Dietary fibres, fibre analogues, and glucose tolerance: importance of viscosity

To define the type of dietary fibre of fibre analogue with the greatest potential use in diabetic treatment, groups of four to six volunteers underwent 50-g glucose tolerance tests (GTT) with and without the addition of either guar, pectin, gum tragacanth, methylcellulose, wheat bran, or cholestyramine equivalent to 12 g fibre. The addition of each substance significantly reduced blood glucose concentration at one or more points during the GTT and generally reduced serum insulin concentrations. The greatest flattening of the glucose response was seen with guar, but this effect was abolished when hydrolysed non-viscous guar was used. The reduction in the mean peak rise in blood glucose concentration for each substance correlated positively with its viscosity (r = 0.926; P less than 0.01), as did delay in mouth-to-caecum transit time (r = 0.885; P less than 0.02). Viscous types of dietary fibre are therefore most likely to be therapeutically useful in modifying postprandial hyperglycaemia.

In vivo biocompatibility of bacterial cellulose

The biocompatibility of a scaffold for tissue engineered constructs is essential for the outcome. Bacterial cellulose (BC) consists of completely pure cellulose nanofibrils synthesized by Acetobacter xylinum. BC has high mechanical strength and can be shaped into three-dimensional structures. Cellulose-based materials induce negligible foreign body and inflammatory responses and are considered as biocompatible. The in vivo biocompatibility of BC has never been evaluated systematically. Thus, in the development of tissue engineered constructs with a BC scaffold, it is necessary to evaluate the in vivo biocompatibility. BC was implanted subcutaneously in rats for 1, 4, and 12 weeks. The implants were evaluated in aspects of chronic inflammation, foreign body responses, cell ingrowth, and angiogenesis, using histology, immunohistochemistry, and electron microscopy. There were no macroscopic signs of inflammation around the implants. There were no microscopic signs of inflammation either (i.e., a high number of small cells around the implants or the blood vessels). No fibrotic capsule or giant cells were present. Fibroblasts infiltrated BC, which was well integrated into the host tissue, and did not elicit any chronic inflammatory reactions. The biocompatibility of BC is good and the material has potential to be used as a scaffold in tissue engineering.

Acetobacter cellulose pellicle as a temporary skin substitute

A bacterial strain with morphological and biochemical properties close to Acetobacter xylinum has been cultured in nonagitated, inverted sucrose- and yeast water-based medium for the production of thick, smooth, and floating cellulosic pellicles. The cellulose content (greater than 90%, dry weight, depending on the efficiency of water washing) and the beta-D-homopolyglucan nature of these pellicles were assessed by physical, chemical, and enzymatic methods. The apyrogenic bacterial biomass, a minor component of the dried biofilm (BioFill), is inactivated by ethylene dioxide. Once applied on exudating or bloody tissues, this biofilm displays several advantages as a biological dressing, and hence, it is valuable as a temporary skin substitute in the treatment of skin wounds, such as burns, ulcers, grafts, and as an adjuvant in dermal abrasions.

Unabsorbable carbohydrates and diabetes: Decreased post-prandial hyperglycaemia

Two test meals were taken in random order on separate days by 8 non-insulin-requiring diabetic volunteers after 14-hour overnight fasts. Addition of 16 g guar and 10 g pectin to the control meal containing 106 g carbohydrate decreased markedly and significantly the rise in blood-glucose between 30 and 90 minutes and also resulted in significantly lower insulin levels between 30 and 120 minutes. When these meals were fed to 3 insulin-dependent diabetic subjects, a similar flattening of the post-prandial glucose rise ensued. This addition of certain forms of dietary fibre to the diet of diabetics significantly decreases post-prandial hyperglycaemia and would be expected to improve the control of blood-glucose concentration.

Effect of dietary fiber on constipation: A meta analysis

AIM: To investigate the effect of dietary fiber intake on constipation by a meta-analysis of randomized controlled trials (RCTs).

METHODS: We searched Ovid MEDLINE (from 1946 to October 2011), Cochrane Library (2011), PubMed for articles on dietary fiber intake and constipation using the terms: constipation, fiber, cellulose, plant extracts, cereals, bran, psyllium, or plantago. References of important articles were searched manually for relevant studies. Articles were eligible for the meta-analysis if they were high-quality RCTs and reported data on stool frequency, stool consistency, treatment success, laxative use and gastrointestinal symptoms. The data were extracted independently by two researchers (Yang J and Wang HP) according to the described selection criteria. Review manager version 5 software was used for analysis and test. Weighted mean difference with 95%CI was used for quantitative data, odds ratio (OR) with 95%CI was used for dichotomous data. Both I² statistic with a cut-off of ≥ 50% and the χ² test with a P value < 0.10 were used to define a significant degree of heterogeneity.

RESULTS: We searched 1322 potential relevant articles, 19 of which were retrieved for further assessment, 14 studies were excluded for various reasons, five studies were included in the analysis. Dietary fiber showed significant advantage over placebo in stool frequency (OR = 1.19; 95%CI: 0.58-1.80, P < 0.05). There was no significant difference in stool consistency, treatment success, laxative use and painful defecation between the two groups. Stool frequency were reported by five RCTs, all results showed either a trend or a significant difference in favor of the treatment group, number of stools per week increased in treatment group than in placebo group (OR = 1.19; 95%CI: 0.58-1.80, P < 0.05), with no significant heterogeneity among studies (I²= 0, P = 0.77). Four studies evaluated stool consistency, one of them presented outcome in terms of percentage of hard stool, which was different from others, so we included the other three studies for analysis. Two studies reported treatment success. There was significant heterogeneity between the studies (P < 0.1, I² > 50%). Three studies reported laxative use, quantitative data was shown in one study, and the pooled analysis of the other two studies showed no significant difference between treatment and placebo groups in laxative use (OR = 1.07; 95%CI 0.51-2.25), and no heterogeneity was found (P = 0.84, I²= 0). Three studies evaluated painful defecation: one study presented both quantitative and dichotomous data, the other two studies reported quantitative and dichotomous data separately. We used dichotomous data for analysis.

CONCLUSION: Dietary fiber intake can obviously increase stool frequency in patients with constipation. It does not obviously improve stool consistency, treatment success, laxative use and painful defecation.

Barley and wheat foods: influence on plasma cholesterol concentrations in hypercholesterolemic men

Twenty-one mildly hypercholesterolemic men aged 30-59 y were provided with comparable barley and wheat foods for each of 4 wk in a crossover-designed experiment. The purpose of the study was to examine the influence of two sources of dietary fiber (nonstarch polysaccharides, NSP) on blood lipids and glucose concentrations. Barley contains beta-glucan as a source of soluble dietary fiber (DF) whereas wheat contains the largely insoluble cellulose and hemicellulose fiber. Total dietary fiber increased from a previous intake of 21-38 g/d during the period of study for the two groups. Consumption of barley relative to wheat foods was associated with a significant fall in both plasma total cholesterol (6%, P less than 0.05) and in low-density-lipoprotein cholesterol (7%, P less than 0.02) whereas triglyceride and glucose concentrations did not change significantly. It is concluded that barley dietary fiber is more effective than wheat dietary fiber at lowering blood cholesterol in hypercholesterolemic men.

Changes in fecal composition and colonic function due to cereal fiber

The effect on colonic function of adding wheat fiber for 3 weeks to the metabolically-controlled diets of six healthy volunteers has been studied. Increasing dietary fiber intake from 17 to 45 g/day increased fecal weight from 79 +/- 6.6 g/day to 228 +/- 29.9 g/day and shortened mean transit time, measured by a continuous marker method, from 57.8 +/- 8.3 hr to 40.3 +/- 8.9 hr. The increase in fecal weight was largely due to water. Fiber caused a dilution of fecal marker and an increase in fecal fat, nitrogen, and calcium output. Fecal sodium, potassium, and chloride showed only small changes but volatile fatty acid output increased significantly without concentrations changing. Fecal bile acid output increased from 199 +/- 46 mg/day to 279 +/- 46 mg/day. These changes are discussed in light of current views of the role of dietary fiber in protecting against colon cancer.

An Overview of Permanent and Semipermanent Fillers

The demand for safe, effective, long-lasting, biocompatible dermal filler materials is increasing. Many products that include synthetic polymers and autologous tissue have emerged that attempt to meet these criteria. An overview of injectable permanent fillers, including ArteFill, Aquamid, and silicone, and semipermanent fillers, including Radiesse, Sculptra, and autologous fat, is presented. A discussion of their composition, histologic characteristics, antigenicity, U.S. Food and Drug Administration approval status, indications for use, efficacy, injection technique, and adverse effects is provided.

Vaginal microbicides: detecting toxicities in vivo that paradoxically increase pathogen transmission

BACKGROUND

Microbicides must protect against STD pathogens without causing unacceptable toxic effects. Microbicides based on nonoxynol-9 (N9) and other detergents disrupt sperm, HSV and HIV membranes, and these agents are effective contraceptives. But paradoxically N9 fails to protect women against HIV and other STD pathogens, most likely because it causes toxic effects that increase susceptibility. The mouse HSV-2 vaginal transmission model reported here: (a) Directly tests for toxic effects that increase susceptibility to HSV-2, (b) Determines in vivo whether a microbicide can protect against HSV-2 transmission without causing toxicities that increase susceptibility, and (c) Identifies those toxic effects that best correlate with the increased HSV susceptibility.

METHODS

Susceptibility was evaluated in progestin-treated mice by delivering a low-dose viral inoculum (0.1 ID50) at various times after delivering the candidate microbicide to detect whether the candidate increased the fraction of mice infected. Ten agents were tested - five detergents: nonionic (N9), cationic (benzalkonium chloride, BZK), anionic (sodium dodecylsulfate, SDS), the pair of detergents in C31G (C14AO and C16B); one surface active agent (chlorhexidine); two non-detergents (BufferGel, and sulfonated polystyrene, SPS); and HEC placebo gel (hydroxyethylcellulose). Toxic effects were evaluated by histology, uptake of a 'dead cell' dye, colposcopy, enumeration of vaginal macrophages, and measurement of inflammatory cytokines.

RESULTS

A single dose of N9 protected against HSV-2 for a few minutes but then rapidly increased susceptibility, which reached maximum at 12 hours. When applied at the minimal concentration needed for brief partial protection, all five detergents caused a subsequent increase in susceptibility at 12 hours of approximately 20-30-fold. Surprisingly, colposcopy failed to detect visible signs of the N9 toxic effect that increased susceptibility at 12 hours. Toxic effects that occurred contemporaneously with increased susceptibility were rapid exfoliation and re-growth of epithelial cell layers, entry of macrophages into the vaginal lumen, and release of one or more inflammatory cytokines (Il-1beta, KC, MIP 1alpha, RANTES). The non-detergent microbicides and HEC placebo caused no significant increase in susceptibility or toxic effects.

CONCLUSION

This mouse HSV-2 model provides a sensitive method to detect microbicide-induced toxicities that increase susceptibility to infection. In this model, there was no concentration at which detergents provided protection without significantly increasing susceptibility.

The role of elastoviscosity in the efficacy of viscosupplementation for osteoarthritis of the knee: a comparison of hylan G-F 20 and a lower-molecular-weight hyaluronan

The objective of this 12-week, double-masked, randomized, multicenter study was to compare the elastoviscous properties of a high-molecular-weight viscosupplement, hylan G-F 20 (polymer concentration, 0.8%), with those of a lower-molecular-weight hyaluronan (LMW HA) product (polymer concentration, 1%) and to determine the relationship of elastoviscosity to efficacy in the treatment of patients with osteoarthritis (OA) of the knee. Patients had radiographically confirmed primary idiopathic OA of the knee (Larsen grades I to V) with pain despite other treatments. After a 2-week washout period, 70 patients (73 knees) received three 2-mL intra-articular injections of test solution at 1-week intervals. Thirty-eight patients (38 knees) received hylan G-F 20, and 32 patients (35 knees) received LMW HA. During the 12-week follow-up period, the primary outcome measures assessed by patients (using a visual analogue scale) were weight-bearing pain, most painful knee movement, and overall treatment response; the primary outcome measures assessed by study evaluators were weight-bearing pain and overall assessment of treatment. The dynamic elastoviscous properties of the test solutions were measured on an oscillating Couette-type rheometer. Hylan G-F 20 was more elastoviscous than the LMW HA at all frequencies measured (0.001 to 10 Hz). At the final evaluation, patients who received hylan G-F 20 had significantly better results on all primary outcome measures compared with those who received LMW HA. No systemic adverse events were reported. Local adverse events consisted of pain or swelling, noted in 2 of 38 knees injected with hylan G-F 20, and pain, noted in 1 of 35 knees injected with LMW HA (adverse event rates per injection, 1.8% and 0.9%, respectively). The difference in the incidence of adverse events between groups was not statistically significant. The higher-molecular-weight, more elastoviscous hylan G-F 20 had significantly greater pain-relieving effects than did the lower-molecular-weight, less elastoviscous hyaluronan.

3D Bioprinting of Carboxymethylated-Periodate Oxidized Nanocellulose Constructs for Wound Dressing Applications

Nanocellulose has a variety of advantages, which make the material most suitable for use in biomedical devices such as wound dressings. The material is strong, allows for production of transparent films, provides a moist wound healing environment, and can form elastic gels with bioresponsive characteristics. In this study, we explore the application of nanocellulose as a bioink for modifying film surfaces by a bioprinting process. Two different nanocelluloses were used, prepared with TEMPO mediated oxidation and a combination of carboxymethylation and periodate oxidation. The combination of carboxymethylation and periodate oxidation produced a homogeneous material with short nanofibrils, having widths <20 nm and lengths <200 nm. The small dimensions of the nanofibrils reduced the viscosity of the nanocellulose, thus yielding a material with good rheological properties for use as a bioink. The nanocellulose bioink was thus used for printing 3D porous structures, which is exemplified in this study. We also demonstrated that both nanocelluloses did not support bacterial growth, which is an interesting property of these novel materials.

Are fibre supplements really necessary in diverticular disease of the colon? A controlled clinical trial

Fifty-eight patients with uncomplicated diverticular disease of the colon took bran crispbread, ispaghula drink, and placebo for four months each in a randomised, cross-over, double-blind controlled trial. Assessments were made subjectively, using a monthly self-administered questionnaire, and objectively, by examining a seven-day stool collection at the end of each treatment period. In terms of a pain score, lower bowel symptom score (the pain score and sensation of incomplete emptying, straining, stool consistency, flatus, and aperients taken), and total symptom score (belching, nausea, vomiting, dyspepsia, and abdominal distension) fibre supplementation conferred no benefit. Symptoms of constipation, however, when assessed alone, were significantly relieved. Both fibre regimens produced the expected changes in stool weight, consistency, and frequency. It is concluded that dietary fibre supplements in the commonly used doses do no more than relieve constipation. Perhaps the impression that fibre helps diverticular disease is simply a manifestation of Western civilisation's obsession with the need for regular frequent defecation.

Cross-linked hyaluronan used as augmentation substance for treatment of glottal insufficiency: safety aspects and vocal fold function

OBJECTIVE

To examine safety aspects and vocal fold function after vocal fold augmentation with a cross-linked hyaluronan derivative (hylan B gel) as compared with bovine collagen. STUDY DESIGN; A prospective, randomized trial.

METHODS

Eighty-three patients with glottal insufficiency were treated with injection augmentation with hylan B gel and bovine collagen and were examined at 1, 6, and 12 months after treatment. Seventy patients with unilateral vocal fold paresis (n = 35) or atrophy (n = 35) were randomly assigned to receive either hylan B gel (n = 47) or collagen (n = 23) injections into one vocal fold. Thirteen patients with glottal insufficiency caused by scar defects or paresis resulting from malignant disease were included in a nonrandomized group and were treated only with hylan B gel. Evaluations were made from patients' subjective ratings (visual analogue scales), digitized videostroboscopic measurements, phonetograms, maximum phonation time, and phonation quotients.

RESULTS

Twelve months after injections, the patients' self-ratings were significantly improved for both the hylan B gel and the collagen groups. In addition, the videostroboscopic measurements showed significantly improved glottal closure for both groups. However, for the hylan B gel group, vibration amplitude and glottal area variations were preserved, and this group showed significantly less resorption at the injected vocal fold edge. Furthermore, maximum phonation time had increased significantly for the hylan B gel patients (collagen, nonsignificant). No serious adverse events were observed; three patients injected with hylan B gel had temporary inflammation at the injection site, which resolved without sequelae.

CONCLUSIONS

The results showed that both hylan B gel and collagen can be safely used for injection treatment of glottal insufficiency. Both treatments resulted in significantly improved voice as rated by the patients. However, the patients treated with hylan B gel showed better vocal fold status and longer maximum phonation time at 12 months after treatment as compared with patients treated with collagen.

Treatment of irritable bowel syndrome with lorazepam, hyoscine butylbromide, and ispaghula husk

A double-blind controlled therapeutic trial of factorial design was used to study the therapeutic effects of lorazepam, hyoscine butylbromide, and ispaghula husk in 12 randomised blocks of eight patients with the irritable bowel syndrome (IBS). Each of the three agents caused a sustained symptomatic improvement in some of the patients, although only with ispaghula was the difference between the real and dummy preparation statistically significant. When the eight possible combinations of treatment were analysed none of the 12 patients who received only dummy preparations of the three agents had maintained any improvement over the three months of the trial. Seven patients improved among the 12 who received potent preparations of all three agents, and between four and six patients improved in the groups receiving one or two of the potent preparations. These therapeutic results, though far from perfect, show that the types of drug commonly used to treat IBS are of some value and may be additive in their effects. Similar combinations of other therapeutic agents may be more effective, but it will be possible to determine this only by carrying out factorial therapeutic trials.

Expression of matrix metalloproteinases and growth factors in diabetic foot wounds treated with a protease absorbent dressing

Wound healing in diabetes is impaired, and nonhealing ulceration represent clinically relevant complications. Persistently high levels of matrix metalloproteases (MMPs) contribute to wound chronicity. Thus, the topical use of protease inhibitors might influence wound healing and promote transition from a chronic to an acute wound.

METHODS

In this study, 33 patients with chronic diabetic foot lesions (stage 2a of the University of Texas Wound Classification system) were included. Fifteen patients received redundant "good standard wound care." In addition, 18 patients were treated with a protease inhibitory modulating matrix (the OCR/collagen Promogran matrix, Ethicon) with dressings changed on a daily basis. Prior to treatment and at 4 and 8 days after treatment, two 3-mm punch biopsies were taken from the center of the wounds and analyzed using ELISA techniques for MMPs, tissue inhibitor of MMP-2 (TIMP-2), and interleukin-1beta (IL-1beta) levels. In addition, mRNA levels of MMPs as well as IL-1beta and TNF-alpha were detected using quantitative real-time polymerase chain reaction (TaqMan, Applied Biosystems, Weiterstadt, Germany).

RESULTS

No differences were detected between both groups and at the three time points for the mRNA levels of MMPs as well as of IL-1beta and TNF-alpha. In addition, MMP levels in wound tissue (analyzed by ELISA) were also not significantly different between both groups. However, IL-1beta was increased on day 8 in the treatment group (P=.01) only. Interestingly, we found a significant reduction of the MMP-9/TIMP-2 ratio in the group being treated with the ORC/collagen. These wounds exhibited a more rapid healing rate when treated with the ORC/collagen matrix.

CONCLUSIONS

The local treatment with a protease inhibitor has a beneficial effect on wound healing. In contrast to the data on wound fluid, our study demonstrated for the first time the unaltered mRNA levels of MMPs during treatment with a protease inhibitory modulating matrix. At the cellular level, MMPs were also not statistically different. However, the more relevant ratio of MMP-9/TIMP-2 was decreased in the treatment group. An equally important finding was that we did not detect a compensatory increase in the MMP-RNA expression even though wound size was clearly reduced.

Wheat fibre and irritable bowel syndrome. A controlled trial

Twenty-six patients with irritable bowel syndrome entered a controlled trial of diets with a high or low wheat-fibre content. After 6 weeks on the high-wheat fibre regimen there was significant improvement in symptoms and an objective change in colonic motor activity. No such improvement occurred on the low-fibre regimen. Patients with irritable bowel syndrome should be encouraged to increase their daily intake of wheat fibre.

Treatment of diabetes with guar gum. Reduction of urinary glucose loss in diabetics

When nine diabetic patients supplemented either their normal home diets (four patients) or metabolic ward diets (five patients) with 25 g guar gum daily for 5 or 7 days their mean urinary glucose excretion fell by 46% (P less than 0-05) and 54% (P less than 0-01), respectively. Gel-forming,, unabsorbable carbohydrate may therefore be a useful adjunct to anti-diabetic therapy, irrespective of the type of treatment or insulin dosage used.

A novel biomaterial: bacterial cellulose and its new era applications

Bacterial cellulose (BC) is a promising natural polymer that is produced by bacteria and that has unique and desirable structural, physical, and chemical properties. From the time when the remarkable properties of BC were found 15 years ago compared with plant cellulose, interest has grown in BC and it has become an article of trade in diverse applications. Following this trend, this paper reviews the progress of relevant studies, including general information about cellulose, production by microorganisms as well as BC cultivation, and its properties. The applications reviewed in the present article comprise biological and nonbiological fields. The latest use of BC in the biomedical, environmental, agricultural, electronic, food, and industrial fields is discussed with its applications in composite form. The present article attempts to amass the assorted uses of BC under one umbrella. Thus, recent advances in BC applications in different fields are thoroughly reviewed. This article concludes with the need for future research of BC to make it commercialized as vital biomaterial.

Guar crispbread in the diabetic diet

Nine diabetic patients who were receiving various treatments supplemented their normal home diets (two patients) or metabolic ward diets (seven patients) with guar crispbread for five days. Their mean urinary glucose excretion fell significantly by 38% during the last two days. A significant fall in fasting blood glucose concentration of 1.1 +/- 0.4 mmol/1 (19.8 +/- 7.2 mg/100 ml) was seen only in those who took guar after the control period. Over eight weeks' treatment insulin dosage was reduced by 21% in five patients, and home testing showed that glycosuria was reduced by 68% in six patients. Guar crispbread is likely to be a useful adjunct to diabetic treatment irrespective of the type of treatment or insulin dosage used.

Treatment of Crohn's disease with an unrefined-carbohydrate, fibre-rich diet

Thirty-two patients with Crohn's disease were treated with a fibre-rich, unrefined-carbohydrate diet in addition to conventional management and followed for a mean of four years and four months. Their clinical course was compared retrospectively with that of 32 matched patients who had received no dietary instruction. Hospital admissions were significantly fewer and shorter in the diet-treated patients, who spent a total of 111 days in hospital compared with 533 days in the non-diet-treated control group. Whereas five of the controls required intestinal operation, only one diet-treated patient needed surgery. This is in strong contrast to general experience with this disease. Treatment with a fibre-rich, unrefined-carbohydrate diet appears to have a favourable effect on the course of Crohn's disease and does not lead to intestinal obstruction.

High-fiber diets in the treatment of diabetes mellitus

Eight patients with insulin-requiring diabetes were given, in random order, a diet containing 3 g and one containing 20 g of crude fiber. Each diet was maintained for 10 days and was the same in calories, carbohydrate, fat, and protein. Insulin dose was kept constant. Mean plasma glucose on the low-fiber diet was 169.4 +/- 11.7 mg/dl, significantly higher (P less than 0.001) than the value of 120.8 +/- 10.1 on the high-fiber diet. Hypoglycemic reactions were more common on the high-fiber diet. Weight remained essentially constant on both diets. Mean serum glucagon level on the high-fiber diet was significantly lower (P less than 0.001) than on the low-fiber diet, while serum free insulin levels were unchanged. These data indicate that substantial changes in fiber content of the diabetic diet may lead to marked changes in diabetic control and that increasing dietary fiber may be a useful means of lowering plasma glucose in some diabetic patients.

Injectable Poly-L-Lactic Acid (Sculptra): Technical Considerations in Soft-Tissue Contouring

BACKGROUND

Poly-L-lactic acid gained U.S. Food and Drug Administration approval for use in human immunodeficiency virus-related facial lipoatrophy in August of 2004. Since that time, it has become available for use in the United States for human immunodeficiency virus facial lipoatrophy patients and for off-label uses in other areas for soft-tissue contouring. This article is intended to enumerate reconstitution, injection techniques, management, and avoidance of complications.

METHODS

The authors have pooled their experiences to arrive at a consensus opinion for recommendations on treatment protocols for injectable poly-L-lactic acid use.

RESULTS

This article prescribes techniques to achieve safer, consistent results while minimizing risks of complications with injectable poly-L-lactic acid. Although the product has been used widely in Europe since 1999, physicians in the United States have only recently begun to explore the uses of Sculptra as a volumizing agent in the face and the body. U.S. physicians have benefited from the European experience with this product, including early problems secondary to overaggressive use, low-volume reconstitution, higher volume injection of product at one session, and inadequate time between injection sessions.

CONCLUSIONS

The authors therefore have opted for a more conservative approach in their treatment recommendations. Higher volume dilution (8 to 12 cc), fewer vials used at each session, injections placed in the subcutaneous plane without any product being placed in the dermis, adequate time between injection sessions (at least 6 weeks), and postinjection patient massage should decrease the risks and avoid the potential complications associated with poly-L-lactic acid soft-tissue augmentation.

Long-term effects of high-carbohydrate, high-fiber diets on glucose and lipid metabolism: a preliminary report on patients with diabetes

High-carbohydrate, high-fiber (HCF) diets have beneficial therapeutic effects for selected patients with diabetes mellitus. We have treated 10 patients with HCF diets on a metabolic ward and followed them for an average of 15 months while they were on maintenance diets at home. The HCF diets containing 70 per cent of calories as carbohydrate were accompanied by significant reductions in requirements for insulin or sulfonylureas. Fasting plasma glucose, serum cholesterol, and triglyceride values were significantly lower on the HCF diet than on a 43 per cent carbohydrate diet. On the HCF diet, insulin therapy was discontinued for five patients and sulfonylurea therapy for three. After an average of 15 months on the maintenance diet containing 55 per cent to 60 per cent carbohydrate, seven patients were still managed without insulin or sulfonylureas. Average fasting plasma glucose values during maintenance diets at home were identical to values on the HCF diets in the hospital. On the maintenance diet, serum cholesterol values were similar to initial values but serum triglyceride values were significantly lower than values on the 43 per cent carbohydrate diet. These studies indicate that moderately high-carbohydrate, high-fiber diets can be successfully followed at home and that improvements in glucose metabolism achieved in the hospital can be sustained outside the hospital.