to control PPG. Here, we use pea seeds (Pisum sativum) and pea flour, derived from two near-identical pea genotypes (BC1/19RR and BC1/19rr) differing primarily in the type of starch accumulated, to explore the contribution of starch structure, food matrix and intestinal environment to PPG. Using stable isotope 13C-labelled pea seeds, coupled with synchronous gastric, duodenal and plasma sampling in vivo, we demonstrate that maintenance of cell structure and changes in starch morphology are closely related to lower glucose availability in the small intestine, resulting in acutely lower PPG and promotion of changes in the gut bacterial composition associated with long-term metabolic health improvements.

Quantifying the differences in structure and mechanical response of confectionery products resulting from the baking and extrusion processes.

Extrusion has potential advantages over baking in terms of throughput, asset cost and flexibility. However, it is challenging to achieve through extrusion the "light, crispy" texture of a more traditional baked confectionery. This study compares and contrasts for the first time confectionery products produced through these two processes, i.e. baking and extrusion. The microstructural differences are measured using imaging techniques, i.e. Scanning Electron Microscopy (SEM) and X-Ray Tomography (XRT) whereas mechanical characterisation is used to highlight differences in the resulting mechanical properties. Crucial information is presented which shows that the two technologies result in different mechanical properties and microstructures, even if the level of porosity in the two products is kept constant. In addition, confectionery products whether they are produced through baking or extrusion, have irregular geometries. The latter makes mechanical characterisation a real challenge. Therefore this study also presents rigorous methods for measuring true mechanical properties such that meaningful and valid comparisons may be made. The accuracy of the chosen methodologies is verified through experiments using flat and tubular extruded geometries as well as testing the products in various directions. It was concluded that the manufacturing method and, in the case of extrusion, the initial moisture content influences the microstructure and mechanics of confectionery products, both of which have an impact on consumer sensory perception.