The use of artificial intelligence algorithms to guide surgical treatment of adolescent idiopathic scoliosis

La scoliose idiopathique de l’adolescent (SIA) est une déformation tri-dimensionelle du rachis. Son traitement comprend l’observation, l’utilisation de corsets pour limiter sa progression ou la chirurgie pour corriger la déformation squelettique et cesser sa progression. Le traitement chirurgical reste controversé au niveau des indications, mais aussi de la chirurgie à entreprendre. Malgré la présence de classifications pour guider le traitement de la SIA, une variabilité dans la stratégie opératoire intra et inter-observateur a été décrite dans la littérature. Cette variabilité s’accentue d’autant plus avec l’évolution des techniques chirurgicales et de l’instrumentation disponible. L’avancement de la technologie et son intégration dans le milieu médical a mené à l’utilisation d’algorithmes d’intelligence artificielle informatiques pour aider la classification et l’évaluation tridimensionnelle de la scoliose. Certains algorithmes ont démontré être efficace pour diminuer la variabilité dans la classification de la scoliose et pour guider le traitement. L’objectif général de cette thèse est de développer une application utilisant des outils d’intelligence artificielle pour intégrer les données d’un nouveau patient et les évidences disponibles dans la littérature pour guider le traitement chirurgical de la SIA. Pour cela une revue de la littérature sur les applications existantes dans l’évaluation de la SIA fut entreprise pour rassembler les éléments qui permettraient la mise en place d’une application efficace et acceptée dans le milieu clinique. Cette revue de la littérature nous a permis de réaliser que l’existence de “black box” dans les applications développées est une limitation pour l’intégration clinique ou la justification basée sur les évidence est essentielle. Dans une première étude nous avons développé un arbre décisionnel de classification de la scoliose idiopathique basé sur la classification de Lenke qui est la plus communément utilisée de nos jours mais a été critiquée pour sa complexité et la variabilité inter et intra-observateur. Cet arbre décisionnel a démontré qu’il permet d’augmenter la précision de classification proportionnellement au temps passé à classifier et ce indépendamment du niveau de connaissance sur la SIA. Dans une deuxième étude, un algorithme de stratégies chirurgicales basé sur des règles extraites de la littérature a été développé pour guider les chirurgiens dans la sélection de l’approche et les niveaux de fusion pour la SIA. Lorsque cet algorithme est appliqué à une large base de donnée de 1556 cas de SIA, il est capable de proposer une stratégie opératoire similaire à celle d’un chirurgien expert dans prêt de 70% des cas. Cette étude a confirmé la possibilité d’extraire des stratégies opératoires valides à l’aide d’un arbre décisionnel utilisant des règles extraites de la littérature. Dans une troisième étude, la classification de 1776 patients avec la SIA à l’aide d’une carte de Kohonen, un type de réseaux de neurone a permis de démontrer qu’il existe des scoliose typiques (scoliose à courbes uniques ou double thoracique) pour lesquelles la variabilité dans le traitement chirurgical varie peu des recommandations par la classification de Lenke tandis que les scolioses a courbes multiples ou tangentielles à deux groupes de courbes typiques étaient celles avec le plus de variation dans la stratégie opératoire. Finalement, une plateforme logicielle a été développée intégrant chacune des études ci-dessus. Cette interface logicielle permet l’entrée de données radiologiques pour un patient scoliotique, classifie la SIA à l’aide de l’arbre décisionnel de classification et suggère une approche chirurgicale basée sur l’arbre décisionnel de stratégies opératoires. Une analyse de la correction post-opératoire obtenue démontre une tendance, bien que non-statistiquement significative, à une meilleure balance chez les patients opérés suivant la stratégie recommandée par la plateforme logicielle que ceux aillant un traitement différent. Les études exposées dans cette thèse soulignent que l’utilisation d’algorithmes d’intelligence artificielle dans la classification et l’élaboration de stratégies opératoires de la SIA peuvent être intégrées dans une plateforme logicielle et pourraient assister les chirurgiens dans leur planification préopératoire.

Étude de la cinétique des pesticides pyréthrinoïdes en conditions contrôlées et en milieu de travail dans un objectif de biosurveillance

Les pyréthrinoïdes sont des insecticides largement utilisés. La population générale y est exposée par l’alimentation tandis que les travailleurs agricoles y sont exposés lors de tâches diverses en champs. Leurs effets neurotoxiques, immunitaires et endocriniens potentiels en font des composés à surveiller pour assurer la santé de la population. La mesure de biomarqueurs d’exposition, qui consiste à quantifier la concentration dans l’organisme d’une substance ou de ses métabolites, permet d’estimer les doses absorbées. Les biomarqueurs peuvent également être des molécules répondant à un stress physiologique, identifiées comme des biomarqueurs d’effets. Pour raffiner les stratégies de biosurveillance de l’exposition, on se doit de bien connaître la toxicocinétique d’un xénobiotique; actuellement, les études de biosurveillance considèrent rarement la variabilité temporelle, intra-invidivuelle et inter-individuelle, qui pourrait influencer l’estimation de l’exposition. L’objectif de la thèse est donc d’appliquer une approche cinétique pour l’évaluation de l’exposition aux pyréthrinoïdes en conditions contrôlées et en milieu de travail. Dans un volet exploratoire, l’effet de cette exposition sur des changements métaboliques précoces a également évalué. Trois métabolites finaux (cis-DCCA, trans-DCCA et 3-PBA) de deux pyréthrinoïdes les plus utilisés, soient la perméthrine et la cyperméthrine, ont été mesurés dans le plasma et l’urine de six volontaires oralement exposés à une dose équivalente à la dose de référence. Une demi-vie moyenne (t½) d’élimination apparente du trans-DCCA, cis-DCCA et 3-PBA dans le plasma de 5,1, 6,9 et 9,2 h, respectivement, a été obtenue après exposition orale à la cyperméthrine, comparativement à 7,1, 6,2 et 6,5 h après exposition à la perméthrine. Dans l’urine, la demi-vie d'élimination apparente (t½) était de 6,3, 6,4 et 6,4 h pour le trans-DCCA, cis-DCCA et 3-PBA, respectivement, après administration de la cyperméthrine comparé à 5,4, 4,5 et 5,7 h après administration de la perméthrine. Les profils temporels étaient semblables suite à l’exposition à la cyperméthrine et perméthrine. Ensuite, une étude en milieu agricole a été réalisée avec la participation de travailleurs pour évaluer leur exposition et raffiner les stratégies de biosurveillance. La variabilité intra-individuelle dans les niveaux de biomarqueurs d’exposition chez plusieurs travailleurs était plus importante que la variabilité inter-individuelle. Les échantillons urinaires ont également été utilisés pour identifier des modifications du métabolome pouvant fournir de nouveaux biomarqueurs d’effets précoces. Chez les travailleurs, une augmentation de l'hippurate urinaire (p <0,0001) a été observée après exposition aux pyréthrinoïdes, un biomarqueur de la conjugaison de l’acide benzoïque. En conclusion, cette étude a permis de mieux documenter la cinétique de biomarqueurs d’exposition aux pyréthrinoïdes dans des conditions contrôlées et réelles afin de raffiner les stratégies de biosurveillance. Elle a aussi contribué à renseigner sur les niveaux d’exposition agricole québécois et sur les paramètres professionnels associés à une plus forte exposition. Ce projet s’insère dans une démarche d’analyse de risque en santé au travail.

Remote Sensing the Signatures of Upwelling in South Eastern Arabian Sea

In this thesis, a variety of available satellite data products have been made use of to bring out a synergistic analysis on the upwelling phenomenon in SEAS. Basic concepts of remote sensing, upwelling and linked oceanography topics have been dealt in this work .Auxiliary data products utilized in this study are described in chapter 2. The climatological monthly variability of the upwelling signatures are detailed under chapter 3. Chapter 4 presents the forcing factors that trigger the upwelling process in SEAS. Chapter 5 describes the oceanic response to the forcing factors with respect to the SST cooling and CHLA blooms. Chapter 6 presents the heat budget of the region and the variability of heat budget terms with respect to upwelling. Chapter 7 describes the inter-annual variability of upwelling intensity in SEAS and the influence of climatic events on upwelling.

Influence of short term climatic fluctuations on the agricultural land use in Kerala

In the present study, the land use over Kerala State and its spatial and temporal variations, spatio-temporal variations of water budget elements, climatic shifts, incidence of droughts and the influence of inter-annual fluctuations of rainfall on area. production and yield of selected crops, have been studied in detail. The thesis consists of seven chapters including the introduction. The first section of the Second Chapter deals with the importance of agrocliinatological studies in general and its application in agricultural land use in particular. It also gives an overview of the short term climatic fluctuations, water balance studies, crop weather relationships, land use patterns and various agricultural indices. This includes a detailed review of available literature in this field. The basic concepts. data used and the methodology adopted in the study forms, the second section of this Chapter. The Third Chapter gives the details of the physical features of the State such as the relief, geology, geomorphologysoils, drainage, and vegetation. The agroclimatology of the State is discussed in detail in Chapter Four. The first Section presents annual and seasonal variations of temperature and rainfall of the State along with a discussion on the water balance of the State. The secondSection of this Chapter deals with the influence of rainfall and water balance elements on various crops. The district-wise general land use pattern of theState and its spatio-temporal variations are discussed in Chapter Five. The first Section of Chapter Six gives an overview of the agricultural land use pattern of the State, cropping patterns, cropping intensity, crop combination and their spatio-temporal variations. The inter-annual variability of water balances of various stations of the State computed using the method of Thornthwaite (1948) and Thornthwaite & Mather (1955) is presented in the second Section of Chapter Six. This also includes a discussion of how the climatic shifts have occurred over the State and the influence of variations of climatic and water balance elements on the crops. The Seventh Chapter gives the summary of the work carried out and the results obtained from the study. Interpretations of the results, conclusions and suggestions made,based on the observations of the study are incorporated in this Chapter.

A Comparative study of germination strategies of two species of genus Allium sect. Allium

Germination experiments were performed with seeds of two species of genus Allium section Allium, a rare and endangered species A. pyrenaicum and a common A. sphaerocephalon. Different pre-treatments and a photoperiod of 24 h darkness were applied in order to simulate different germination conditions. Both species showed a high percentage of viable seeds a part of which were dormant. An elevate percentage of dormant seeds could be caused by a later collection time. Low altitude populations had more mortality than the others, possibly caused by the hard summer conditions during flowering and fruiting time. Comparisons between dates of species coexistence localities only show inter-population variability and it could be caused by the detected dormancy. Darkness accelerates germination, possibly for elongation radicle stimulation. Heat-shock pre-treatments decreased germination time in seeds from localities where fire is a probable event. The rarity of A. Pyrenaicum not seems to be caused by restricted germination requirements but is attributable to distinct habitat preferences, related to his altitudinal range of distribution

Impacto de un curso teórico de mamografía en la categorización de microcalcificaciones de acuerdo al BI-RADS 4ed

Introducción: Por medio del presente estudio se busca determinar el impacto de un curso teórico de mamografía en la categorización de microcalficaciones mamarias. Materiales y métodos: Se realizó un estudio doble ciego para evaluar la variación de los valores predictivos positivos (VPP) de los descriptores morfológicos y de distribución de calcificaciones del BI-RADS 4ed, luego de un curso teórico de mamografía de 6 horas distribuido en 12 charlas semanales de 30 minutos. Se utilizó la base de datos de un estudio previo, en el cual dos radiólogos clasificaron las calcificaciones presentes en 108 mamografías de pacientes con diagnóstico histológico. Se realizó una nueva categorización de las calcificaciones según los descriptores. Se calcularon además, los valores kappa ponderados de concordancia intra e inter-observador, la sensibilidad y especificidad. Resultados: Para las calcificaciones de alta probabilidad de malignidad (pleomórficas finas y lineales ramificadas en conjunto), se obtuvieron VPP de 41 y 40%, con aumento leve respecto a la lectura inicial. El índice kappa ponderado para el acuerdo inter-observador fue de 0,305 lo que indica concordancia débil, con discreto incremento respecto a la evaluación inicial 0,260. La concordancia intra-observador para el evaluador 1 dio un valor kappa 0,471, moderada; y para el evaluador 2 un valor kappa 0,400, débil. Discusión: Un módulo teórico corto permite mejorar ligeramente la concordancia inter-observador en la evaluación de microcalcificaciones mamarias mediante el BI-RADS 4ed, así como los valores predictivos positivos de microcalficaciones de alta probabilidad de malignidad.

Polimorfismos de los genes ABCB1 y CYP2C8 en pacientes sometidos a TASPE. Análisis farmacogenético del Paclitaxel en la toxicidad y movilización de progenitores hemopoyéticos

Fundamentos. La eficacia de paclitaxel junto con rhG-CSF en la movilización de progenitores hematopoyéticos, se ha probada en pacientes hematológicos. Farmacogenéticamente el paclitaxel presenta una alta variabilidad inter-individual. Los genes CYP2C8 y ABCB1 involucrados en su metabolismo y transporte podrían afectar dicha variabilidad inter-individual. Objetivo. Evaluar en una cohorte retrospectiva de pacientes sometidos a TASPE, el efecto de algunos polimorfismos de nucleótido simple (del gen CYP2C8 y del gen ABCB1) sobre la eficacia en la movilización y toxicidad hematológica inducida por del paclitaxel. Materiales y Métodos. Un grupo de 107 pacientes recibieron paclitaxel y rhG-CSF como esquema movilizador. Los polimorfismos genotipados fueron para los genes ABCB1 rs1045642 A>G, ABCB1 rs2032582 C>A, ABCB1 rs2032582 C>T, CYP2C8 rs10509681 C>T, y CYP2C8 rs11572080 A>G. Resultados. El uso de paclitaxel logró éxito movilizador en más del 80% de los pacientes con linfomas o mieloma (p=0,0021), pero no lo fue en la leucemia aguda. En pacientes con mieloma la variable G>rs1045642 del gen ABCB1 se asoció con mala movilización (p= 0,018) y mayor toxicidad hematológica (p= 0,034). El alelo C>rs10509681 del gen CYP2C8 se relacionó con mayor toxicidad en pacientes con linfoma (p= 0,045) y mieloma múltiple (p=0,042), y portadores del alelo TT en homocigosis presentaron una mayor toxicidad hematológica comparada con los portadores CC o CT (p= 0,027). Conclusión. Este estudio sugiere que los SNPs de las variables alélicas analizadas en los genes CYP2C8 y ABCB1 en algunos grupos de pacientes inciden en la capacidad movilizadora y afectan el grado de toxicidad hematológica.

Búsqueda de selección en el polimorfismo 677C>T (c.665C>T) del gen de la metilentetrahidrofolato reductasa (MTHFR) en una población Colombiana

Se realizó un estudio genético – poblacional en dos grupos etarios de población colombiana con la finalidad de evaluar las diferencias genéticas relacionadas con el polimorfismo MTHFR 677CT en busca de eventos genéticos que soporten la persistencia de este polimorfismo en la especie humana debido que este ha sido asociado con múltiples enfermedades. De esta manera se genotipificaron los individuos, se analizaron los genotipos, frecuencias alélicas y se realizaron diferentes pruebas genéticas-poblacionales. Contrario a lo observado en poblaciones Colombianas revisadas se identificó la ausencia del Equilibrio Hardy-Weinberg en el grupo de los niños y estructuras poblacionales entre los adultos lo que sugiere diferentes historias demográficas y culturales entre estos dos grupos poblacionales al tiempo, lo que soporta la hipótesis de un evento de selección sobre el polimorfismo en nuestra población. De igual manera nuestros datos fueron analizados junto con estudios previos a nivel nacional y mundial lo cual sustenta que el posible evento selectivo es debido a que el aporte de ácido fólico se ha incrementado durante las últimas dos décadas como consecuencia de las campañas de fortificación de las harinas y suplementación a las embarazadas con ácido fólico, por lo tanto aquí se propone un modelo de selección que se ajusta a los datos encontrados en este trabajo se establece una relación entre los patrones nutricionales de la especie humana a través de la historia que explica las diferencias en frecuencias de este polimorfismo a nivel espacial y temporal.  

Isolating the signal of ocean global warming

Identifying the signature of global warming in the world's oceans is challenging because low frequency circulation changes can dominate local temperature changes. The IPCC fourth assessment reported an average ocean heating rate of 0.21 ± 0.04 Wm−2 over the period 1961–2003, with considerable spatial, interannual and inter-decadal variability. We present a new analysis of millions of ocean temperature profiles designed to filter out local dynamical changes to give a more consistent view of the underlying warming. Time series of temperature anomaly for all waters warmer than 14°C show large reductions in interannual to inter-decadal variability and a more spatially uniform upper ocean warming trend (0.12 Wm−2 on average) than previous results. This new measure of ocean warming is also more robust to some sources of error in the ocean observing system. Our new analysis provides a useful addition for evaluation of coupled climate models, to the traditional fixed depth analyses.

Granulometric characterization and evaluation of annually banded mid-Holocene estuarine silts, Welsh Severn Estuary (UK): coastal change, sea level and climate

Holocene silts (salt marshes) and highest intertidal-supratidal peats are superbly exposed on a 15 kin coastal transect which reveals two laterally extensive units of annually banded silts (Beds 3, 7) associated with three transgressive-regressive silt-peat cycles (early sixth-early fourth millennium BC). Bed 3 in places is concordantly and gradationally related to peats above and below, but in others transgresses older strata. Bed 7 also grades up into peat, but everywhere overlies a discordance. The banding in Bed 3 at three main and two minor sites was resolved and characterized texturally at high-resolution (2.5/5 mm contiguous slices) using laser granulometry (LS230 with PIDS) and a comprehensive scheme of data-assessment. Most of Bed 3 formed very rapidly, at peak values of several tens of millimetres annually, in accordance with modelled effects of sea-level fluctuations on mature marshes (bed concordant and gradational) and on marshes growing up after coastal erosion and retreat (bed with discordant base). Using data from the modern Severn Estuary, the textural contrast within bands, and its variation between bands, points to a variable but overall milder mid-Holocene climate than today. The inter-annual variability affected marsh dynamics, as shown by the behaviour of the finely divided plant tissues present. Given local calibration, the methodology is applicable to other tidal systems with banded silts in Britain and mainland northwest Europe. (c) 2006 Elsevier Ltd. All rights reserved.

Spatial and temporal scale issues in determining biomass burning regimes in Bolivia and Peru

ATSR-2 active fire data from 1996 to 2000, TRMM VIRS fire counts from 1998 to 2000 and burn scars derived from SPOT VEGETATION ( the Global Burnt Area 2000 product) were mapped for Peru and Bolivia to analyse the spatial distribution of burning and its intra- and inter-annual variability. The fire season in the region mainly occurs between May and October; though some variation was found between the six broad habitat types analysed: desert, grassland, savanna, dry forest, moist forest and yungas (the forested valleys on the eastern slope of the Andes). Increased levels of burning were generally recorded in ATSR-2 and TRMM VIRS fire data in response to the 1997/1998 El Nino, but in some areas the El Nino effect was masked by the more marked influences of socio-economic change on land use and land cover. There were differences between the three global datasets: ATSR-2 under-recorded fires in ecosystems with low net primary productivities. This was because fires are set during the day in this region and, when fuel loads are low, burn out before the ATSR-2 overpass in the region which is between 02.45 h and 03.30 h. TRMM VIRS was able to detect these fires because its overpasses cover the entire diurnal range on a monthly basis. The GBA2000 product has significant errors of commission (particularly areas of shadow in the well-dissected eastern Andes) and omission (in the agricultural zone around Santa Cruz, Bolivia and in north-west Peru). Particular attention was paid to biomass burning in high-altitude grasslands, where fire is an important pastoral management technique. Fires and burn scars from Landsat Thematic Mapper (TM) and Enhanced Thematic Mapper (ETM) data for a range of years between 1987 and 2000 were mapped for areas around Parque Nacional Rio Abiseo (Peru) and Parque Nacional Carrasco (Bolivia). Burn scars mapped in the grasslands of these two areas indicate far more burning had taken place than either the fires or the burn scars derived from global datasets. Mean scar sizes are smaller and have a smaller range in size between years the in the study area in Peru (6.6-7.1 ha) than Bolivia (16.9-162.5 ha). Trends in biomass burning in the two highland areas can be explained in terms of the changing socio-economic environments and impacts of conservation. The mismatch between the spatial scale of biomass burning in the high-altitude grasslands and the sensors used to derive global fire products means that an entire component of the fire regime in the region studied is omitted, despite its importance in the farming systems on the Andes.

Characterization of the 23S and 5S rRNA genes and 23S-5S intergenic spacer region (ITS-2) of Photobacterium damselae

The 23S ribosomal RNA (rRNA) gene has been sequenced in strains of the fish pathogens Photobacterium damselae subsp. damselae (ATCC 33539) and subsp. piscicida (ATCC 29690), showing that 3 nucleotide positions are clearly different between subspecies. In addition, the 5S rRNA gene plus the intergenic spacer region between the 23S and 5S rRNA genes (ITS-2) were amplified, cloned and sequenced for the 2 reference strains as well as the field isolates RG91 (subsp. damselae) and DI21 (subsp. piscicida). A 100% similarity was found for the consensus 5S rRNA gene sequence in the 2 subspecies, although some microheterogeneity was detected as inter-cistronic variability within the same chromosome. Sequence analysis of the spacer region between the 23S and 5S rRNA genes revealed 2 conserved and 3 variable nucleotide sequence blocks, and 4 different modular organizations were found. The ITS-2 spacer region exhibited both inter-subspecies and inter-cistronic polymorphism, with a mosaic-like structure. The EMBL accession numbers for the 23S, 5S and ITS-2 sequences are: P. damselae subsp. piscicida 5S gene (AJ274379), P. damselae subsp. damselae 23S gene (Y18520), subsp. piscicida 23S gene (Y17901), R damselae subsp. piscicida ITS-2 (AJ250695, AJ250696), P. damselae subsp. damselae ITS-2 (AJ250697, AJ250698).

Introduction to the DISRUPT postprandial database: subjects, studies and methodologies

Dysregulation of lipid and glucose metabolism in the postprandial state are recognised as important risk factors for the development of cardiovascular disease and type 2 diabetes. Our objective was to create a comprehensive, standardised database of postprandial studies to provide insights into the physiological factors that influence postprandial lipid and glucose responses. Data were collated from subjects (n = 467) taking part in single and sequential meal postprandial studies conducted by researchers at the University of Reading, to form the DISRUPT (DIetary Studies: Reading Unilever Postprandial Trials) database. Subject attributes including age, gender, genotype, menopausal status, body mass index, blood pressure and a fasting biochemical profile, together with postprandial measurements of triacylglycerol (TAG), non-esterified fatty acids, glucose, insulin and TAG-rich lipoprotein composition are recorded. A particular strength of the studies is the frequency of blood sampling, with on average 10-13 blood samples taken during each postprandial assessment, and the fact that identical test meal protocols were used in a number of studies, allowing pooling of data to increase statistical power. The DISRUPT database is the most comprehensive postprandial metabolism database that exists worldwide and preliminary analysis of the pooled sequential meal postprandial dataset has revealed both confirmatory and novel observations with respect to the impact of gender and age on the postprandial TAG response. Further analysis of the dataset using conventional statistical techniques along with integrated mathematical models and clustering analysis will provide a unique opportunity to greatly expand current knowledge of the aetiology of inter-individual variability in postprandial lipid and glucose responses.

The importance of the relationship between scale and process in understanding long-term DOC dynamics

Concentrations of dissolved organic carbon have increased in many, but not all, surface waters across acid impacted areas of Europe and North America over the last two decades. Over the last eight years several hypotheses have been put forward to explain these increases, but none are yet accepted universally. Research in this area appears to have reached a stalemate between those favouring declining atmospheric deposition, climate change or land management as the key driver of long-term DOC trends. While it is clear that many of these factors influence DOC dynamics in soil and stream waters, their effect varies over different temporal and spatial scales. We argue that regional differences in acid deposition loading may account for the apparent discrepancies between studies. DOC has shown strong monotonic increases in areas which have experienced strong downward trends in pollutant sulphur and/or seasalt deposition. Elsewhere climatic factors, that strongly influence seasonality, have also dominated inter-annual variability, and here long-term monotonic DOC trends are often difficult to detect. Furthermore, in areas receiving similar acid loadings, different catchment characteristics could have affected the site specific sensitivity to changes in acidity and therefore the magnitude of DOC release in response to changes in sulphur deposition. We suggest that confusion over these temporal and spatial scales of investigation has contributed unnecessarily to the disagreement over the main regional driver(s) of DOC trends, and that the data behind the majority of these studies is more compatible than is often conveyed.

The role of monounsaturated fatty acids in the mitigation of insulin resistance

With the rising rate of obesity, there is considerable interest in dietary strategies to reduce insulin resistance, a major characteristic of the metabolic syndrome and type 2 diabetes. Diets rich in monounsaturated fatty acids (MUFA) have been suggested as an alternative to low-fat, high-carbohydrate diets to improve glycemic control. However, inconsistent effects have been observed with MUFA-rich diets in both healthy and insulin-resistant individuals. In studies that have reported favorable effects on insulin sensitivity, Mediterranean-style diets have been used that are rich not only in MUFA but also whole-grain foods, fiber, and carbohydrates with a low glycemic index. There is a need for intervention studies to examine the true impact of MUFA-rich oils on glycemic control in both Mediterranean and non-Mediterranean populations. In addition, the metabolic and genotypic status of the participants may also play a role in the inter-individual variability in insulin sensitivity in response to MUFA-rich diets.