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Daher werden die Ergebnisse dieser Studien unter dem Gliederungspunkt Mono- und Disaccharide in den entsprechenden Kapiteln aufgefьhrt. Als weitere Ausnahme wurde nach Studien zum Aspekt Vollkornprodukte (Suchbegriff whole grain[s]) bzw. Getreideprodukte aus Mehl mit niedrigem Ausmahlungsgrad (Suchbegriff refined grain[s]) recherchiert, da mit der Betrachtung dieser Lebensmittelgruppen als Expositionsfaktoren indirekt eine Aussage ьber den Einfluss von Getreideballaststoffen ermцglicht wird und zu diesem Aspekt zahlreiche Studien existieren. Neben den qualitativen und quantitativen Aspekten der Kohlenhydratzufuhr bestьnde auch die Mцglichkeit, Ernдhrungsmuster und ihren Zusammenhang mit der Kohlenhydratzufuhr und chronischen Krankheiten zu betrachten. Da bei dieser Art der Betrachtungsweise jedoch nicht direkt auf die Wirkung der Kohlenhydratzufuhr geschlossen werden kann, wurden Ernдhrungsmuster im Rahmen dieser Leitlinie nur sehr eingeschrдnkt bearbeitet. Bei der Literatursuche wurden mцglichst wenige Begriffe von vornherein ausgeschlossen. Unter der,grauen Literatur" werden Verцffentlichungen wissenschaftlicher Natur verstanden, die in den gдngigen Literaturdatenbanken nicht zu finden sind, wie z. Diese Art von Literatur ist oft schwer zugдnglich und kann nur unter erheblichem personellem und finanziellem Aufwand zusammengetragen werden. Fьr die vorliegende Leitlinie musste aus diesen Grьnden auf die Suche nach grauer Literatur verzichtet werden. Es ist nicht davon auszugehen, dass durch fehlende graue Literatur entscheidende Literaturquellen ьbersehen wurden. Insbesondere Erkenntnisse mit hochrangiger Evidenzbewertung, wie Interventionsstudien oder 26 Kapitel 2: Methodische Vorgehensweise Kohortenstudien bzw. Anders verhдlt es sich allerdings mit nicht in Fachzeitschriften publizierten Studienergebnissen, die z. Auch im Bereich der Ernдhrungsepidemiologie ist von der Tendenz auszugehen, dass Studienergebnisse, die keinen Zusammenhang zwischen einer Exposition und einer Krankheit aufzeigen konnten, seltener publiziert wurden als positive oder negative Effektschдtzungen. Eine empirische Erhebung ьber das AusmaЯ dieses Problems fьr den hier betrachteten Themenbereich gibt es nicht. Bei zugesetztem Zucker handelt es sich um Zucker als Zutat zu verarbeiteten Lebensmitteln sowie um Zucker, der bei der Lebensmittelzubereitung im Haushalt oder wдhrend der Mahlzeit hinzugefьgt wird. Nicht gemeint sind natьrlich vorkommende Mono- und Disaccharide in Milch, Obst und Sдften. Als zuckergesьЯte Getrдnke werden kohlensдurehaltige Erfrischungsgetrдnke wie ColaGetrдnke und Limonaden sowie solche ohne Kohlensдure wie Fruchtsaftgetrдnke, -nektare und Eistee bezeichnet, denen Zucker zugesetzt wurde. ZuckergesьЯte Getrдnke haben zum Teil einen hohen Gehalt an zugesetzten Zuckern und liefern Energie (Kalorien) aber essenzielle Nдhrstoffe nur in unbedeutenden Mengen. Ein Zusammenhang zwischen dem Konsum dieser Getrдnke und dem Risiko fьr Adipositas und Diabetes mellitus Typ 2 wird цffentlich diskutiert. Deswegen und aufgrund des groЯen Interesses an diesen Getrдnken hat die Leitlinienkommission entschieden, diese Lebensmittelgruppe neben den Kohlenhydratfraktionen als einziges Lebensmittel zu betrachten. Ballaststoffe, Vollkorn(produkte) und Getreideprodukte aus niedrig ausgemahlenem Mehl (z. Type 405): Neben der Betrachtung des Einflussfaktors,gesamte Ballaststoffzufuhr" erfolgte hдufig auch eine Analyse hinsichtlich der Herkunft der Ballaststoffe (aus Getreide, Gemьse, Obst bzw. Lag der Vollkornanteil darunter, erfolgte eine Zuordnung zu Getreideprodukten aus Mehl mit niedrigem Ausmahlungsgrad. In anderen Studien wurde der Verzehr bestimmter vollkornhaltiger Lebensmittel gesondert abgefragt und unter Heranziehung der genannten Verzehrshдufigkeit und PortionsgrцЯe eine tдgliche Zufuhrmenge geschдtzt. Es kam auch vor, dass der Gehalt an Vollkorn, Kleie und Keimling in allen von den Studienteilnehmern verzehrten Lebensmitteln berechnet und danach summiert wurde, so dass sehr genaue Angaben zur Zufuhr von Vollkorn(bestandteilen) vorlagen (Koh-Banerjee et al. Cummings und Stephen (2007) wiesen darauf hin, dass auch die Struktur des Vollkornbestandteils eines Lebensmittels (intakt versus vermahlen) eine Rolle spielt, dies aber in Studien bislang kaum berьcksichtigt wurde. Unter dem in der Leitlinie verwendeten Begriff Getreideprodukte, werden Getreideflocken und Getreidemehlprodukte verstanden. Falls eine zu hohe Trefferzahl eine weitere Begrenzung erforderlich machte, erfolgte dies durch Eingabe der folgenden Begriffe: intake, uptake, ingestion, consumption, prevention, nutrition(al), diet, dietary. Eur J Clin Nutr 2007; 61: S5­S18 Deutsche Adipositas-Gesellschaft, Deutsche Diabetes-Gesellschaft, Deutsche Gesellschaft fьr Ernдhrung, Deutsche Gesellschaft fьr Ernдhrungsmedizin. Evidenzbasierte Leitlinie: Fettkonsum und Prдvention ausgewдhlter ernдhrungsmitbedingter Krankheiten.

The chloroform layer was separated, dried, and resuspended in 100 L of isopropyl alcohol to measure the lipid levels as described above. The epididymal fat pads were fixed with 10% neutral formalin and postfixed in 1% osmium tetroxide. The expression levels of genes were normalized using -actin as an internal control. Figure 1 shows the levels of major citrus fruit flavonoids including neoeriocitrin, narirutin, naringin, hesperidin, neohesperidin, poncirin, naringenin, nobiletin, and tangeretin. Naringin, the glycoside form of naringenin abundantly found in citrus fruits, possesses a wide range of pharmacological activities including antioxidative stress, anti-inflammatory, and anticancer effects. The total area under the curve of blood glucose levels between 0 to 90 min was 11. The liver, one of the insulin-sensitive tissues, plays a pivotal role in the processes of hyperglycemia and dyslipidemia [38, 39]. The mice were fasted for 12 hours and the tail vein blood was used to test the glucose level. Our results suggest that Citrus ichangensis could be used as a dietary supplement for antiobesity and hyperlipidemia-lowering therapy. Discussion Citrus peels are rich in flavonoids that have various biological activities. This is different from the findings from Citrus unshiu peel extract, which showed that the flavonoid compositions were hesperidin, narirutin, and naringin, with hesperidin being the highest [18]. Both hesperidin and naringin exhibit various biological and pharmacological effects, including antitumor, antiinflammatory, and antioxidant activities, and the potential to improve hyperglycemia, dyslipidemia, and hepatic steatosis in Type 2 diabetes [21, 40­42]. These positive effects were due to the citrus flavanones such as naringin and hesperidin. The active element of Citrus ichangensis probably is naringin, that is, the richest flavonoid in the extract. Acknowledgment this work was supported by the National Natural Science Foundation of China (31171930). Risk factor, paradox, and impact of weight loss," Journal of the American College of Cardiology, vol. Choi, "The development of tolerance to drugs that suppress food intake," Pharmacology and Therapeutics, vol. Sharma, "Natural products: a safest approach for obesity," Chinese Journal of Integrative Medicine, vol. Grover, "Development of functional food products in relation to obesity," Functional Foods in Health and Disease, vol. Okwu, "Citrus fruits: a rich source of phytochemicals and their roles in human health," International Journal of Chemical Sciences, vol. Kuno, "Cancer chemoprevention by citrus pulp and juices containing high amounts of betacryptoxanthin and hesperidin," Journal of Biomedicine and Biotechnology, vol. Bagchi, "Citrus aurantium as a thermogenic, weight-reduction replacement for eprhedra: an overview," Journal of Medicine, vol. Shyu, "Functional antioxidant and tyrosinase inhibitory properties of extracts of Taiwanese pummelo (Citrus grandis Osbeck)," African Journal of Biotechnology, vol. Concentrations of hydroxycinnamates and polymethoxylated flavones in citrus peel molasses," Journal of Agricultural and Food Chemistry, vol. Millner, "Novel one-pot synthesis and characterization of bioactive thiol-silicate nanoparticles for biocatalytic and biosensor applications," Nanotechnology, vol. Hong, "Inhibitory effect of citrus peel extract on lipid accumulation of 3T3-L1 adipocytes," Journal of Applied Biological Chemistry, vol. Takaku, "Lipolysis induced by segment wall extract from Satsuma mandarin orange (Citrus unshu Mark)," Journal of Nutritional Science and Vitaminology, vol. Allison, "Citrus aurantium and synephrine alkaloids in the treatment of overweight and obesity: an update," Obesity Reviews, vol. Sato, "Anti-obesity and anti-hyperglycemic effects of the dietary citrus limonoid nomilin in mice fed a high-fat diet," Biochemical and Biophysical Research Communications, vol. Evans, "Minireview: lipid metabolism, metabolic diseases, and peroxisome proliferatoractivated receptors," Endocrinology, vol. Waksman, "Peroxisome proliferator-activated receptor: its role in atherosclerosis and restenosis," Cardiovascular Radiation Medicine, vol.

Workers who complain of insomnia should not routinely have polysomnography to screen for sleep disorders. This test may be indicated for patients with symptoms in addition to insomnia, including sleep apnea, obesity, a risky neck diameter, or risky fullness of the flesh in the oropharynx. Usually, the test is not needed to make a diagnosis, and insomnia especially for working people can often be treated by changing a job schedule to make time for sufficient sleep and by improving sleep hygiene. The sleep study will involve the assessment tools of a polysomnogram and the multiple sleep latency test and will be conducted in a sleep center or a designated hotel. Specialists in sleep medicine are qualified to diagnose the many different sleep disorders. Patients with various disorders, including delayed 124 the Effortless Sleep Method: Cure for Insomnia. When a person has trouble getting to sleep, but has a normal sleep pattern once asleep, a delayed circadian rhythm is the likely cause. In many cases, insomnia is co-morbid with another disease, side-effects from medications, or a psychological problem. In depression in many cases "insomnia should be regarded as a co-morbid condition, rather than as a secondary one;" insomnia typically predates psychiatric symptoms. Prevention Going to sleep and waking up at the same time every day can create a steady pattern which may help to prevent or treat insomnia. Avoidance of vigorous exercise and anycaffeinated drinks a few hours before going to sleep is recommended, while exercise earlier in the day is beneficial. The bedroom should be cool and dark, and the bed should only be used for sleep and sex. The beneficial effects, in contrast to those produced by medications, may last well beyond the stopping of therapy. Medications have been used mainly to reduce symptoms in insomnia of short duration; their role in the management of chronic insomnia remains unclear. Several different types of medications are also effective Insomnia: Classification, Types and Patterns 125 for treating insomnia. However, many doctors do not recommend relying on prescription sleeping pills for long-term use. It is also important to identify and treat other medical conditions that may be contributing to insomnia, such as depression, breathing problems, and chronic pain. Non-pharmacological Non-pharmacological strategies have comparable efficacy to hypnotic medication for insomnia and they may have longer lasting effects. Hypnotic medication is only recommended for short-term use because dependence with rebound withdrawal effects upon discontinuation or tolerance can develop. Non pharmacological strategies provide long lasting improvements to insomnia and are recommended as a first line and long term strategy of management. The strategies include attention to sleep hygiene, stimulus control, behavioral interventions, sleep-restriction therapy, paradoxical intention, patient education and relaxation therapy. Some examples are keeping a journal, restricting the time spent awake in bed, practicing relaxation techniques, and maintaining a regular sleep schedule and a wake-up time. Behavioral therapy can assist a patient in developing new sleep behaviors to improve sleep quality and consolidation. Behavioral therapy may include, learning healthy sleep habits to promote sleep relaxation, undergoing light therapy to help with worry-reduction strategies and regulating the circadian clock. Stimulus control therapy is a treatment for patients who have conditioned themselves to associate the bed, or sleep in general, with a negative response. As stimulus control therapy involves taking steps to control the sleep environment, it is sometimes 126 the Effortless Sleep Method: Cure for Insomnia. Examples of such environmental modifications include using the bed for sleep or sex only, not for activities such as reading or watching television; waking up at the same time every morning, including on weekends; going to bed only when sleepy and when there is a high likelihood that sleep will occur; leaving the bed and beginning an activity in another location if sleep does not result in a reasonably brief period of time after getting into bed (commonly ~20 min); reducing the subjective effort and energy expended trying to fall asleep; avoiding exposure to bright light during nighttime hours, and eliminating daytime naps. A component of stimulus control therapy is sleep restriction, a technique that aims to match the time spent in bed with actual time spent asleep. This technique involves maintaining a strict sleep-wake schedule, sleeping only at certain times of the day and for specific amounts of time to induce mild sleep deprivation. Complete treatment usually lasts up to 3 weeks and involves making oneself sleep for only a minimum amount of time that they are actually capable of on average, and then, if capable. Bright light therapy, which is generally used to help early morning wakers reset their natural sleep cycle, can also be used with sleep restriction therapy to reinforce a new wake schedule. Although applying this technique with consistency is difficult, it can have a positive effect on insomnia in motivated patients.

Random comparison of four treatments (placebo, estrogen, placebo and orchiectomy, and estrogen and orchiectomy) reveals no significant differences among them, nor in comparison with radical prostatectomy. For a broad survey of analogous research on cancer in various sites, see note 40 above. Kutner, "Current Status of Steroid Therapy in Rheumatic Fever," American Heart Journal 70 (August 1965): 147-9. Brest, "Treatment of Coronary Occlusive Disease: Critical Review," Diseases of the Chest 45 (January 1964): 40-45. Spiekerman, "Re-evaluation of Therapy of Acute Myocardial Infarction," American Heart Journal 67 (April 1964): 559-64. Spain, the Complications of Modem Medical Practices (New York: Grune & Stratton, 1963). Goossens, Klinik und Therapie der Nebenwirkungen (Stuttgart: Thieme, 1973 [1st ed. Heintz, Erkrankungen durch Arzneimittel: Diagnostik, Klinik, Patkogenese, Therapie (Stuttgart: Thieme, 1966). Ackerknecht, "Zur Geschichte der iatrogenen Krankhei-ten," Gesnerus 27 (1970): 57-63. He distinguishes three waves, or periods, since 1750 when the study of iatrogenesis was considered important by the medical establishment. Ackerknecht, "Zur Geschichte der iatrogenen Erkrankungen des Nervensystems," Therapeutische Umschau/Revue thйrapeutique 27, no. A short survey of medical awareness of the 50 side-effects of drugs on the central nervous system, starting with Avicenna (980-1037) on mercury. Adverse Reactions Titles, a monthly bibliography of titles from approximately 3,400 biomedical journals published throughout the world; published in Amsterdam since 1966. Sartwell, "Iatrogenic Disease: An Epidemiological Perspective," International Journal of Health Services 4 (winter 1974): 89-93. Includes information on inactivation, incompatibility, potentiation, and plasma binding, as well as on interference with elimination, digestion, and test procedures. Horn, "Verhutung iatrogener Infektionen bei Schutzimpfungen," Deutsches Gesundheitswesen 27/24 (1972): 1131-6. Petersdorf, "Iatrogenic Factors in Infectious Disease," Annals of Internal Medicine 65 (October 1966): 641-56. Discretionary operations such as tonsillectomy and adenoidectomy, hemorroidectomy, and inguinal herniorrhaphy were two or more times higher. The main determinants may be differences in payment of health services and available hospital beds and surgeons. Lewis, "Variations in the Incidence of 58 Surgery," New England Journal of Medicine 281 (1969): 880-4, finds three- to fourfold variations in regional rates for six common surgical procedures in the U. The number of surgeons available was found to be the significant predictor in the incidence of surgery. Doyle, "Unnecessary Hysterectomies: Study of 6,248 Operations in Thirty-five Hospitals During 1948," Journal of the American Medical Association 151 (1953): 360-5. Doyle, "Unnecessary Ovariectomies: Study Based on the Removal of 704 Normal Ovaries from 546 Patients," Journal of the American Medical Association 148 (1952): 1105-11. Weller, "Pediatric Perceptions: the Pediatrician and latric Infectious Disease," Pediatrics 51 (April 1973): 595-602. Clifton Meador, "The Art and Science of Nondisease," New England Journal of Medicine 272 (1965): 92-5. For the physician accustomed to dealing only with pathologic entities, terms such as "nondisease entity" or "nondisease" are foreign and difficult to comprehend. This paper presents, with tongue in cheek, a classification of nondisease and the important therapeutic principles based on this concept. Iatrogenic disease probably arises as often from treatment of nondisease as from treatment of disease.

Raghavan, "Antioxidant and radical-scavenging carbazole alkaloids from the oleoresin of curry leaf (Murraya koenigii Spreng. Wu, "Induction of apoptosis by girinimbine in K562 cell," Chinese Traditional and Herbal Drugs, vol. Wah, "The growth suppressing effects of girinimbine on Hepg2 involve induction of apoptosis and cell cycle arrest," Molecules, vol. Ibrahim, "Biological activities of Pereskia bleo extracts," International Journal of Pharmacology, vol. Green, "Detection of apoptosis by annexin V labeling," Methods in Enzymology, vol. Joseph, "Quantifying cellular oxidative stress by dichlorofluorescein assay using microplate reader," Free Radical Biology and Medicine, vol. Elmore, "Apoptosis: a review of programmed cell death," Toxicologic Pathology, vol. Krishan, "Apoptosis-based drug screening and detection of selective toxicity to cancer cells," AntiCancer Drugs, vol. Reutelingsperger, "Annexin V-affinity assay: a review on an apoptosis detection system based on phosphatidylserine exposure," Cytometry, vol. Freitas, "Apoptosis and lysosome membrane permeabilization induction on breast cancer cells by an anticarcinogenic Bowman-Birk protease inhibitor from Vigna unguiculata seeds," Cancer Letters, vol. JЁattelЁ, "Lysosomal involvement in cell aЁ a death and cancer," Biochimica et Biophysica Acta-Molecular Cell Research, vol. Ollinger, "Regulation of apoptosis-associated lysosomal membrane permeabilization," Apoptosis, vol. Kim, "Oxidative stress-mediated apoptosis: the anticancer effect of the sesquiterpene lactone parthenolide," Journal of Biological Chemistry, vol. Vayssi`re, "Mitochondrial e reactive oxygen species in cell death signaling," Biochimie, vol. Wang, "The expanding role of mitochondria in apoptosis," Genes and Development, vol. Ruoslahti, "Fibronectin and its integrin receptors in cancer," Advances in Cancer Research, vol. Elmlinger, "Integrin-mediated action of insulin-like factor binding protein-2 in tumor cells," Journal of Molecular Endocrinology, vol. Morphology assessments demonstrated distinctive morphological changes corresponding to a typical apoptosis. Introduction Plants, in particular have been used by mankind as a source of medicine since the times of yore. Evidence on plants with healing properties exists about 5000 years ago, which had been documented since Sumerian civilization [1]. Purification of this fraction was done by column chromatography using mixture of hexane and ethyl acetate as eluent. No previous studies have been reported on this compound except for its phytochemical structure determination and physicochemical characterization. These pieces ancient knowledge were brought down from one generation to another and with the advancement of science and technology, plant-derived drugs have made massive contributions in various clinical conditions and had provided important leads against various pharmacological targets including cancer [3]. Zingiber cassumunar (family: Zingiberaceae) is commonly known as "Plai" in Thailand and "Bonglai" in Malaysia. It has long been used in traditional medicine in Thailand, being the prime ingredient in massage oil to relieve muscle pain. Therefore, the current study was conducted to investigate the in vitro antileukemic properties of this compound to substantiate its anticancer activity. Voucher specimen was deposited in Herbarium of Faculty of Pharmacy, Gajah Mada University, Jogjakarta. The extraction was repeated 3 times to remove the nonpolar organic compounds, waxes, and fats. The solvents were removed under reduced pressure and crude extracts were obtained.