Does the addition of visceral manipulation alter outcomes for patients with low back pain? A randomized placebo controlled trial.

BACKGROUND: This study aimed to investigate whether the addition of visceral manipulation, to a standard physiotherapy algorithm, improved outcomes in patients with low back pain. METHODS: Sixty-four patients with low back pain who presented for treatment at a private physiotherapy clinic were randomized to one of two groups: standard physiotherapy plus visceral manipulation (n = 32) or standard physiotherapy plus placebo visceral manipulation (n = 32). The primary outcome was pain (measured with the 0-10 Numerical Pain Rating Scale) at 6 weeks. Secondary outcomes were pain at 2 and 52 weeks, disability (measured with the Roland-Morris Disability Questionnaire) at 2, 6 and 52 weeks and function (measured with the Patient-Specific Functional Scale) at 2, 6 and 52 weeks. This trial was registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12611000757910). RESULTS: The addition of visceral manipulation did not affect the primary outcome of pain at 6 weeks (-0.12, 95% CI = -1.45 to 1.21). There were no significant between-group differences for the secondary outcomes of pain at 2 weeks or disability and function at 2, 6 or 52 weeks. The group receiving addition of visceral manipulation had less pain than the placebo group at 52 weeks (mean 1.57, 95% CI = 0.32 to 2.82). Participants were adequately blinded to group status and there were no adverse effects reported in either group. CONCLUSIONS: Our study suggests that visceral manipulation in addition to standard care is not effective in changing short-term outcomes but may produce clinically worthwhile improvements in pain at 1 year.

Estimating insulin demand for protein-containing foods using the food insulin index.

BACKGROUND/OBJECTIVE: The Food Insulin Index (FII) is a novel algorithm for ranking foods on the basis of insulin responses in healthy subjects relative to an isoenergetic reference food. Our aim was to compare postprandial glycemic responses in adults with type 1 diabetes who used both carbohydrate counting and the FII algorithm to estimate the insulin dosage for a variety of protein-containing foods. SUBJECTS/METHODS: A total of 11 adults on insulin pump therapy consumed six individual foods (steak, battered fish, poached eggs, low-fat yoghurt, baked beans and peanuts) on two occasions in random order, with the insulin dose determined once by the FII algorithm and once with carbohydrate counting. Postprandial glycemia was measured in capillary blood glucose samples at 15-30 min intervals over 3 h. Researchers and participants were blinded to treatment. RESULTS: Compared with carbohydrate counting, the FII algorithm significantly reduced the mean blood glucose level (5.7±0.2 vs 6.5±0.2 mmol/l, P=0.003) and the mean change in blood glucose level (-0.7±0.2 vs 0.1±0.2 mmol/l, P=0.001). Peak blood glucose was reached earlier using the FII algorithm than using carbohydrate counting (34±5 vs 56±7 min, P=0.007). The risk of hypoglycemia was similar in both treatments (48% vs 33% for FII vs carbohydrate counting, respectively, P=0.155). CONCLUSIONS: In adults with type 1 diabetes, compared with carbohydrate counting, the novel FII algorithm improved postprandial hyperglycemia after consumption of protein-containing foods.

Avoidance of meat and poultry decreases intakes of omega-3 fatty acids, vitamin B12 , selenium and zinc in young women.

BACKGROUND: Inadequate nutrient intake and physical inactivity may have adverse health consequences. The present study aimed to describe young female students' dietary intake, food choices and physical activity (PA) patterns, and also to determine the influence of dietary avoidance of meat and poultry on nutrient intake. METHODS: A cross-sectional study of female university students was conducted. Questionnaires were used to measure dietary intakes, food habits and PA. Anthropometric measurements of participants included height, weight and calculated body mass index (BMI). RESULTS: There were 308 participants with a mean (SD) age of 22.9 (3.9) years and a BMI of 21.5 (2.8) kg m(-2) ; 78% were in the BMI range 18.5-24.9 kg m(-2) . Of those who responded to the PA questionnaire (n = 218), 53% reported activity ≥150 min per week, with walking being the largest contributor. Completed food frequency questionnaires were returned by 256 participants. National recommendations for servings of cereals, vegetables, meat, fish and energy-dense 'extra foods' were not met by the majority of participants. Avoidance of animal foods was reported in 23% of women, and resulted in lower intakes of omega-3 fatty acids, vitamin B12 , selenium and zinc (P < 0.05) compared to non-avoidance. Iron intake from animal sources decreased significantly (P < 0.05) with the increase in meat and poultry avoidance. CONCLUSIONS: Female students had a healthy weight and reported adequate physical activity. However, in comparison to meat and poultry consumers, the avoidance of these foods was associated with a lower intake of some micronutrients. A sustained low intake of micronutrients may lead to adverse health effects in the longer-term, such as compromised immune function and iron deficiency anaemia.

Short term effects of kinesiotaping on acromiohumeral distance in asymptomatic subjects: a randomised controlled trial.

OBJECTIVES: The first aim of this study was to investigate whether kinesiotaping (KT) can increase the acromiohumeral distance (AHD) in asymptomatic subjects in the short term. The second aim was to investigate whether the direction of kinesiotaping application influences AHD. BACKGROUND: In recent years, the use of KT has become increasingly popular for a range of musculoskeletal conditions and for sport injuries. To date, we are unaware of any research investigating the effect of kinesiotaping on AHD. Moreover, it is unknown whether the direction of kinesiotaping application for the shoulder is important. METHODS: Forty nine participants were randomly assigned to one of three groups: kinesiotaping group 1 (KT1), kinesiotaping group 2 (KT2) and sham kinesiotaping (KT3). AHD ultrasound measurements at 0° and 60° of shoulder elevation were collected at baseline and immediately after kinesiotape application. RESULTS: The results showed significant improvements in AHD after kinesiotaping, compared with sham taping. The mean difference in AHD between KT1 and KT3 groups was 1.28 mm (95% CI: 0.55, 2.03), and between KT2 and KT3 was 0.98 mm (95% CI: 0.23, 1.74). Comparison of KT1 and KT2 groups, which was performed to identify whether the direction of taping influences the AHD, indicated there were no significant differences. CONCLUSION: KT increases AHD in healthy individuals immediately following application, compared with sham kinesiotape. No differences were found with respect to the direction in which KT was applied.

Higher protein diet for weight management in young overweight women: a 12-month randomized controlled trial.

UNLABELLED: Clinical research on weight management in young women is limited. This randomized controlled trial compared the efficacy of two iso-energetically restricted (5600 kJ) diets [higher protein (HP): 32% protein, 41% carbohydrate, 25% fat or higher carbohydrate (HC): 20, 58, 21%, respectively] in 71 (HP: n = 36; HC: n = 35) young healthy women (18-25 years; body mass index ≥ 27.5 kg/m2) for weight (kg; percent weight loss), body composition, metabolic and iron changes assessed at baseline, 6 and 12 months. DATA: mean (95% CI). In HP completers at 6 months, percent weight loss was higher [HP: 9.3 (5.6-13.1); HC: 5.1 (2.3-7.9)%; p = 0.06]; although, this did not reach statistical significance. Absolute weight [HP: 8.9 (5.3-12.5); HC: 4.6 (2.2-7.0) kg; p = 0.034] and fat loss [HP: 8.0 (4.4-11.5); HC: 3.4 (1.3-5.6) kg; p = 0.022] were significantly greater. No significant between-diet differences were observed at 12 months. Biochemistry remained within normal ranges with HP showing superior preservation of ferritin at 6 months [HP: 53 (40-66); HC: 46 (30-61) µg/l; p = 0.029]. Both diets supported clinically meaningful weight loss with HP tending to be more effective in the medium-term.

Malnutrition screening and early nutrition intervention in hospitalised patients in acute aged care: a randomised controlled trial.

OBJECTIVES: High rates of malnutrition have been reported in the older hospitalized patient population. This is recognised to impact on patient outcomes and health costs. This study aimed to assess the impact of nutrition screening and intervention on these parameters. DESIGN: Randomised controlled prospective study. SETTING: The study was performed in the acute geriatric medicine wards of the Prince of Wales Hospital, Sydney Australia. PARTICIPANTS: All patients admitted to these wards under a geriatrician with an expected length of stay of at least 72 hours were considered for the study. INTERVENTION: Patients were screened on admission for malnutrition using the Mini Nutritional Assessment (MNA) tool and randomly assigned to control or intervention groups. Intervention patients were immediately commenced on a malnutrition care plan (MCP). Control patients were only commenced on a MCP if referred by clinical staff. MEASUREMENTS: Length of stay (LOS), weight change and frequency of readmission to hospital were compared between the groups. RESULTS: 143 patients were screened. 119 were identified as malnourished (MN) or at risk of malnutrition (AR). Overall LOS was not different between the two groups (control v. intervention: 13.4 ± 1.3 days v. 12.5 ± 1.2 days, p=0.64). However there was a significant decrease in LOS in the MN (control v. intervention: 19.5 ± 3 days v. 10.6 ± 1.6 days, p=0.013) and a trend to reduced readmissions. There was no difference in weight change over admission between the groups. Without screening, clinical staff identified only a small proportion of malnourished patients (35% of MN and 20% of AR). CONCLUSIONS: Malnutrition in the older hospital population is common. Malnutrition screening on hospital admission facilitated targeted nutrition intervention, however length of stay and re-presentations were only reduced in older malnourished patients with an MNA score less than 17.

B vitamin status, dietary intake and length of stay in a sample of elderly rehabilitation patients.

OBJECTIVES: To investigate the relationships between previous diet, biomarkers of selected B vitamins, nutritional status and length of stay. DESIGN: Cross sectional study. SETTING: Geriatric rehabilitation patients, Sydney, Australia. PARTICIPANTS: Fifty two consenting patients with normal serum creatinine levels and no dementia. MEASUREMENTS: Serum vitamin B12, plasma vitamin B6, serum and erythrocyte folate, homocysteine and methylmalonic acid (MMA) concentrations; dietary intake using a validated semi-quantitative food frequency questionnaire and nutritional assessment using the Mini Nutritional Assessment (MNA). Length of stay data were collected from medical records after discharge. RESULTS: The age was 80 ± 8 year (mean ± SD), BMI 26.4 ± 6.8 kg/m2 and MNA score 22 ± 3 indicating some risk of malnutrition. Deficiencies of vitamins B6, B12 and folate were found in 30, 22 and 5 subjects respectively. Length of stay was positively correlated with age and MMA (Spearman's correlation 0.4, p<0.01 and 0.28, p<0.05 respectively) and negatively correlated with albumin, vitamin B6 and MNA score (Spearman's correlation -0.35, -0.33 and -0.29, p<0.05). After adjustment for age and sex, ln vitamin B6 and ln MMA concentrations were significant in predicting ln LOS (p=0.006 and p=0.014 respectively). CONCLUSION: The study indicates a high risk of vitamin B deficiencies in the elderly and suggests that deficiencies of vitamins B6 and B12 are associated with length of stay. This is concerning as B vitamin status is rarely fully assessed.

Profile of lingual orthodontic users in Australia.

BACKGROUND: The use of lingual orthodontic appliances and the training background of orthodontists in Australia using the lingual orthodontic technique are largely unknown. The aim of this study was to investigate the profile of lingual orthodontic users in Australia. METHODS: Four hundred and fifty questionnaires consisting of 15 questions were sent out to orthodontists in Australia. We obtained a 62 per cent return rate (278) with a 58 per cent rate of completed questionnaires. Statistical analysis using SPSS was performed and various outputs were obtained. RESULTS: Of the completed returns, 23 per cent were current lingual users; 69 per cent were not and 8 per cent were previous users but have stopped using the appliance. The majority (90 per cent) of the current lingual users were males. The highest percentage of users (35 per cent) was in New South Wales while the smallest percentage was in Tasmania (2 per cent). Around 40 per cent of respondents attended lingual courses as part of their specialist training programme, while 73 per cent had attended lingual courses since graduation and 82 per cent would consider attending a lingual course in the future. Of the 60 per cent current users who did not have a lingual component in their specialist training programme, almost nine-tenths had attended lingual courses since graduation. Of the non-lingual users, 14 per cent attended lingual courses as part of their specialist training programme, 28 per cent attended lingual courses since graduation and 38 per cent would consider attending a lingual course in the future. The main reason cited for being a non-lingual user was that lingual orthodontics could not be an integral part of the practice. CONCLUSIONS: Most of the orthodontists who graduated more than 16 years ago from their postgraduate training were non-users of the lingual appliance. It seems that around one in four orthodontists currently use the lingual technique, of which NSW orthodontists make up the largest group. Only one-fifth of users had some lingual component in their formal orthodontic training and about half of them have attended lingual courses after graduation. Almost half of orthodontists in Australia would consider attending a lingual course in the future. This survey provides a sound basis for course co-ordinators to plan for continuing lingual orthodontics in the future.

Changes in the physical properties of human premolar cementum after application of 4 weeks of controlled orthodontic forces.

This study was performed to assess the relationship between the magnitude of orthodontic force and physical properties of individual human cementum, and to identify the sites that may be predisposed to root resorption. The findings may assist in relating physical properties of dental root cementum and its susceptibility to root resorption. Sixteen maxillary first premolar teeth were selected in eight orthodontic patients (three males and five females), mean age 14.8 years (range 11.2-17.5 years), requiring first premolar extractions. In each patient, a light orthodontic force of 25 cN was applied buccally using a sectional archwire on the first premolar on one side, while a heavy force of 225 cN was applied to the contralateral side. The teeth were extracted 4 weeks after initial force application. Hardness and elastic modulus were measured on the buccal and the lingual surfaces of the cementum at the cervical, middle, and apical third of the root. The results showed that the mean hardness and elastic modulus of cementum in the light force group were greater than in the heavy force group at all positions. There were highly significant differences in both hardness and elastic modulus between the heavy and light force groups (P < 0.01). The mean hardness and elastic modulus of cementum gradually decreased from the cervical to the apical regions for buccal as well as lingual surfaces in both groups. There was, however, an insignificant difference between hardness and elastic modulus on the buccal surface compared with the lingual surface (P < 0.05). It was concluded that the hardness and elastic modulus of cementum were affected by the application of orthodontics forces.

Validation of two-dimensional measurements of root resorption craters on human premolars after 28 days of force application.

The aims of this study were to develop a three-dimensional (3D) mathematical model of a typical root resorption crater and to correlate two-dimensional (2D) surface area measurements to 3D volumetric measurements of root resorption craters created under light and heavy orthodontic forces. Data were obtained from a previous study of 36 first premolars from 16 subjects requiring extraction of these teeth as part of their orthodontic treatment. Buccal tipping forces of 25 or 225 g were applied for an experimental period of 28 days. After extraction, the samples were prepared for scanning electron microscopy (SEM) imaging, image processing and analysis. Surface area (2D) and volumetric (3D) measurements of all craters were obtained. A mathematical analysis of the 2D/3D relationship enabled the determination of an appropriate digital model for the shape, type and dimensions of resorption craters, which was also able to distinguish between a 'hemispheric' model versus a 'layered' model of craters. The results demonstrated that 2D and 3D measurements were strongly correlated (r = 0.991**). Within the light and heavy force groups, the measurements were also strongly correlated (r = 0.978** and r = 0.994**, respectively). For a 28 day experimental period, 2D measurements of root resorption craters were found to be as reliable as 3D measurements.

Urinary isoflavonoid excretion is inversely associated with the ratio of protein to dietary fibre intake in young women.

OBJECTIVE: To examine the prevalence of excretion of urinary isoflavonoids in women and determine any relationships with accustomed macronutrient intake. DESIGN: Volunteers in one of two 4-month studies. Study 1 was a randomised crossover study whereby subjects consumed a placebo or isoflavone supplement for 2 months and crossed over. Study 2 was a parallel design in which subjects consumed a placebo for 1 month and an isoflavone supplement for 3 months. SETTING: All subjects were free-living, healthy volunteers. SUBJECTS: A total of 25 (study 1, n=14; study 2, n=11) premenopausal women were recruited through advertisements. INTERVENTIONS: Volunteers were supplemented for 2 months (study 1) or 3 months (study 2) with purified isoflavones (86 mg/day) derived from red clover. Urinary isoflavonoids were measured during the placebo and the second month of isoflavone treatment. Macronutrient intakes were determined from weighed food records. RESULTS: During isoflavone supplementation, the concentration of urinary total isoflavonoids increased by 15-fold (P<0.0001), with 5.4-fold variation between individuals. Multiple linear regression analysis showed that 24% of this variation could be explained by an interaction between dietary fibre and protein (P=0.047), with a highly significant inverse association between total isoflavonoid concentration and the protein to fibre ratio (r=-0.51, P=0.009). CONCLUSIONS: Supplementation with purified isoflavones results in an increase in urinary isoflavonoid excretion and part of the individual variation in response is associated with an interaction between intakes of protein and dietary fibre. Whether manipulation of these macronutrients could enhance efficacy of isoflavone supplements remains to be determined.

Root resorption and its association with alterations in physical properties, mineral contents and resorption craters in human premolars following application of light and heavy controlled orthodontic forces.

OBJECTIVES: To study the effect of different orthodontic force levels on cementum, investigating from the point of view of its physical properties, alterations in the mineral components, type and location of the resorption craters and the exploration in 3D of space. DESIGN: In vivo human premolars subjected to heavy and light forces were employed for this study. After a period of movement they were analyzed for hardness and elasticity. Also, the mineral composition measuring Ca, P and F of the cementum root surface was investigated. A new method for volumetric analysis of resorption craters was developed. RESULTS: There were no significant differences for hardness and elastic modulus between the light and heavy force groups and no significant effects for different tooth positions. Significant inter-individual variation in the Ca, P and F concentrations was noted. Force-related data showed that mean volume of the resorption crater in light-force group was 3.49-fold greater than the control group, and the heavy-force group 11.59-fold more than control group. The heavy force group had 3.31-fold greater total resorption volume then light force group. Buccal cervical and lingual apical regions demonstrated significantly more resorption craters than the other regions. The 2D measurements were strongly correlated to 3D measurements. CONCLUSION: The application of light and heavy forces did not show any statistically significant differences in hardness and elastic modulus when compared with untreated teeth. The inconsistent increase or decrease of Ca, P and F contents between control and experimental teeth at sites of compression and tension were difficult to explain. There was more resorption by volume in the heavy force group as compared with the light group and controls. Our data also suggested that the high-pressure zones might be more susceptible to resorption after 28 days of force application.

Physiological validation of the concept of glycemic load in lean young adults.

Dietary glycemic load, the mathematical product of the glycemic index (GI) of a food and its carbohydrate content, has been proposed as an indicator of the glucose response and insulin demand induced by a serving of food. To validate this concept in vivo, we tested the hypotheses that 1). portions of different foods with the same glycemic load produce similar glycemic responses; and 2). stepwise increases in glycemic load for a range of foods produce proportional increases in glycemia and insulinemia. In the first study, 10 healthy subjects consumed 10 different foods in random order in amounts calculated to have the same glycemic load as one slice of white bread. Capillary blood samples were taken at regular intervals over the next 2 h. The glycemic response as determined by area under the curve was not different from that of white bread for nine foods. However, lentils produced lower than predicted responses (P < 0.05). In the second study, another group of subjects was tested to determine the effects of increasing glycemic load using a balanced 5 x 5 Greco-Latin square design balanced for four variables: subject, dose, food and order. Two sets of five foods were consumed at five different glycemic loads (doses) equivalent to one, two, three, four and six slices of bread. Stepwise increases in glycemic load produced significant and predictable increases in both glycemia (P < 0.001) and insulinemia (P < 0.001). These findings support the concept of dietary glycemic load as a measure of overall glycemic response and insulin demand.

The impact of site specificity and needle manipulation on changes to pain pressure threshold following manual acupuncture: a controlled study.

OBJECTIVES: To investigate the contribution of two principal features that underlie traditional Chinese acupuncture: site specificity and application of needle manipulation. DESIGN: Thirteen volunteers completed a randomised, dual blind (subject and assessor) repeated measures study involving five interventions. Pressure pain threshold (PPT) was measured with an algometer, before and after intervention at 10 sites (acupoints and nonacupoints) across the body. INTERVENTIONS: Deep needling, with or without manual needle rotation, applied to the acupoint Large Intestine 4 (LI4) or to a nonacupoint located on the medial side of the second metacarpal. Inactive laser to LI4 was used as a control. All interventions were administered for 21 min. MAIN OUTCOME MEASURES: Percentage change in PPT from preintervention baseline at the 10 sites during the 18 min immediately following intervention. RESULTS: Statistically significant increases from preintervention PPT means were obtained at all 10 sites following needling of LI4 with manipulation compared with one site after needling LI4 without manipulation. Needling the nonacupoint led to statistically significant increases at six sites when manipulation was present compared with none in the absence of manipulation. No significant changes in mean PPT followed inactive laser. Needling LI4 with manipulation produced mean increases that were statistically significantly greater than those for the other interventions with one exception: needling the nonacupoint with manipulation was as effective as needling LI4 with manipulation at one measurement site only. CONCLUSIONS: Both manipulation and site of needling contributed significantly to the elevation of PPT following acupuncture. Distribution of effects on PPT did not support either neural segmental or Traditional Chinese Medicine channel theories. Psychological and physiological nonspecific effects appeared to play a minimal role in changes to PPT.

Postprandial hyperglycemia and insulin sensitivity differ among lean young adults of different ethnicities.

Both postprandial hyperglycemia and insulin resistance (IR) have implications for the development of cardiovascular disease. The present study was designed to examine differences in postprandial glycemia and insulin sensitivity among young adults of different ethnic origins. Lean, healthy subjects (n = 60) from five ethnic groups [20 European Caucasians, 10 Chinese, 10 South East (SE) Asians, 10 Asian Indians and 10 Arabic Caucasians] were matched for age, body mass index, waist circumference, birth weight and current diet. A 75-g white bread carbohydrate challenge was fed to assess postprandial glycemia and insulinemia. Insulin sensitivity was assessed in three groups by the euglycemic-hyperinsulinemic clamp and in all subjects by homeostasis model assessment (HOMA) modeling. Postprandial hyperglycemia (incremental area under the curve) and insulin sensitivity (M-value) both showed a twofold variation among the groups (P < 0.001) and were significantly related to each other (R(2) = 56%, P < 0.001). Young SE Asians had the highest postprandial glycemia and lowest insulin sensitivity, whereas European and Arabic Caucasian subjects were the most insulin sensitive and carbohydrate tolerant. These findings suggest that IR is evident even in lean, young adults of some ethnic groups and is associated with significant increases in postprandial glycemia and insulinemia in response to a realistic carbohydrate load.

The use of the Box-Behnken experimental design in the optimisation and robustness testing of a capillary electrophoresis method for the analysis of ethambutol hydrochloride in a pharmaceutical formulation.

Box-Behnken experimental designs do not appear to be extensively used in optimisation of analytical methods using capillary electrophoresis (CE). This paper describes the use of the Box-Behnken experimental design to optimise the factors affecting the separation of ethambutol hydrochloride (EB), its impurity 2-amino-1-butanol and the internal standard (phenylephrine hydrochloride) in a CE method for a pharmaceutical tablet assay. The three factors studied simultaneously were: buffer pH, buffer concentration and applied electric field, each at three levels. The method was optimised with respect to three responses: resolution between peaks, theoretical plate count and the migration time of the EB peak. A statistical programme, which applies a multiple response optimisation algorithm, was used to calculate and optimise the three responses simultaneously. The optimum conditions were established to be 58.0 mM sodium borate buffer at pH 9.50 and an applied electric field of 412 V/cm. The robustness of the method was also determined and confirmed using a second Box-Behnken design, as part of the validation exercise. System suitability values for the method were derived from the regression surface analysis. The CE method for a pharmaceutical tablet formulation was further validated according to current regulatory requirements, with respect to linearity and range, precision, specificity, accuracy and limit of quantitation. The optimised method gives a fast and efficient separation under 4 min, with complete resolution between the three peaks, and represents an improvement over the existing USP method. It can be concluded that the Box-Behnken experimental design provides a suitable means of optimising and testing the robustness of a CE pharmaceutical method.

Concentration and distribution of sialic acid in human milk and infant formulas.

BACKGROUND: In animal studies, sialic acid supplementation is associated with increases of gangliosides in the brain and improved learning ability. Only limited data are available on the sialic acid content of human milk and infant formulas. OBJECTIVE: We compared the concentrations of oligosaccharide-bound, protein-bound, and free sialic acid in milk from mothers of full-term and preterm infants and in a range of infant formulas. DESIGN: The milk from 20 and 14 mothers of full-term and preterm infants (mean gestational age: 31 +/- 3 wk), respectively, was collected at 4 stages of lactation (colostrum, transition, 1 mo, and 3 mo) and compared with 21 different infant formulas. RESULTS: Total sialic acid concentrations were highest in colostrum (x +/- SEM: 5.04 +/- 0.21 mmol/L in full term) and decreased by nearly 80% over the next 3 mo. Human milk from mothers of preterm infants contained 13-23% more sialic acid than did milk from mothers of full-term infants at 3 of the 4 lactation stages (P < 0.02). The sialic acid content of most formulas was <25% of that found in mature human milk (P < 0.01). Most of the sialic acid in the formulas ( approximately 70%) was bound to glycoproteins, whereas in human milk most sialic acid was bound to free oligosaccharides. CONCLUSIONS: Human milk, including milk from mothers of preterm infants, is a rich source of oligosaccharide-bound sialic acid, which contrasts with the relatively small amounts found in infant formulas. The nutritional significance of sialic acid is presently unknown, but it is plausible that it is a conditional nutrient that contributes to sialic acid accretion in the brain.

A longitudinal study of salivary sialic acid in preterm infants: Comparison of human milk-fed versus formula-fed infants.

We found that the saliva of preterm infants fed human milk contains twice the level of sialic acid as that in infants fed commercial formulas. The higher sialic acid level suggests greater viscosity and enhanced protection of the mucosal surfaces in breast-fed infants. Human milk itself is a rich source of sialylated oligosaccharides.

A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea.

Although there is increasing interest in the use of oral appliances to treat obstructive sleep apnea (OSA), the evidence base for this is weak. Furthermore, the precise mechanisms of action are uncertain. We aimed to systematically investigate the efficacy of a novel mandibular advancement splint (MAS) in patients with OSA. The sample consisted of 28 patients with proven OSA. A randomized, controlled three-period (ABB/BAA) crossover study design was used. After an acclimatization period, patients underwent three polysomnographs with either a control oral plate, which did not advance the mandible (A), or MAS (B), 1 wk apart, in either the ABB or BAA sequence. Complete response (CR) was defined as a resolution of symptoms and a reduction in Apnea/Hypopnea Index (AHI) to < 5/h, and partial response (PR) as a > or = 50% reduction in AHI, but remaining > or = 5/h. Twenty-four patients (19 men, 5 women) completed the protocol. Subjective improvements with the MAS were reported by the majority of patients (96%). There were significant improvements in AHI (30 +/- 2/h versus 14 +/- 2/h, p < 0.0001), MinSa(O(2)) (87 +/- 1% versus 91 +/- 1%, p < 0.0001), and arousal index (41 +/- 2/h versus 27 +/- 2/h, p < 0.0001) with MAS, compared with the control. The control plate had no significant effect on AHI and MinSa(O(2)). CR (n = 9) or PR (n = 6) was achieved in 62.5% of patients. The MAS is an effective treatment in some patients with OSA, including those patients with moderate or severe OSA.

The glycaemic index values of Vietnamese foods.

OBJECTIVE: To determine and compare the glycaemic index (GI) values of a range of Vietnamese foods in two racial groups. DESIGN AND SUBJECTS: Twelve healthy subjects (six Asian and six Caucasian) consumed 50 g carbohydrate portions of a reference food (glucose sugar) and nine Vietnamese foods (three rices, three noodle products and three sweet foods) in random order after an overnight fast. The reference food was tested on two separate occasions, and the Vietnamese foods were each tested once. Capillary blood samples were taken at time 0 (fasting), 15, 30, 45, 60, 90 and 120 min from the start of each meal. Samples were analysed for plasma glucose and the incremental areas under the plasma glucose curves (AUC) were used to calculate the GI values of the test foods, using glucose as the reference food (ie GI value of glucose=100). The mean GI value of each food was calculated for the entire group of subjects (n=12) and for both racial groups (n=6). RESULTS: The three rices had surprisingly high GI values (86-109), whereas the noodle products had relatively low GI values (39-61). The sugar-rich foods produced intermediate GI values (54-79). The GI values for the nine foods calculated separately for the two racial groups were not significantly different from each other (P=0.26). CONCLUSIONS: The GI values derived from Caucasian subjects are likely to be applicable to Asian populations. Varieties of imported rice from Thailand were found to have high GI values. Alternative low-GI staples, such as rice noodles, may be preferable for Asian/Vietnamese people with diabetes. SPONSORSHIP: This study was funded by the University of Sydney.