Improvement of metabolic control after 3-month use of real-time continuous glucose monitoring in patients with type 1 diabetes: a multicenter study in Greece.

PURPOSE: To assess the efficacy of a real-time continuous glucose monitoring (RT-CGM) system added to insulin pump therapy for 3 months, in sub-optimally controlled adults with type 1 diabetes mellitus (T1D). METHODS: This was a prospective, multicenter, non-randomized, post-market release study. A total of 43 adult patients with T1D on insulin pump therapy and inadequate glycemic control (HbA1c > 7.0%) participated in the study. The primary endpoint was the change from baseline HbA1c levels. Secondary objectives were to evaluate the impact of the RT-CGM system on glucose variability, daily insulin requirements, and the frequency of hypoglycemic and ketoacidosis events. RESULTS: At 3 months, the baseline HbA1c values decreased from 8.0 (7.6, 8.7) to 7.1 (6.7, 8.0) % (p < 0.001). Nineteen participants (44.2%) had a posttreatment HbA1c level ≤ 7%. Average total daily insulin requirements, as well as the average number of insulin boluses per day, increased significantly after the use of the RT-CGM system. The number of hypoglycemic events recorded did not differ between the first week and last week of RT-CGM usage, while no severe hypoglycemic episodes, ketoacidosis events, or hospitalizations related to diabetes occurred during the 3-month follow-up period. CONCLUSION: Addition of a RT-CGM system to insulin pump therapy for 3 months in inadequately controlled patients with T1D resulted in improved HbA1c levels, without increasing the risk of hypoglycemic events.

No considerable changes in papillary thyroid microcarcinoma characteristics over a 30-year time period.

BACKGROUND: The prevalence of papillary thyroid microcarcinoma (PTMC) is continuously increasing but its clinical significance and management is still debatable. The aim of this study was to investigate possible changes in the clinical presentation, tumor characteristics, treatment modalities and long-term outcome during the last three decades in patients with PTMC. METHODS: We studied 335 patients with PTMC who were followed up for at least 5 years, from 1982 to 2015, and treated in accordance with the current literature or guidelines at each time-period. Patients were classified according to year of diagnosis into two time periods, TP1 from 1982-2000 and TP2 from 2001-2010. RESULTS: The mean follow-up of the whole cohort was 10.6 ± 5.3 (median 9) years. No change was noted in the mean age at diagnosis or the female to male ratio during the two time periods. In regard to tumor characteristics, multifocality and non-encapsulated follicular variant of PTMC was more often present while classic PTMC was less common in patients in the TP2, compared to patients in the TP1 (p = 0.007, p < 0.001 and p = 0.043 respectively). The prevalence of incidental PTMC was high but similar in both time periods (84.6 vs 80 %, p = 0.286). The majority of patients in TP2 underwent a total or near total thyroidectomy compared to patients in TP1 (91.7 vs 80 %, p = 0.001). However, more patients underwent thyroidectomy for toxic multinodular disease and less for Graves' disease during TP1 compared to patients in the TP2 (p = 0.02 and 0.043 respectively). A significant percentage of patients underwent adjuvant radioiodine ablation, yet no difference was found between the two time periods (73.8 vs 79.5 %, p = 0.228). The rate of persistence was very low and not significant (3.1 vs 6.6 %, p = 0.165), while disease recurrence was observed in only 2 (0.6 %) patients, one from each time period. CONCLUSIONS: We did not observe any important changes regarding the clinical presentation or tumor characteristics of PTMCs during a 30-year period. With applied interventions a favorable course was confirmed in the majority of patients without differences in recurrence or persistence during the last three decades.

Shelf-life Reduction as an Emerging Problem in Cooked Hams Underlines the Need for Improved Preservation Strategies.

Cooked hams have gained an important position within the delicatessen market. Nowadays, consumers not only demand superior sensory properties but also request low levels of sodium and fat and the absence of conventional chemicals and preservatives used for the increase of the technological yield and shelf-life of the products. As a result, products that apply strict quality certificates or ''clean'' labels become increasingly important. However, such cooked hams suffer from a limited shelf-life. Besides some physicochemical effects, this is mainly due to microbial impact, despite the application of modified-atmosphere-packaging and chilling. Microbial spoilage is mostly due to the metabolic manifestation of lactic acid bacteria and Brochothrix thermosphacta, although Enterobacteriaceae and yeasts may occur too. Several preservation strategies have been developed to prolong the shelf-life of such vulnerable cooked meat products by targeting the microbial communities, with different rates of success. Whereas high-pressure treatments do not always pose a straightforward solution, a promising strategy relates to the use of bioprotective cultures containing lactic acid bacteria. The latter consist of strains that are deliberately added to the ham to outcompete undesirable microorganisms. Spoilage problems seem, however, to be specific for each product and processing line, underlining the importance of tailor-made solutions.

Interactions between bacterial isolates from modified-atmosphere-packaged artisan-type cooked ham in view of the development of a bioprotective culture.

Growth and metabolite production of three dominant bacterial isolates (Carnobacterium divergens 3M14, Leuconostoc carnosum 3M42, and Brochothrix thermosphacta RMS6) from modified-atmosphere-packaged (MAP), artisan-type cooked ham were assessed for their interactions in view of the development of a bioprotective culture. During monoculture experiments in cooked ham simulation medium, Leuc. carnosum 3M42 converted the available glucose into lactic acid and ethanol, whereas the two other strains produced additional metabolites such as acetic acid and 3-methyl-1-butanol. When grown in co-culture, Leuc. carnosum 3M42 suppressed the growth and metabolism of B. thermosphacta RMS6. In contrast, a co-culture of the latter bacterium with C. divergens 3M14 led to a variety of spoilage-related metabolic compounds. Subsequently, experiments with a commercial cooked ham product indicated that Leuc. carnosum 3M42 dominated the meat matrix and improved acceptability of the product over time, hence acting as a bioprotective culture for MAP, artisan-type cooked ham.

Technology-induced selection towards the spoilage microbiota of artisan-type cooked ham packed under modified atmosphere.

The microbiota associated with a highly-perishable Belgian artisan-type cooked ham was analyzed through plating and (GTG)(5)-fingerprinting of isolates throughout its processing chain. The raw tumbled meat was characterized by the presence of a versatile microbiota around 4.8 log(cfu g(-1)), consisting of lactic acid bacteria, staphylococci, Brochothrix thermosphacta, Gram-negative bacteria, and yeasts. Pasteurisation of the ham logs reduced bacterial counts below 2 log(cfu g(-1)) and subsequent manipulations selected for leuconostocs and carnobacteria. Also, B. thermosphacta and several Enterobacteriaceae were found at this stage. During storage in an intermediate high-care area for 2 days, a selection towards certain Enterobacteriaceae (Hafnia alvei, Enterobacter spp., and Pantoea agglomerans) and lactic acid bacteria (mainly vagococci and Streptococcus parauberis) was observed. B. thermosphacta, Leuconostoc carnosum and carnobacteria were also detected, but only after allowing bacterial outgrowth by incubating the meat logs at 7 degrees C for four weeks. After a mild post-pasteurisation process and subsequent handling, incubation of the meat logs at 7 degrees C for four weeks led to outgrowth of Enterobacteriaceae (mainly Enterobacter spp. and Serratia spp.). B. thermosphacta, and lactic acid bacteria (Enterococcus faecalis, Leuc. carnosum, and Carnobacterium maltaromaticum) were also found. After slicing and packaging under modified atmosphere, the microbiota of the refrigerated end-product consisted of leuconostocs, carnobacteria, and B. thermosphacta.

Volatile analysis of spoiled, artisan-type, modified-atmosphere-packaged cooked ham stored under different temperatures.

Metabolite production due to bacterial outgrowth and oxidation phenomena lead to spoilage development of cooked ham. Artisan-type products, with low salt concentrations and a minimum of additives, are particularly sensitive. Cold chain variations related to distribution and consumer habits have a negative influence on the shelf-life. In this study, sliced, modified atmosphere packaged artisan-type cooked ham was stored at different temperatures (4, 7, 12, and 26 degrees C). The evolution of volatiles over time for the different storage temperatures was monitored with static headspace gas chromatography/mass spectrometry (SH-GC-MS). The latter method was compared to solid phase microextraction (SPME). Several of the detected compounds could be ascribed to bacterial glucose and amino acid metabolism and their production was related to the storage temperature. The compounds 3-methyl butanol and ethanol were related with bacterial cell growth. Maillard-derived compounds, leading to the formation of furans, probably originated from endogenous reactions during cooking. Several detected aliphatic compounds probably originated from fatty acid oxidation reactions, including thermal fat degradation, chemical auto-oxidation, and enzymatic beta-oxidation.

Treating iodine deficiency: long-term effects of iodine repletion on growth and pubertal development in school-age children.

BACKGROUND: Iodine deficiency (ID) is still a major universal health problem. Iodine deficiency disorders (IDDs) affect people of all ages, among whom the most vulnerable are children and adolescents. The aim of the present study was to assess the long-term effects on growth and pubertal development of correcting severe ID in areas of Azerbaijan between 1999 and 2000. METHODS: Iodized oil was administered orally to 293,000 children, aged 6-16 years. Among those, 364 children were randomly selected and were examined 1 year before the administration of iodized oil (Group I-neg, iodine negative) and 295 children (Group I-Rx, iodine treated) were examined 4 years (Group I-R x 4, iodine treated 4 years later; n = 173) or 5 years (Group I-R x 5, iodine treated 5 years later; n = 122) after the last dose of iodide. RESULTS: In Group I-neg the median urine iodine concentration (UIC) (mcg/L) was 36 (mean: 36.272 +/- 11.036) and increased significantly (p < 0.001) in Group I-R x 4: 188 (mean: 230.969 +/- 155.818) and in Group I-R x 5: 175 (mean: 201.176 +/- 130.369). The prevalence of goiter was 99% in Group I-neg and 2% in Group I-R x 4. Children in Group I-Rx had a greater standard deviation score (SDS) for height (-0.1364 +/- 1.279, n = 294) than children in Group I-neg (-0.5019 +/- 1.17, n = 363) (p < 0.001, t = -3.817), which was more significant for boys. SDS for weight was similar in both groups (Group I-neg: -0.17 +/- 0.78, n = 363; Group I-Rx: -0.115 +/- 0.917, n = 294). The rate of puberty development as judged by the development of breast and pubic hair was normalized in both sexes after the correction of ID. CONCLUSIONS: Our results demonstrate that long-term correction of severe ID leads to sustained improvement of linear growth accompanied by a normalization of the time of onset of pubertal development for both sexes.