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Objective This study investigates the effect of food intake on 143 different biomarkers. Methods Twenty-two healthy subjects (11 male and 11 female aged 25.9 ± 4.2 years) were investigated. A total of 143 biomarkers were measured before a standardized meal as well as 30 and 120 minutes afterwards with the Proseek Multiplex Inflammation I, and Multiplex Organ Damage panels. Results The levels for 23 biomarkers were significantly (p

Objective To evaluates the effect of food intake on 92 oncological biomarkers to evaluate whether the timing of blood sampling could be relevant. Twenty-two healthy subjects were investigated. A total of 92 biomarkers were measured before a standardised meal as well as 30 and 120 min afterwards with the Proseek Multiplex Oncology II kit. Results The levels of 6 biomarkers decreased significantly (P Trial registration National Library of Medicine trial registration number NCT01027507 (retrospectively registered on December 8, 2009)

The aim of this study was to evaluate the diagnostic performance of color Doppler ultrasound (CDU) after stenting of superior mesenteric artery (SMA) stenosis using mean arterial pressure (MAP) gradients as a reference method.This is a prospective study. Thirty-one patients underwent 51 paired measurements of MAP gradients and CDU after endovascular intervention with endoprosthesis in the SMA for mesenteric atherosclerotic disease between March 2009 and July 2016.Peak systolic velocities (PSVs; r = 0.44, P = 0.001) and end-diastolic velocities (EDVs; r = 0.59, P 0.001) correlated with MAP gradients. The area under the receiver-operating characteristics curve for diagnosis of significant in-stent stenosis for different threshold values of PSV and EDV using MAP gradient of ≥10 mm Hg as reference was 0.75 and 0.80, respectively. Sensitivity and specificity for PSV3.3 m/s were 43.5% (95% confidence interval [CI] 23.2-63.7) and 92.9% (95% CI 83.3-100.0), respectively. Sensitivity and specificity for EDV0.50 m/s were 63.6% (95% CI 43.5-83.7) and 92.3% (95% CI 82.1-100.0), respectively. Specificity and positive predictive value were both 100% for combined PSV3.0 m/s and EDV0.5 m/s.PSV and EDV were equally useful in evaluation of significant SMA stent stenosis, when using trans-stenotic MAP gradient as reference. Finding of a significant stenosis on CDU should be considered as a true significant SMA stent stenosis.

Objectives: The present study evaluates the effect of food intake on 90 biomarkers for cardiovascular disease (CVD) and inflammation with the Proseek Multiplex CVD II kit. Methods: Twenty-two healthy subjects (11 male and 11 females aged 25.9±4.2 years) were investigated. A total of 90 biomarkers were measured before a standardized meal, 30 and 120 minutes thereafter with the Proseek Multiplex CVD II kit. Results: The levels for 27 biomarkers changed significantly after food intake. Two biomarkers increased 120 minutes after food intake, five biomarkers decreased 30 minutes after food intake, seven biomarkers decreased 120 minutes after food intake, and 13 biomarkers decreased both 30 and 120 minutes after food intake. Fourteen biomarkers changed 10% or more after food intake, all 120 minutes after food intake: Heat shock 27 kDa protein (10%), Proto-oncogene tyrosine-protein kinase Src (13%), Growth hormone (13%), Carbonic anhydrase 5A, mitochondrial (14%), Carcinoembryonic antigen related cell adhesion molecule 8 (15%), Fatty acid-binding protein, intestinal (16%), Pentraxin-related protein PTX3 (17%), Fibroblast growth factor 21 (18%), C-C motif chemokine 3 (25%), 2,4-dienoyl-CoA reductase, mitochondrial (28%), Gastrotropin (36%), Poly [ADP-ribose] polymerase 1 (37%), Interleukin-6 (42%), and Melusin (52%). Conclusions: The present study shows that food intake affects several different biomarkers analyzed with the Proseek Multiplex CVD II kit, and the effect is at times substantial. Timing of blood sampling in relation to food intake, therefore, appears to be a major concern. Further studies are warranted in older healthy subjects and in patients with various cardiac diseases to determine whether the findings are reproducible.

Systolic tissue Doppler measurements (s') have been used to measure the velocity in myocardial motion and are a valuable tool for evaluating the systolic function of the left and right ventricles. Digestion of food is known to significantly alter hemodynamics and may therefore affect s'. The effect of food intake on s' parameters has not yet been studied. We assessed whether s' is affected by food intake. Nineteen healthy subjects aged 26·2 ± 4·2 years were investigated. s' was measured with pulsed tissue Doppler imaging in the right and left ventricles before the subjects ate a standardized meal and also 30 and 110 min after the meal. Three measurements were taken in each projection, and a mean value was calculated for each. s' increased significantly (P

Objective: The present study evaluates the effect of food intake on 92 biomarkers for cardiovascular disease (CVD). Methods: Twenty two healthy subjects (11 male and 11 female aged 25.9±4.2 years) were investigated. A total of 92 biomarkers were measured before a standardized meal as well as 30 and 120 minutes afterwards with the Proseek Multiplex CVD III kit. Results: The levels for eight biomarkers decreased significantly (P

Background Myocardial performance index (MPI) has been investigated in a variety of populations, but the effect of food intake has not been evaluated. We assessed whether myocardial performance index is affected by food intake in healthy subjects. Methods Twenty-three healthy subjects aged 25.6 ± 4.5 years were investigated. MPI was measured before, 30 min after, and 110 min after a standardized meal. Results MPI decreased significantly (P

Objective: This study evaluates the effect of food intake on commonly used pulsed Doppler and tissue Doppler measurements. Methods: Twenty-three healthy subjects aged 25.6 ± 4.5 years were investigated. A wide selection of pulsed Doppler and tissue Doppler variables were measured before a standardized meal as well as and 30 and 110 minutes afterwards. Results: The following variables increased significantly (P 0.05) changes in E/A, early diastolic tissue Doppler velocities (e'), and E/e'. Most, but not all variables returned to baseline values 110 minutes after food intake. Conclusions: This study shows that food intake affects several echocardiographic variables used to routinely assess diastolic function and hemodynamics. Further studies are warranted in older healthy subjects and in patients with various cardiac diseases to determine whether the findings are reproducible in such populations. (Echocardiography, 2011;**:1-5). (Less)

BACKGROUND: A previous study of healthy subjects showed that intake of 6 g cinnamon with rice pudding reduced postprandial blood glucose and the gastric emptying rate (GER) without affecting satiety. OBJECTIVE: The objective was to study the effect of 1 and 3 g cinnamon on GER, postprandial blood glucose, plasma concentrations of insulin and incretin hormones [glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1)], the ghrelin response, and satiety in healthy subjects. DESIGN: GER was measured by using real-time ultrasonography after ingestion of rice pudding with and without 1 or 3 g cinnamon. Fifteen healthy subjects were assessed in a crossover trial. RESULTS: The addition of 1 or 3 g cinnamon had no significant effect on GER, satiety, glucose, GIP, or the ghrelin response. The insulin response at 60 min and the area under the curve (AUC) at 120 min were significantly lower after ingestion of rice pudding with 3 g cinnamon (P = 0.05 and P = 0.036, respectively, after Bonferroni correction). The change in GLP-1 response (DeltaAUC) and the change in the maximum concentration (DeltaC(max)) were both significantly higher after ingestion of rice pudding with 3 g cinnamon (P = 0.0082 and P = 0.0138, respectively, after Bonferroni correction). CONCLUSIONS: Ingestion of 3 g cinnamon reduced postprandial serum insulin and increased GLP-1 concentrations without significantly affecting blood glucose, GIP, the ghrelin concentration, satiety, or GER in healthy subjects. The results indicate a relation between the amount of cinnamon consumed and the decrease in insulin concentration.

Pelle G Lindqvist1,3, Jelena Torsson2, Åsa Almqvist1, Ola Björgell21Department of Obstetrics and Gynecology; 2Radiology, Malmö University Hospital, Lund University, Malmö, Sweden; 3Department of Obstetrics and Gynecology, Karolinska Hospital, Huddinge, SwedenBackground: Pregnancy-related venous thromboembolism (VTE) is a major cause of maternal morbidity and mortality. A new risk assessment model for VTE in relation to pregnancy has been introduced in Sweden. We wished to determine the proportion of preventable VTE cases if the model had been in use and make a brief cost-benefit analysis.Methods: A hospital-based retrospective case-control study of all postpartum thromboembolic instances of deep venous thrombosis and pulmonary embolisms during a 16-year period. Large anamnestic risk factors at the time of delivery were assessed. We correlated the findings with the new Swedish guidelines for thromboprophylaxis.Results: We found 37 cases of postpartum VTE during the study period. Nineteen of all VTE cases (51%) and eight out of eleven of cases of pulmonary embolism (73%) had two or more large anamnestic risk factors, ie, they would have been subjected to thromboprophylaxis if the new guidelines had been used. The cost of each preventable VTE was lower than treating a VTE.Conclusion: Approximately one-half of postpartum VTE cases and 70% of pulmonary emboli cases have at least two large risk factors and might be preventable using the new algorithm. From the perspective of the health care system the new recommendations appears to be cost-effective.Keywords: thromboprophylaxis, low molecular weight heparin, scoring system, health care financing, ultrasonography, phlebography

Background: Previous studies of patients with type 2 diabetes showed that cinnamon lowers fasting serum glucose, triacylglycerol, and LDL- and total cholesterol concentrations. Objective: We aimed to study the effect of cinnamon on the rate of gastric emptying, the postprandial blood glucose response, and satiety in healthy subjects. Design: The gastric emptying rate (GER) was measured by using standardized real-time ultrasonography. Fourteen healthy subjects were assessed by using a crossover trial. The subjects were examined after an 8-h fast if they had normal fasting blood glucose concentrations. GER was calculated as the percentage change in the antral cross-sectional area 15-90 min after ingestion of 300 g rice pudding (GER1) or 300 g rice pudding and 6 g cinnamon (GER2). Results: The median value of GER 1 was 37%, and that of GER2 was 34.5%. The addition of cinnamon to the rice pudding significantly delayed gastric emptying and lowered the postprandial glucose response (P < 0.05 for both). The reduction in the postprandial blood glucose concentration was much more noticeable and pronounced than was the lowering of the GER. The effect of cinnamon on satiety was not significant. Conclusions: The intake of 6 g cinnamon with rice pudding reduces postprandial blood glucose and delays gastric emptying without affecting satiety. Inclusion of cinnamon in the diet lowers the postprandial glucose response, a change that is at least partially explained by a delayed GER. (Less)

Limited deep tissue defects in the elbow area can occur after burns, advanced bursitis, and inflammatory processes, to name a few. Reconstruction is complicated because sufficient tissue with adequate elasticity and strength has to be transferred. Often major surgical procedures such as free tissue transfer are considered. A novel method for reconstruction of deep tissue defects in the elbow area, based on a single perforator artery and vein, is described. Perforator vessels are identified preoperatively using color Doppler ultrasonography, and a flap from the upper arm is rotated 180 degrees. The authors describe the successful treatment of two patients. The surgical technique is comparatively simple and can be performed with regional anesthesia. Postoperative recovery is short and skin sensibility is retained. The authors suggest that local, single perforator flaps can be considered as a first alternative in treatment of limited, deep tissue defects in the elbow area, especially for elderly or severely ill patients.

To compare scintigraphic measurements of total stomach emptying of a semisolid meal with ultrasonographic measurements of changes in antral area as estimates of antral emptying in type 1 diabetic patients.Eleven patients with insulin-dependent diabetes mellitus were studied with simultaneous measurements of gastric emptying by scintigraphy and ultrasonography. Patients were imaged immediately after ingestion (time 0) and every 15 minutes over 120 minutes. The gastric emptying rate was expressed as percent reduction in antral cross-sectional area from 15 to 90 minutes after meal ingestion.Ultrasonographic measurements showed a postprandial maximal antral area at 15 minutes, continuously decreasing with time, and reaching a plateau 45 to 90 minutes after the end of meal ingestion, whereas the scintigraphic counts attained their maximum immediately after the meal and began to fall thereafter. Between 15 and 90 minutes, the residual radioactivity and antral ultrasonographically measured distension curves were concordant. The curves then showed a tendency toward deviation for the last 15 minutes (median, 51% versus 59% at 105 minutes and 40% versus 57% at 120 minutes, respectively). A strong significant correlation could be seen between the ultrasonographic gastric emptying rate and scintigraphic half-time values (r = -0.94; P.001). Comparing scintigraphic and ultrasonographic half-time values showed a systematic measurement error of 9.9 minutes and a random measurement error of 18.6 minutes.The use of standardized real-time ultrasonography to determine the gastric emptying rate of semisolid meals in diabetic patients, with the use of the change in gastric antral cross-sectional area in a single section of the stomach 15 and 90 minutes postprandially, offers a valid method for clinical practice.

Objective: This study evaluates the effect of food intake on 92 neurological biomarkers in plasma. Moreover, it investigated if any of the biomarkers were correlated with body mass index. Materials and Methods: Twenty-two healthy subjects (11 male and 11 female aged 25.9 ± 4.2 years) were investigated. A total of 92 biomarkers were measured before a standardized meal as well as 30 and 120 min afterward with the Proseek Multiplex Neurology I kit. Results: The levels for 13 biomarkers decreased significantly (p < .001) 30 min after food intake. The levels for four biomarkers remained significantly decreased (p < .001) 120 min after food intake. One biomarker increased significantly (p < .001) 30 min after food intake. The changes were between 1% and 12%, with an average difference of about 5%. Only one biomarker showed a difference over 10% due to food intake. The biggest difference was observed for Plexin-B3 120 min after food intake (12%). Of all the 92 neurological biomarkers, only one was correlated with BMI, Kynureninase r = .46, p < .05. Conclusions: This study shows that food intake has a very modest effect on 92 different neurological biomarkers. Timing of blood sampling in relation to food intake, therefore, appears not to be a major concern. Only Kynureninase was correlated with BMI. Further studies are warranted in older healthy subjects and in patients with various neurological diseases to determine whether the findings are reproducible in such populations. (Less)

To investigate associations between combined hormonal contraception and progestogen-only contraception and risks of venous thromboembolism by progestogen and carriership of genetic hemostatic variations.This was a case-control study in Sweden carried out between 2003 and 2009, which included 948 patients with venous thromboembolism and 902 individuals in a control group, all aged 18-54 years. Information was obtained by telephone interviews and DNA analyses of blood samples. Radiologic referrals were used for case ascertainment. For comparisons, odds ratios were estimated by unconditional logistic regression analysis adjusting for smoking, body mass index (BMI), and immobilization.The odds ratio (OR) for current use of combined hormonal contraception was 5.3 (95% confidence interval [CI] 4.0-7.0). Desogestrel combinations had the highest OR (11.4, 95% CI 6.0-22.0). The OR for injection of medroxyprogesterone acetate was 2.2 (95% CI 1.3-4.0). In users of combined hormonal contraception with the factor V Leiden mutation, the OR was 20.6 (95% CI 8.9-58). In women who used progestogen-only contraception and carried the factor V Leiden mutation, the OR was 5.4 (95% CI 2.5-13).Risks of venous thromboembolism in association with combined hormonal contraception vary by type of progestogen and independently of BMI and smoking. Thrombophilic genotypes such as factor V Leiden increase risks of venous thromboembolism in users of combined hormonal contraception. Except for injection of medroxyprogesterone acetate, progestin-only contraception seems to be the least thrombogenic hormonal contraception for women carrying genetic hemostatic variations.II.

This prospective, double-blind trial was performed to determine whether 4 weeks' prophylaxis with enoxaparin after total hip replacement (THR) is more effective in protecting against deep vein thrombosis (DVT) than prophylaxis during hospitalization. Two hundred sixty-two patients undergoing THR were given enoxaparin 40 mg once daily during hospitalization (9 ± 2 days) before being randomized at discharge to continue enoxaparin (N=131) or receive placebo (N=131) for a total of 1 month (30 ± 4 days). According to intention-to-treat analysis, 43 DVT and 2 pulmonary emboli (PE) occurred in the placebo group (34.4%) versus 21 DVT and no PE in the enoxaparin group (P

Objective: Left ventricular wall stress has been investigated in a variety of populations, but the effect of food intake has not been evaluated. We assessed whether left ventricular wall stress is affected by food intake in healthy subjects. Methods: Twenty-three healthy subjects aged 25.6 +/- 4.5 years were investigated. Meridional end-systolic wall stress (ESS) and circumferential end-systolic wall stress (cESS) were measured before, 30 minutes after, and 110 minutes after a standardised meal. Results: Both ESS and cESS decreased significantly (P < 0.001) from fasting values 30 minutes after the meal, and had not returned to baseline after 110 minutes. ESS decreased from 65 +/- 16 kdynes/cm(2) (fasting) to 44 +/- 12 kdynes/cm(2) 30 minutes after, and to 58 +/- 13 kdynes/cm(2) 110 minutes after eating. cESS decreased from 98 +/- 24 kdynes/cm(2) to 67 +/- 18 kdynes/cm(2) 30 minutes after, and to 87 +/- 19 kdynes/cm(2) 110 minutes after the meal. Conclusion: This study shows that left ventricular wall stress is affected by food intake in healthy subjects.

Nonfilling of contrast in deep veins on phlebography is claimed to be an indirect sign of deep vein thrombosis (DVT) by some authors but rejected by others. The aim of this study was to prospectively assess, with color Doppler ultrasound (CDU), the occurrence and distribution of DVT in isolated, nonfilling, deep vein segments seen on a phlebo gram. One hundred consecutive patients with clinical signs of acute DVT, in whom phle bography displayed nonfilling of the posterior tibial veins and/or the deep calf muscle veins, were examined with CDU on the same occasion. Ultrasound confirmed a DVT in 31 (31%) patients; in another 38 (38%) patients other pathology, without concomitantly detected DVT, such as edema, bleedings, ligament and muscle ruptures, Baker cysts, or superficial thrombophlebitis were found instead; and in the remaining 31 (31%) patients no pathology that could explain the nonfilling was identified. Isolated, nonfilling of the posterior tibial and/or deep muscle veins of the calf found by phlebography may be an indirect sign of DVT but is equally commonly caused by other pathological conditions or arises without any detectable explanation. When the thrombotic burden is to be scored, and to facilitate the establishment of the correct diagnosis, additional CDU is recom mended when isolated nonfilling is present.

SummaryResistance to activated protein C due to FV:R 506Q mutation is the most common known genetic risk factor for deep leg vein thrombosis (DVT). The aim of this prospective study was to describe and compare the location and extent of DVT, reflected by a scoring system, in a group of patients with and without FV:R 506Q mutation. Of 247 consecutively included patients undergoing phlebography 105 had a DVT, 36 (35%) in the FV:R 506Q mutation group and 69 (65%) in the non-FV:R 506Q mutation group. Compared to the non-FV:R 506Q mutation group there was a significant increase in the incidence of DVT in the FV:R 506Q mutation group (p = 0.041, OR = 1.79 [1.02–3.15]), a significantly lower mean DVT score of the iliofemoral vein segments (p = 0.0081) and a significantly lower incidence of DVT in the iliofemoral vein segments (p = 0.007, OR = 10.6 [1.3–83.3]), 1/36 (2.8%) compared to 16/69 (23.2%). As controls 288 blood donors were included, with and without FV:R 506Q mutation and with no history of DVT in order to evaluate risk factors of DVT. The odds ratio of an iliofemoral DVT was 0.5 ([0.06–3.90), p = 0.50]) when FV:R 506Q mutation was present, compared to the control group, and at locations below the iliofemoral segments 5.28 ([3.01–9.28], p = less than 0.0001). Our findings provide the basis of a detailed phlebographic description and for the first time, to our best knowledge, shows a specific phlebographic pattern that may be linked to an inherited hypercoagulable state.

The scoring system most commonly used to date to describe the thrombotic burden of deep vein thrombosis (DVT) excludes several deep vein segments and is thereby of limited use in research. The aim of this prospective, comparative study was to develop a new scoring and distribution system that would include all major deep veins of the leg and pelvis. In total, 247 consecutive patients were included, of whom 105 had a positive phlebography. The positive phlebographies were registered in the new system and the result was compared with that obtained by the Marder system. In 72% (76/105) of the patients the DVT distribution was not completely described and the thrombotic burden was significantly underestimated by the Marder system. Of these, 12% (13/105) were not scored at all, thus representing false-negative investiga tions. It was possible to score all DVTs and important vein segments of these patients with the new system. The scoring system previously used excludes several deep vein segments. A description of the important vein segments, where DVT is shown to originate and propagate, is mandatory in a scoring system designed for the purpose of research of DVT and later detected deep vein insufficiency. The new system meets this demand.

OBJECTIVES: To evaluate the recurrence rate after deep calf-vein thrombosis treated with 6 weeks of oral anticoagulation. DESIGN AND SUBJECTS: A 2 year follow-up of 126 consecutive patients admitted to the Department of Internal Medicine with venographically verified deep calf-vein thrombosis. RESULTS: One hundred and twenty-six patients were treated with warfarin for 6 weeks, 18 of them having had a previous episode of venous thrombosis (DVT). Eleven patients (8.7%) suffered a recurrent thromboembolic episode within 2 years, four of which were within the first 3 months. Eight of those without a history of DVT had a recurrence (7.4%). Three of these were activated protein C (APC)-resistant, one was protein C-deficient and one had malignant melanoma. Eight patients (6.3%) reported minor haemorrhagic complications, but no major bleeding was seen. CONCLUSION: Our data support the use of a 6 week regimen of secondary oral prophylaxis after a first episode of deep calf-vein thrombosis in patients without a permanent risk factor. Whether individuals with inherited thrombophilia require prolonged treatment remains to be evaluated.

SummaryResistance to activated protein C (APC) caused by the R506Q mutation in factor V is the most common inherited risk factor for venous thrombosis. To elucidate whether APC-resistance is a risk factor for venous thrombosis after elective total hip replacement, the association between APC-resistance (presence of FV:Q506 allele) and postoperative thrombosis was investigated in patients (n = 198) randomised to received short (during hospitalisation, n = 100) or prolonged prophylaxis (three weeks after hospitalisation, n = 98) with low molecular weight heparin (LMWH). Among APC-resistant individuals receiving short prophylaxis, 7/10 developed thrombosis as compared to 2/12 receiving long prophylaxis (p

Background Ingestion of a meal increases the blood flow to the gastrointestinal organs and affects the heart rate (HR), blood pressure and cardiac output (CO), although the mechanisms are not known. The aim of this study was to evaluate the effect of endogenously released glucose, insulin, glucagon-like peptide 1 (GLP-1), ghrelin on CO, HR, stroke volume (SV), and blood pressure. Methods Eleven healthy men and twelve healthy women ((mean ± SEM) aged: 26 ± 0.2 y; body mass index: 21.8 ± 0.1 kg/m2)) were included in this study. The CO, HR, SV, systolic and diastolic blood pressure, antral area, gastric emptying rate, and glucose, insulin, GLP-1 and ghrelin levels were measured. Results The CO and SV at 30 min were significantly higher, and the diastolic blood pressure was significantly lower, than the fasting in both men and women (P < 0.05). In men, significant correlations were found between GLP-1 level at 30 min and SV at 30 min (P = 0.015, r = 0.946), and between ghrelin levels and HR (P = 0.013, r = 0.951) at 110 min. Significant correlations were also found between the change in glucose level at 30 min and the change in systolic blood pressure (P = 0.021, r = -0.681), and the change in SV (P = 0.008, r = -0.748) relative to the fasting in men. The insulin 0-30 min AUC was significantly correlated to the CO 0-30 min AUC (P = 0.002, r = 0.814) in men. Significant correlations were also found between the 0-120 min ghrelin and HR AUCs (P = 0.007, r = 0.966) in men. No statistically significant correlations were seen in women. Conclusions Physiological changes in the levels of glucose, insulin, GLP-1 and ghrelin may influence the activity of the heart and the blood pressure. There may also be gender-related differences in the haemodynamic responses to postprandial changes in hormone levels. The results of this study show that subjects should not eat immediately prior to, or during, the evaluation of cardiovascular interventions as postprandial affects may affect the results, leading to erroneous interpretation of the cardiovascular effects of the primary intervention. Trial registration number NCT01027507

This study evaluates the effect of food intake on commonly used pulsed Doppler and tissue Doppler measurements.Twenty-three healthy subjects aged 25.6 ± 4.5 years were investigated. A wide selection of pulsed Doppler and tissue Doppler variables were measured before a standardized meal as well as and 30 and 110 minutes afterwards.The following variables increased significantly (P0.05) 30 minutes after food intake: left ventricular stroke volume, left ventricular cardiac output, left ventricular outflow velocity-time integral, peak of early diastolic (E) and late diastolic (A) mitral flow velocities, pulmonary vein peak velocities in systole (S) and in diastole (D), S/D, pulsed tissue Doppler peak systolic velocities, and late diastolic velocities. Deceleration time of E-wave decreased significantly (P0.05). The change in measured variables between fasting and 30 minutes after the food intake ranged from 7% to 28%. There were no significant (P0.05) changes in E/A, early diastolic tissue Doppler velocities (e'), and E/e'. Most, but not all variables returned to baseline values 110 minutes after food intake.This study shows that food intake affects several echocardiographic variables used to routinely assess diastolic function and hemodynamics. Further studies are warranted in older healthy subjects and in patients with various cardiac diseases to determine whether the findings are reproducible in such populations.

Background The intake of dietary fibre has been shown to reduce the risk of developing diabetes mellitus. The aim of this study was to compare the effects of commercial rye whole-meal bread containing whole kernels and white wheat bread on the rate of gastric emptying and postprandial glucose response in healthy subjects. Methods Ten healthy subjects took part in a blinded crossover trial. Blood glucose level and gastric emptying rate (GER) were determined after the ingestion of 150 g white wheat bread or 150 g whole-meal rye bread on two different occasions after fasting overnight. The GER was measured using real-time ultrasonography, and was calculated as the percentage change in antral cross-sectional area 15 and 90 minutes after completing the meal. Results No statistically significant difference was found between the GER values or the blood glucose levels following the two meals when evaluated with the Wilcoxon signed rank sum test. Conclusion The present study revealed no difference in postprandial blood glucose response or gastric emptying after the ingestion of rye whole-meal bread compared with white wheat bread. Trial registration NCT00779298

Products enriched with oat beta-glucan have been shown to reduce postprandial glucose and insulinemic responses. The aim of this study was to evaluate the effect of an extruded muesli product based on oat beta-glucan on the rate of gastric emptying, postprandial blood glucose and satiety in healthy subjects.Gastric emptying rate (GER) was measured by standardized real-time ultrasonography. Twelve healthy subjects were assessed using a randomized crossover double blind trial. The meals were administered after 8 hours' fasting after measuring the subject's normal fasting blood glucose level. Blood glucose measurements were made before, 30 and 60 min after the end of the meal. Satiety scores were estimated 15 and 90 min after the end of the meal. The GER was calculated as the percentage change in the antral cross-sectional area 15 and 90 minutes after ingestion of vanilla yoghurt with muesli containing 4 g oat beta-glucan (GER1) or vanilla yoghurt with muesli containing cornflakes (GER2).The median values were 60% for GER1 and 44% for GER2. The effect of 4 g oat beta-glucan on the rate of gastric emptying was not statistically significant compared with corn flakes. Muesli with 4 g oat beta-glucan lowered the postprandial glucose response significantly compared to the cornflakes meal (p = 0.045). The effect of oat beta-glucan on satiety was not statistically significantly.The results of this study suggest that intake of muesli with 4 g oat beta-glucan does not affect the gastric emptying rate or satiety but lowers the postprandial blood glucose response, indicating that the GER does not regulate the blood glucose level.

Background Maintenance of the botanical integrity of cereal kernels and the addition of acetic acid (as vinegar) in the product or meal has been shown to lower the postprandial blood glucose and insulin response and to increase satiety. However, the mechanism behind the benefits of acetic acid on blood glucose and satiety is not clear. We hypothesized that the gastric emptying rate could be involved. Thus, the aim of this study was to evaluate the possible influence of maintained botanical integrity of cereals and the presence of acetic acid (vinegar) on gastric emptying rate (GER), postprandial blood glucose and satiety. Methods Fifteen healthy subjects were included in a blinded crossover trial, and thirteen of the subjects completed the study. Equicarbohydrate amounts of the following wheat-based meals were studied: white wheat bread, whole-kernel wheat bread or wholemeal wheat bread served with white wine vinegar. The results were compared with a reference meal consisting of white wheat bread without vinegar. The GER was measured with standardized real-time ultrasonography using normal fasting blood glucose Results The whole-kernel wheat bread with vinegar resulted in significantly higher ( Conclusion The present study shows higher satiety after a whole-kernel wheat bread meal with vinegar. This may be explained by increased antral distension after ingestion of intact cereal kernels but, in this study, not by a lower gastric emptying rate or higher postprandial blood glucose response. Trial registration NTR1116

Background Previous studies on healthy people show that vinegar delays gastric emptying and lowers postprandial blood glucose and insulin levels. The aim of this study was to investigate the effect of apple cider vinegar on delayed gastric emptying rate on diabetes mellitus patients. Methods Ten patients with type 1 diabetes and diabetic gastroparesis, including one patient who had undergone vagotomy, were included and completed the investigator blinded crossover trial. The gastric emptying rate (GER) was measured using standardized real-time ultrasonography. The GER was calculated as the percentage change in the antral cross-sectional area 15 and 90 minutes after ingestion of 300 g rice pudding and 200 ml water (GER1), or 300 g rice pudding and 200 ml water with 30 ml apple cider vinegar (GER2). The subjects drank 200 ml water daily before breakfast one week before the measurement of GER1. The same subjects drank 200 ml water with 30 ml vinegar daily before breakfast for two weeks before the measurement of GER2. Results The median values of GER1 and GER2 were 27% and 17%, respectively. The effect of vinegar on the rate of gastric emptying was statistically significant (p < 0.05). Conclusion This study shows that vinegar affects insulin-dependent diabetes mellitus patients with diabetic gastroparesis by reducing the gastric emptying rate even further, and this might be a disadvantage regarding to their glycaemic control. Trial registration number ISRCTN33841495.

Background Dietary fibre food intake is related to a reduced risk of developing diabetes mellitus. However, the mechanism of this effect is still not clear. The aim of this study was to evaluate the effect of commercial fibre cereals on the rate of gastric emptying, postprandial glucose response and satiety in healthy subjects. Methods Gastric emptying rate (GER) was measured by standardized real time ultrasonography. Twelve healthy subjects were assessed using a randomized crossover blinded trial. The subjects were examined after an 8 hour fast and after assessment of normal fasting blood glucose level. Satiety scores were estimated and blood glucose measurements were taken before and at 0, 20, 30, 40, 60, 80, 100 and 120 min after the end of the meal. GER was calculated as the percentage change in the antral cross-sectional area 15 and 90 min after ingestion of sour milk with corn flakes (GER1), cereal bran flakes (GER2) or wholemeal oat flakes (GER3). Results The median value was, respectively, 42% for GER1, 33 % for GER2 and 51% for GER3. The difference between the GER after ingestion of bran flakes compared to wholemeal oat flakes was statistically significant (p = 0.023). The postprandial delta blood glucose level was statistically significantly lower at 40 min (p = 0.045) and 120 min (p = 0.023) after the cereal bran flakes meal. There was no statistical significance between the areas under the curve (AUCs) of the cereals as far as blood glucose and satiety were concerned. Conclusion The result of this study demonstrates that the intake of either bran flakes or wholemeal oat flakes has no effect on the total postprandial blood glucose response or satiety when compared to corn flakes. However, the study does show that the intake of cereal bran flakes slows the GER when compared to oat flakes and corn flakes, probably due to a higher fibre content. Since these products do not differ in terms of glucose response and satiety on healthy subjects, they should be considered equivalent in this respect. Trial registration ISRCTN90535566

Objectives The aim of the present study was to evaluate weather early supervised exercise improves recanalization of acute deep vein thrombosis (DVT) and reduces symptoms. Patients and methods From September 2001 to March 2004, of 381 patients, 72 eligible patients were included and with a mean age 54 +/- 14 years, 39 (52%) men with deep vein thrombosis ( DVT) proven with phlebography were randomized to: an exercise group (n = 36) receiving routine anticoagulation, class II compression stockings and additionally supervised exercise and a control group ( n = 36) receiving the same therapy but no exercise. Patients were followed-up during six months. Phlebography was scored initially and at six-months. Results There were at inclusion no differences between the two groups regarding age, body weight, body mass index (BMI), calf circumference of the affected leg, and overall quality of life estimated by visual analog scale ( VAS)-scale. In both groups there were significant reductions regarding calf circumference in the affected leg compared to the inclusion time, both at one-month ( P = 0.0012) and six month ( P = 0.0002) follow-up. The degree of recanalization of the affected venous segments was high and did not differ between groups. There were no recurrent DVT or pulmonary emboli or other treatment complications in any individual during the six-month follow-up period. Conclusions Early exercise did not acutely exacerbate the risk of complications in patients with DVT. No benefits of early exercise were seen regarding the degree of recanalization of the thrombi, or faster resolution of pain or swelling. Nevertheless, our study shows that early exercise/ambulation is safe in combination with anticoagulation and compression stockings for the majority of patients with DVT.

Background Oxytocin is released in response to a meal. Further, mRNA for oxytocin and its receptor have been found throughout the gastrointestinal (GI) tract. The aim of this study was therefore to examine whether oxytocin, or the receptor antagonist atosiban, influence the gastric emptying. Methods Ten healthy volunteers (five men) were examined regarding gastric emptying at three different occasions: once during oxytocin stimulation using a pharmacological dose; once during blockage of the oxytocin receptors (which also blocks the vasopressin receptors) and thereby inhibiting physiological doses of oxytocin; and once during saline infusion. Gastric emptying rate (GER) was assessed and expressed as the percentage reduction in antral cross-sectional area from 15 to 90 min after ingestion of rice pudding. The assessment was performed by real-time ultrasonography. At the same time, the feeling of satiety was registered using visual satiety scores. Results Inhibition of the binding of endogenous oxytocin by the receptor antagonist delayed the GER by 37 % compared to saline (p = 0.037). In contrast, infusion of oxytocin in a dosage of 40 mU/min did not affect the GER (p = 0.610). Satiation scores areas in healthy subjects after receiving atosiban or oxytocin did not show any significant differences. Conclusion Oxytocin and/or vasopressin seem to be regulators of gastric emptying during physiological conditions, since the receptor antagonist atosiban delayed the GER. However, the actual pharmacological dose of oxytocin in this study had no effect. The effect of oxytocin and vasopressin on GI motility has to be further evaluated.

A questionnaire revealed that nearly 40 000 examinations of clinically suspected deep venous thrombosis (DVT) were performed in Sweden in 2001, with a slight predominance of phlebographies. In about two thirds of all cases the deep muscle veins of the calf were included in the interpretation when phlebography was performed, but in less than one fifth when Doppler sonography (CDU) was used. In more than half of the cases a negative CDU was not followed by phlebograghy. On the other hand, the combination of CDU and phlebography was routinely used in nearly two thirds of all ambiguous cases. The interpretation of nonfiling of contrast medium in vein segments on phlebography varied from DVT to no DVT. Most of the phlebographies were performed with digital X-ray technique.

SummaryA first clinical evaluation has been made of the performance of a newly devised immunofluorometric assay for measuring plasma concentrations of activated protein C (APC) in complex with protein C inhibitor (PCI). The method was compared with testing for other markers of hypercoagulability in a case-control study comprising 123 patients with clinical suspicion of deep vein thrombosis (DVT). The diagnosis was confirmed by ascending phlebography, and the thrombotic burden estimated with a newly developed scoring system. Receiver operating characteristics (ROC) curves calculated to demonstrate the discriminatory capacity of the methods, showed the area under the curves (AUCs) to be similar for the APC-PCI and D-dimer methods. However, in contrast to the D-dimer method, the APC-PCI method measures a well-defined analyte, a prerequisite for reliable comparisons of future clinical studies. The APC-PCI method appears to be particularly useful as a marker for detection of recently developed proximal thrombi.

Gastroparesis is a frequent complication of longstanding diabetes and has been attributed to vagal nerve dysfunction, occurring as part of a generalized autonomic neuropathy. We wanted to clarify the relationship between delayed gastric emptying (GE) and cardiac autonomic neuropathy (CAN) in type 1 diabetics. Using a standardized ultrasound technique, GE was studied in 20 type 1 diabetic patients with poor glycaemic control despite good compliance and 10 normal healthy volunteers (Group 1). Measurements of GE were done on condition that the fasting blood glucose was 3.5-9.0 mmol/l. Diabetic patients were classified into two groups according to the absence (Group 2) or presence (Group 3) of CAN, using the deep breathing test (E:I ratio) to evaluate parasympathetic vagal nerve function. Age-related reference values were used to evaluate the indices of CAN. The supine resting heart rate was also checked, and the patients were asked for symptoms of gastroparesis. The three groups were similar in terms of sex and smoking habits, and there was no significant difference regarding the age and body mass index (BMI). The mean duration of diabetes and the glycaemic control (HbA1c) was insignificant between patients in Groups 2 and 3. Diabetic patients in Group 3 showed lower gastric emptying rates (GER) than the healthy volunteers in Group 1 (median GER 16% vs. 63%, P

Purpose: To evaluate whether wide-spread non-filling of contrast in vein segments, displayed on phlebography, is interpreted as deep venous thrombosis (DVT) on colour Doppler ultrasonography (CDU) and if the same score value is obtained. Material and Methods: Twenty consecutive patients were analysed by both phlebography and CDU with a scoring system. Results: One hundred and fifty-one venous segments were initially analysed, but 19 (12.6%) were excluded because their entire extent could not be interpreted by CDU. The total score was 366 (mean 18.3) according to the phlebograms and 298 (mean 14.9) when interpreted by CDU, p=0.0001. The difference was due mainly to the scoring of the anterior tibial vein found to be open on CDU in most cases, and then the thrombotic burden percentage was 84% and 75%, respectively. In 19 of the 20 patients (95%) a DVT was confirmed by CDU. The great saphenous vein, the femoropopliteal vein, and the deep femoral vein, formed the main collateral circulation. Conclusion: Wide-spread non-filling of vein segments is due to an extensive DVT in the vast majority of cases. Scoring is possible by both phlebography and CDU and the difference in the results of the scoring is generally of minor importance.

The aim was to describe the phlebographic pattern of asymptomatic and symptomatic deep vein thrombosis (DVT) after total hip replacement by the use of a scoring system in 102 consecutive patients (54 asymptomatic, 48 symptomatic). The DVTs were scored from 1 to 3, and registered in a scoring system dividing the deep veins into 12 separate segments. The asymptomatic patients had a significantly lower total mean DVT score of 3.7 compared to 9.1 in the symptomatic group of patients. The mean ratio of the DVT scores in the deep muscle veins in conjunction with the superficial femoral vein in relation to the total mean score was significantly higher in the asymptomatic patients (74.9%) compared to the symptomatic group (62.4%). A direct sign of DVT, displayed as a filling defect, was seen on the phlebogram in 116 of the 119 legs, and concomitant nonfilling in other vein segments was noted in 6% of the asymptomatic patients, while in the symptomatic group this was the case to a significantly higher level, namely, 46%. A subgroup of asymptomatic patients operated unilaterally, with bilateral DVT had a significantly higher total mean DVT score on the operated side (4.6) compared to the unoperated side (3.4). The total mean DVT score increased with time after surgery Spearman Correlation Coefficient =0.46, r 2 =0.22% in the group of symptomatic patients. A low total mean DVT score with a predominance of DVT in, or in the connection to, the deep muscle veins is displayed among the asymptomatic patients. This is significantly different from the symptomatic patients who have more extensive DVTs, especially when diagnosed several weeks postoperatively, and frequently with edema and occlusive DVT.

The aim of this study was to simplify and standardize a reproducible, well-tolerated and clinically applicable method for the assessment of gastric emptying rate by real-time ultrasonography. A total of 33 subjects were examined, including 19 healthy subjects and 14 patients with insulin-dependent diabetes mellitus and clinically suspected delayed gastric emptying. Measurements of the gastric antrum were taken in the supine position and in relation to internal landmarks to obtain a standardized cross-sectional image producing the area of a selected slice of the antrum. Diabetic patients were examined on the condition that the fasting blood glucose level was 3.5 to 9.0 mmol/l. Gastric emptying rate was estimated and expressed as the percentage reduction in antral cross-sectional area from 15 to 90 min after the ingestion of a standardized semisolid breakfast meal (300 g rice pudding, 330 kcal). Interobserver and intraobserver measurement errors were assessed, as was the significance of age and sex on gastric emptying. In comparison to healthy subjects, diabetic patients showed significantly wider median values of the 90 min postprandial antral area, but only a mild tendency toward greater dilation of the gastric antrum prior to and 15 min after meal ingestion. The median value of gastric emptying rate in these diabetic patients was estimated at 29%, which was less than half of that in the healthy subjects (63%). Statistically the difference was highly significant. Interpersonal variability of gastric emptying rate and antral areas was large for both groups. Measurements of gastric emptying rate gave highly reproducible results on separate days and from different observers (interobserver systematic measurement error 0.3% and random measurement error 10.9%; intraobserver systematic measurement error 3.6% and random measurement error 9.5%). No difference in gastric emptying rate was found related to age or sex. We conclude that the use of standardized real-time ultrasonography to determine gastric antral cross-sectional area in a single section of the stomach is a valid method for estimating gastric emptying rate.