Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding: UK Medical Research Council and Health Technology Assessment Programme

Effect of chestnut extract and chestnut fiber on viability of potential probiotic Lactobacillus strains under gastrointestinal tract conditions.

The main challenge to probiotics, during their passage through the gastrointestinal tract, are the acidic gastric secretions of the stomach, and the bile salts released into the duodenum. The survival of the strains, in this phase, is strongly influenced by the food used for their delivery. This work is part of a project studying the development of novel food processes, based on the use of chestnuts from cultivar “Castagna di Montella”. In detail, the effect of indigestible chestnut fiber and of chestnut extract on the viability of selected lactic acid bacteria strains was evaluated. Among 28 cultures, twelve strains were selected, on the basis of tolerance to low pH values and bile salts, and submitted to exposition to simulated gastric or bile juice in presence of chestnut extract with or without immobili- zation in chestnut fiber. The presence of chestnut extract proved to play a significant role on the gastric tolerance improvement of lactobacilli. The recorded protective effect could not be simply related to the starch or reducing sugars content. RP-HPLC demonstrated that in the chestnut flour, there are one or more hydrophobic peptides or oligopeptides, which specifically offer a marked resistance to simulated gastric juice, albeit present at low concentration. These beneficial effects proved to be dependent by the cultivar used to produce the flour

Evidence for different supramolecular arrangements in pasta from durum wheat (Triticum durum) and einkorn (Triticum monococcum) flours

The effects of the replacement of einkorn flour on pasta proteins aggregation were studied by sodium dodecyl sulfate polyacrylamide gel electrophoresis and size exclusion high performance chromatography. Pasta was produced replacing durum wheat semolina with an increasing amount of einkorn flour (30, 50 and 100%). The polymeric protein structure of flours and related pasta and pasta mixture was determined by protein subunits composition and size of polymeric proteins. The unextractability of polymeric protein was related to the unextractable protein fraction and to the determination of -SH/-SS groups. Durum wheat semolina and einkorn flours increased their unextractable and polymeric fractions during pasta processing. The unexpected results derived from the areas of unextractable fractions and total and large unextractable polymeric fractions of 70/30 semolina/einkorn pasta mixture that were lower than those of 50/50 semolina/einkorn pasta mixture. Although the semolina flour contained more gluten proteins than einkorn flour, a higher aggregation was registered for 50/50 semolina/einkorn flour pasta. These results suggested that a different assessment of gluten network occurred in pasta mixture and it was regulated by a self-assembling machine influenced by nature of HMW-GS. The 50/50 semolina/einkorn pasta mixture determined a supramolecular structure in the developing of its network architecture

Bacillus megaterium SF185 induces stress pathways and affects the cell cycle distribution of human intestinal epithelial cells

The interaction between the enteric microbiota and intestinal cells often involves signal molecules that affect both microbial behaviour and host responses. Examples of such signal molecules are the molecules secreted by bacteria that induce quorum sensing mechanisms in the producing microorganism and signal transduction pathways in the host cells. The pentapeptide competence and sporulation factor (CSF) of Bacillus subtilis is a well characterized quorum sensing factor that controls competence and spore formation in the producing bacterium and induces cytoprotective heat shock proteins in intestinal epithelial cells. We analysed several Bacillus strains isolated from human ileal biopsies of healthy volunteers and observed that some of them were unable to produce CSF but still able to act in a CSF-like fashion on model intestinal epithelial cells. One of those strains belonging to the Bacillus megaterium species secreted at least two factors with effects on intestinal HT29 cells: a peptide smaller than 3 kDa able to induce heat shock protein 27 (hsp27) and p38-MAPK, and a larger molecule able to induce protein kinase B (PKB/Akt) with a pro-proliferative effect

Detection of Alfa s1-I casein in mozzarella Fiordilatte: a possible tool to reveal the use of stored curd in cheesemaking

The assessment of the origin and quality of raw materials is pivotal for the protection and valorisation of typical dairy products. Italian high moisture mozzarella cheese, also called “Fiordilatte”, is manufactured by stretching in hot water the curd, which can be produced inside the dairy (fresh curd) or purchased as semi-finished product from specialized companies (pre-made stored curd). The employment of stored curd allows cheese manufacturers to obtain economic profit thanks to the reduction of the production costs. The use of the semi-finished product has not to be mentioned in the label according to the actual EU regulation, and this has given rise to competition between local milk farmers and curd-producing companies causing misinformation among the consumers, and unfair competition to the disadvantage of the traditional dairies. In the present research, a proteomic approach was used to investigate “Fiordilatte” produced with or without the employment of stored curd. The results obtained allowed us to identify a molecular marker which is present in very small amounts in cheese made from fresh curd and at high levels in cheese made from stored curd. The marker is αs1-I casein (fragment 24-199), the main product of primary proteolysis formed by the action of chymosin on αs1 casein. It can be easily detected by electrophoresis in the presence of urea (urea-PAGE) and is measured by image analysis. Even though the kinetic of formation of this proteolytic product has been well known for several decades, in mozzarella it has a peculiar behaviour compared to other cheeses. As a matter of fact, it originates during the first part of cheesemaking, and has a very slow increase during storage of the cheese, due to the denaturation of the clotting enzyme by the hot water stretching process. The results obtained demonstrated that the quantification of αs1-I fragment should be recommended to guarantee the production of “Fiordilatte” obtained from fresh milk under normal conditions, and could be the basis for the development of a method able to fully protect the traditional cheesemaking procedure