Effect of manufacturing conditions on in vitro starch and protein digestibility of (cellular) lentil-based ingredients.

(Cellular) pulse powders are being proposed as ingredients for different foods. However, the effect of manufacturing conditions on the properties of those powders remained unknown. Therefore, this study investigated the effect of specific manufacturing conditions (cooking time, application of cell isolation, and drying method) on the composition, microstructure, and in vitro starch and protein digestibility of lentil powders. Next to powders consisting of isolated cotyledon cells (ICC), this study proposes the production of precooked whole lentil powders (WL), without a cellular isolation step. In a model food system (heat-treated suspension), starch and protein digestion were significantly attenuated for both WL and ICC compared to raw-milled lentil flour. The applied cooking time determined macronutrient digestibility in the powders by (i) affecting the susceptibility of ICC to in vitro digestion, and (ii) determining the microstructural properties of WL. Freeze-dried ICC powder showed a stronger attenuation of amylolysis compared air-dried ICC. This study showed that WL powders have an important potential as innovative food ingredients higher in fiber but lower in starch compared to ICC.

[Pyoderma gangrenosum associated with anti-proteinase 3 antineutrophil cytoplasmic antibodies (PR3-ANCA) induced by propylthiouracil]. / Pyoderma gangrenosum avec anticorps anti-cytoplasme des neutrophiles de type anti-protéinase 3 (PR3-ANCA) induits par le propylthiouracile.

BACKGROUND: Synthetic antithyroid drugs are often used in the treatment of hyperthyroidism, regardless of aetiology. They may cause various side effects, including the development of anti-neutrophil cytoplasmic antibodies (ANCA), ANCA-associated vasculitis, and neutrophilic dermatoses. Propylthiouracil (PTU) is the antithyroid drug most frequently implicated in ANCA-associated diseases specifically involving anti-myeloperoxidase ANCA (MPO-ANCA). To our knowledge, there are no clinical reports describing the association of pyoderma gangrenosum (PG) and anti-proteinase3-ANCA (PR3-ANCA) induced by PTU, with ANCA levels decreasing after antithyroid drug withdrawal. PATIENTS AND METHODS: A 68-year-old woman was treated with propylthiouracil (PTU) for toxic multinodular goitre. She presented necrotic ulceration of the lower abdomen. The patient's history, physical examination, and bacteriological and histological samples led to a diagnosis of pyoderma gangrenosum. This pyoderma involved ANCA with antigenic specificity for proteinase 3. Withdrawal of PTU and a short course of corticosteroids and cyclosporine resulted in rapid and complete resolution of the pyoderma gangrenosum as well as a decrease in ANCA. No relapse was observed one year after cessation of treatment. DISCUSSION: We report a case of PG associated with PR3-ANCA induced by PTU, without any demonstrable vasculitis.

Impaired Akt phosphorylation in insulin-resistant human muscle is accompanied by selective and heterogeneous downstream defects.

AIMS/HYPOTHESIS: Muscle insulin resistance, one of the earliest defects associated with type 2 diabetes, involves changes in the phosphoinositide 3-kinase/Akt network. The relative contribution of obesity vs insulin resistance to perturbations in this pathway is poorly understood. METHODS: We used phosphospecific antibodies against targets in the Akt signalling network to study insulin action in muscle from lean, overweight/obese and type 2 diabetic individuals before and during a hyperinsulinaemic-euglycaemic clamp. RESULTS: Insulin-stimulated Akt phosphorylation at Thr309 and Ser474 was highly correlated with whole-body insulin sensitivity. In contrast, impaired phosphorylation of Akt substrate of 160 kDa (AS160; also known as TBC1D4) was associated with adiposity, but not insulin sensitivity. Neither insulin sensitivity nor obesity was associated with defective insulin-dependent phosphorylation of forkhead box O (FOXO) transcription factor. In view of the resultant basal hyperinsulinaemia, we predicted that this selective response within the Akt pathway might lead to hyperactivation of those processes that were spared. Indeed, the expression of genes targeted by FOXO was downregulated in insulin-resistant individuals. CONCLUSIONS/INTERPRETATION: These results highlight non-linearity in Akt signalling and suggest that: (1) the pathway from Akt to glucose transport is complex; and (2) pathways, particularly FOXO, that are not insulin-resistant, are likely to be hyperactivated in response to hyperinsulinaemia. This facet of Akt signalling may contribute to multiple features of the metabolic syndrome.

Classification of basic daily movements using a triaxial accelerometer.

A generic framework for the automated classification of human movements using an accelerometry monitoring system is introduced. The framework was structured around a binary decision tree in which movements were divided into classes and subclasses at different hierarchical levels. General distinctions between movements were applied in the top levels, and successively more detailed subclassifications were made in the lower levels of the tree. The structure was modular and flexible: parts of the tree could be reordered, pruned or extended, without the remainder of the tree being affected. This framework was used to develop a classifier to identify basic movements from the signals obtained from a single, waist-mounted triaxial accelerometer. The movements were first divided into activity and rest. The activities were classified as falls, walking, transition between postural orientations, or other movement. The postural orientations during rest were classified as sitting, standing or lying. In controlled laboratory studies in which 26 normal, healthy subjects carried out a set of basic movements, the sensitivity of every classification exceeded 87%, and the specificity exceeded 94%; the overall accuracy of the system, measured as the number of correct classifications across all levels of the hierarchy, was a sensitivity of 97.7% and a specificity of 98.7% over a data set of 1309 movements.

Detection of daily physical activities using a triaxial accelerometer.

Triaxial accelerometers have been employed to monitor human movements in a variety of circumstances. The study considered the use of data from a single waist-mounted triaxial accelerometer to distinguish between activity states and rest A method using acceleration magnitude was applied to data collected from 26 normal subjects performing sit-to-stand and stand-to-sit transitions and walking. The effects of three parameters were investigated: the length n of a smoothing median filter, the width w of the averaging window used to process the signal and the value of the acceleration magnitude threshold th. These were found to be inter-related, and sets of parameters that resulted in accurate discrimination were determined by the relationship between th and the product of w and n, and by the relationship between n and w. The subjects were randomly divided into control (N = 13) and test (N = 13) groups. Optimum parameter sets were determined using the control group. Eleven sets of parameters yielded the same optimum results of a sensitivity of 1.0 and a specificity of 0.96 in the control group. Upon application to the test group, using these parameters, the system successfully distinguished between activity and rest, giving sensitivities greater than 0.98 and specificities between 0.88 and 0.94.

Phase response of model sinoatrial node cells.

When a brief current pulse is incident on excitable cells in cardiac and other nervous tissue, a change in phase of the cell's response is usually observed. In cardiac tissue, the cells are exposed to external stimulation of mainly positive currents, which depolarize the cells. We performed a systematic study of the effect of depolarizing stimuli, covering timing, magnitude, and duration, and demonstrated that all of these parameters influence the phase response of the cell. The phase response of our model cell compares favorably with measurements on isolated sinoatrial node cells. We investigated the phase response to single depolarizing stimuli as a function of the stimulus parameters (phase response curves), and then studied cell responses to the combined effect of a pulse train (entrainment phenomena). The range of magnitudes and durations for the stimuli were 0.01-5 nA and 0.01-50 ms. Comparisons of the entrainment properties of the model with experimental results show good agreement with similar modes and different entrainment ratios occurring for similar basic cycle lengths (as functions of the unperturbed cell period). Our results demonstrate that any combination of parameters that provide the same charge transfer to the cell causes a similar phase response, independent of the specific magnitude and duration for the entire range of stimuli investigated.

[Osteomalacia in immigrants: therapeutic management of two cases]. / Immigrantenosteomalazie. Zwei Fallvorstellungen mit Therapieverlauf.

BACKGROUND: Vitamin D deficiency in immigrant adults eventually leads to an osteomalacia syndrome with its characteristic clinical features of bone pain, muscle weakness and difficulty in walking (waddling gait). CASE REPORT: We report on 2 female immigrants from Ethiopia and Eritrea who developed the typical clinical signs of osteomalacia such as generalized bone pain and muscle weakness. Also in osteomalacia there is a significant decrease in bone density but more relevant for diagnosis are low serum levels of 25-OH-vitamin D and as radiological features pseudofractures (Looser's zones). Bone biopsy definitely proves the diagnosis. Simple treatment with vitamin D and calcium is highly effective. CONCLUSION: Since there is an increasing number of immigrants into northern European countries osteomalacia should always be taken into consideration if such patients develop skeletal pain syndrome and muscle weakness.

[Therapy of glucocorticoid-induced osteoporosis with alfacalcidol/calcium and vitamin D/calcium]. / Therapie der Glucocorticoid-induzierten Osteoporose mit Alfacalcidol/Kalzium und Vitamin D/Kalzium.

Calcium/vitamin D supplementation is generally used as a first step treatment of glucocorticoid-induced osteoporosis (GIOP). The aim of this trial was to compare the efficacy of the D-hormone alfacalcidol with plain vitamin D in patients with established GIOP with or without vertebral fractures. Patients on long-term glucocorticoid-therapy were treated either with 1 microgram alfacalcidol plus 5000 mg calcium (group A: n = 43) or with 1000 IU vitamin D plus 500 mg calcium (group B: n = 42). The two groups were not different in respect to initial characteristics such as age, sex distribution, concomittant diseases, bone mineral density (mean T-score values at lumbar spine and femoral neck: -3.29 and -3.25 resp.), and in the number of prevalent vertebral and non-vertebral fractures. During the 3 years of treatment we found a significant increase in lumbar spine density in group A (+2.0%, p < 0.0001), while no significant changes could be documented in group B at both measuring sites. After 3 years 12 new vertebral fractures had occurred in 10 patients of group A and 21 in 17 patients in group B (ns). Correspondingly we registered a significant decrease of back pain only in group A (p < 0.0001). We conclude that alfacalcidol treatment in superior to plain vitamin D in GIOP.

Treatment of glucocorticoid-induced osteoporosis with alfacalcidol/calcium versus vitamin D/calcium.

Vitamin D/calcium substitution is generally regarded as an effective first step treatment for glucocorticoid-induced osteoporosis (GIOP). The aim of our study was to evaluate the efficacy of the active vitamin D metabolite alfacalcidol (1alpha) compared with the native vitamin D(3) in patients with established GIOP with or without vertebral fractures. Patients on long-term corticoid therapy were given either 1 microg alfacalcidol plus 500 mg calcium per day (group A, n = 43) or 1000 IU vitamin D(3) plus 500 mg calcium (group B, n = 42). The two groups were alike in age range, sex ratio, percentages of underlying diseases, average initial bone density values (lumbar spine: mean T-score -3.28 and -3.25, respectively), and rates of vertebral and nonvertebral fractures. During the 3-year study we found a small but significant increase of lumbar spine density in group 1alpha (+2.0%, P < 0.0001) and no significant changes at the femoral neck. In the D(3) group, there were no significant changes at both sites. At the end of the study, 12 new vertebral fractures had occurred in 10 patients of the group 1alpha and 21 in 17 patients of the D(3) group. In accordance with the observed fracture rates, the alfacalcidol group showed a significant decrease in back pain (P < 0.0001) whereas no change was seen in the vitamin D group. We conclude that with the doses used in this trial, alfacalcidol is superior to vitamin D in the treatment of established GIOP.

Therapy of established postmenopausal osteoporosis with monofluorophosphate plus calcium: dose-related effects on bone density and fracture rate.

Recent experience from different groups suggests that low fluoride doses resulting in moderate increases in bone mineral density (BMD) may be advantageous in terms of fracture-reducing potency. In a randomized prospective 3-year study we examined the therapeutic efficacy of different dosages of monofluorophosphate (MFP) plus calcium in comparison with calcium alone in 134 women with established postmenopausal osteoporosis (mean age 64.0 years, average vertebral fractures per patient 3.6). Group A received 1000 mg calcium/day and a low-dose intermittent MFP regimen (3 months on, 1 month off) corresponding to an average daily fluoride ion dose of 11.2 mg. Group B received 1000 mg calcium/day plus continuous MFP corresponding to 20 mg fluoride ions per day. Group C was treated with 1000 mg calcium alone throughout the study period. Bone density was measured with dual-energy X-ray absorptiometry at L2-4 and three proximal femur areas and with single photon absorptiometry at two radius sites. New vertebral fractures were identified from annual lateral radiographs of the spine. A significant reduction in subjective complaints as measured by a combined pain-mobility score (CPMS) was found in both fluoride groups in comparison with the calcium monotherapy group. Group A showed increases in BMD at all six measuring sites, reaching +12.6% at the spine after 3 years. In group B we found significant increases at the spine, Ward's triangle and distal radius, but slight decreases at the femoral neck and radius shaft. For the spine the average change amounted to +19.5% after 3 years. In group C losses of BMD were observed at all six sites, with an average loss of 1.6% for the spine at the end of the study. The incidence of new vertebral fractures per 100 patient-years was 8.6, 17.0 and 31.6 in groups A, B and C, respectively. In conclusion, both calcium-MFP regimens resulted in significantly lower vertebral fracture rates than calcium monotherapy. However, the low intermittent MFP regimen, leading to a mean annual increase in spinal BMD of only 4.2%, showed a clear trend to greater effectiveness in reducing vertebral fracture than the higher fluoride dosage that was followed by an average spinal BMD increase of 6.5% per year. Furthermore the rate of fluoride-specific side effects (lower-extremity pain syndrome) was 50% lower in patients receiving the lower fluoride dosage.

[Incidence of femoral neck fractures in the German Federal Republic in comparison to other countries]. / Inzidenz von Schenkelhalsfrakturen in der Bundesrepublik Deutschland im internationalen Vergleich.

Reported age-adjusted incidence rates vary markedly in Europe and the US, making the transposition of results from elsewhere questionable. The aim of this study is to fill this gap and to compare the hip fracture incidence between Germany and other countries. Population-based epidemiologic research was conducted in Düren (84251 residents), because its population is representative for West Germany as far as age and social structure are concerned, and because medical care is virtually self-contained within the community. Patient files and discharge statistics of the three local hospitals were thoroughly reviewed. Hip fractures after adequate trauma and pathological fractures were excluded. Between 1987 and 1989 276 inadequate hip fractures were identified among the resident population. There was a highly significant increase in the age-specific incidence of hip fractures in both sexes, but females were more frequently affected (crude average annual incidence rate per 100,000: females 291.3 males 110.2). The age-adjusted incidence rates for Germany in comparison to published international data follow on third position after the high rates reported for Norway and the US. The annual incidence of 70,000 hip fractures for the former Federal Republic of Germany is significantly higher than expected.

Effects of pulsed argon laser energy on bone.

Several investigators have reported that the presence of calcium may totally preclude resection of plaque material from the lumen of an occluded vessel. Because the authors did not support these findings, they tested the hypothesis and studied the effects of pulsed argon ion laser energy on other non-plaque but dense calcified tissue, such as cortical bone, and found that bone can be cut with ease and safety. Fresh bovine specimens were irradiated with a Spectra Physics model 170 argon ion laser, and the irradiated areas were examined, measured, and photographed.

Influence of exercise and CO2 on breathing pattern in patients with chronic obstructive lung disease (COLD).

In ten eucapnic patients with chronic obstructive lung disease (COLD) we evaluated the breathing pattern during induced progressive hypercapnia (CO2 rebreathing) and progressive exercise on an ergometric bicycle (30 W/3 min). The time and volume components of the respiratory cycle were measured breath by breath. When compared to hypercapnia, the increase in ventilation (VE) during exercise was associated with a smaller increase in tidal volume (VT) and a greater increase in respiratory frequency (fR). Plots of tidal volume (VT) against both inspiratory time (TI) and expiratory time (TE) showed a greater decrease in both TI and TE during exercise than with hypercapnia. Analysis of VE in terms of flow (VT/TI) and timing (TI/TT) showed VE to increase by a similar increase to that in VT/TI during both exercise and hypercapnia, while TI/TT did not change significantly. When the patients were matched for a given VE (28 l.min-1), exercise induced a smaller increase in VT (p less than 0.05), a greater increase in fR (p less than 0.025); TI (p less than 0.025) and TE (p less than 0.01) were found to be smaller during exercise than hypercapnia. The change in the off-switch mechanism during exercise and hypercapnia could account for our results.

[Instrumentation support in respiratory kinesiotherapy]. / Le support instrumental en kinésithérapie respiratoire.

The points of impact of instrumental support in respiratory physiotherapy are numerous; they concern primarily the pulmonary expansion, bronchial drainage and function of respiratory muscles. The pulmonary expansion may be helped by incitant spirometry and either intermittent or continuous positive pressure respiration, or indirectly by the utilisation of respiration against resistance (expiratory bottles, masks with uni-directional valves and expiratory resistances etc.). These different techniques may be used in the presence of instability of the respiratory units, secondary to an alteration of surfactant or to closure of the small airways induced by a transitory reduction (in the post-operative period) or permanent reduction (such as parietal wall disease of mechanical or neuro-muscular origin) of the functional residual capacity (CRF). If the continuous positive airway pressure (CPAP) seems particularly helpful for the CRF to recover to the pre-operative level it also appears on the contrary as the least efficacious technique to increase trans-pulmonary pressure. The instrumental support for bronchial drainage may theoretically affect the tension activity of the transport (instrumental help in the pulmonary expansion and in hyperventilation), muco-ciliary transport (external parietal vibration or internal vibrations applied to the upper airways), the biphasic flow (expiratory assistance by negative pressure and humidifiers). The function of the respiratory muscles may in certain cases be improved by the use of abdominal pneumatic cuirasses, by hyperventilation exercises in an isocapnoeic milieu or in breathing exercises against an additional inspiratory or expiratory resistance. If the physiological foundation of mechanical support in respiratory education may be frequently identified, the clinical results reported in the literature are often contradictory.

Dental technician's pneumoconiosis. A report of two cases.

Diagnosis of pneumoconiosis was made in 2 dental technicians presenting with interstitial lung disease. The occupational origin of inhaled dust was confirmed by mineralogic analyses, which disclosed mainly large amounts of chromium-cobalt-molybdenum particles originating from Vitallium prostheses, but also showed abrasives (silica and silicon carbide) and asbestos in 1 patient. The presence of Vitallium and its chemical stability in bronchoalveolar lavage and lung several years after cessation of exposure confirm the resistance of this alloy to corrosion by body fluids. This contrasts with the high solubility of cobalt described in cobalt or hard metal disease. We suggest that dental technician's pneumoconiosis is a complex pneumoconiosis distinct from silicosis, asbestosis, or hard metal disease and that Cr-Co-Mo alloys play a role in its pathogenesis.

Acute pancreatitis in Legionnaires' disease.

Legionnaires' disease may cause severe multisystem damage. We report the case of a patient in whom Legionnaires' disease induced an acute pancreatitis.