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The optimal treatment for patients with asymptomatic carotid artery stenosis is under debate. Since best medical treatment (BMT) has improved over time, the benefit of carotid endarterectomy (CEA) or carotid artery stenting (CAS) is unclear. Randomised data comparing the effect of CEA and CAS versus BMT alone are absent. We aimed to directly compare CEA plus BMT with CAS plus BMT and both with BMT only.SPACE-2 was a multicentre, randomised, controlled trial at 36 study centres in Austria, Germany, and Switzerland. We enrolled participants aged 50-85 years with asymptomatic carotid artery stenosis at the distal common carotid artery or the extracranial internal carotid artery of at least 70%, according to European Carotid Surgery Trial criteria. Initially designed as a three-arm trial including one group for BMT alone (with a randomised allocation ratio of 2·9:2·9:1), the SPACE-2 study design was amended (due to slow recruitment) to become two substudies with two arms each comparing CEA plus BMT with BMT alone (SPACE-2a) and CAS plus BMT with BMT alone (SPACE-2b); in each case in a 1:1 randomisation. Participants and clinicians were not masked to allocation. The primary efficacy endpoint was the cumulative incidence of any stroke or death from any cause within 30 days or any ipsilateral ischaemic stroke within 5 years. The primary safety endpoint was any stroke or death from any cause within 30 days after CEA or CAS. The primary analysis was by intention-to treat, which included all randomly assigned patients in SPACE-2, SPACE-2a, and SPACE-2b, analysed using meta-analysis of individual patient data. We did two-step hierarchical testing to first show superiority of CEA and CAS to BMT alone then to assess non-inferiority of CAS to CEA. Originally, we planned to recruit 3640 patients; however, the study had to be stopped prematurely due to insufficient recruitment. This report presents the primary analysis at 5-year follow-up. This trial is registered with ISRCTN, number ISRCTN78592017.513 patients across SPACE-2, SPACE-2a, and SPACE-2b were recruited and surveyed between July 9, 2009, and Dec 12, 2019, of whom 203 (40%) were allocated to CEA plus BMT, 197 (38%) to CAS plus BMT, and 113 (22%) to BMT alone. Median follow-up was 59·9 months (IQR 46·6-60·0). The cumulative incidence of any stroke or death from any cause within 30 days or any ipsilateral ischaemic stroke within 5 years (primary efficacy endpoint) was 2·5% (95% CI 1·0-5·8) with CEA plus BMT, 4·4% (2·2-8·6) with CAS plus BMT, and 3·1% (1·0-9·4) with BMT alone. Cox proportional-hazard testing showed no difference in risk for the primary efficacy endpoint for CEA plus BMT versus BMT alone (hazard ratio [HR] 0·93, 95% CI 0·22-3·91; p=0·93) or for CAS plus BMT versus BMT alone (1·55, 0·41-5·85; p=0·52). Superiority of CEA or CAS to BMT was not shown, therefore non-inferiority testing was not done. In both the CEA group and the CAS group, five strokes and no deaths occurred in the 30-day period after the procedure. During the 5-year follow-up period, three ipsilateral strokes occurred in both the CAS plus BMT and BMT alone group, with none in the CEA plus BMT group.CEA plus BMT or CAS plus BMT were not found to be superior to BMT alone regarding risk of any stroke or death within 30 days or ipsilateral stroke during the 5-year observation period. Because of the small sample size, results should be interpreted with caution.German Federal Ministry of Education and Research (BMBF) and German Research Foundation (DFG).

Plant-based dairy alternatives are gaining increasing interest, e.g. alternatives to yoghurt, cheese, and butter. In all these products butter flavor (diacetyl + acetoin) plays an important role. We previously have reported efficient butter flavor formation from low value dairy side streams using a dairy isolate of Lactococcus lactis deficient in lactate dehydrogenase. Here, we have tested the ability of this strain, RD1M5, to form butter flavor in plant milks based on oat and soy. We found that oat milk, with its high sugar content, supported more efficient production of butter aroma, when compared to soy milk. When supplemented with glucose, efficient butter aroma production was achieved in soy milk as well. We also carried out an extended adaptive laboratory evolution of the dairy strain in oat milk. After two months of adaptation, we obtained a strain with enhanced capacity for producing butter aroma. Despite of its high sugar content, RD1M5 and its adapted version only metabolized approximately 10% of the fermentable sugars available in the oat milk, which we found was due to amino acid starvation and partly starvation for vitamins. The study demonstrates that dairy cultures have great potential for use in plant-based fermentations.

Fermented foods and beverages are the product of the enzymaticcally transformed food components which are acived by different microorganisms. Fermented foods have grown in popularity in recent years because of their alleged health benefits. Biogenic amines, bioactive peptides, antinutrient reduction, and polyphenol conversion to physiologically active chemicals are all possible health benefits of fermentation process products. In Ethiopian-fermented foods, which are mostly processed using spontaneous fermentation process. Injera is one of the fermented food products consumed in all corners of the country which sourdough fermentation could be achieved using different LAB and yeast strains. Moreover, the kind and concentration of the substrate and the type of microbial flora, as well as temperature, air supply, and pH, all influence the fermentation process of injera. This review article gives an overview of factors influencing the fermentation process of teff ('Eragrostis tef.') and other cereal-based Ethiopian injera.

Rhamnus prinoides (Gesho) is an angiosperm dioecious plant, which is used for cash income, as a bittering agent for the preparation of the local alcoholic beverage and medicinal values. Although it has intense use, still its practical application is limited for local alcoholic beverage preparation, and there is no sufficient scientific report on the level and quantity of bittering agents, essential oils, and antioxidants of this plant. Therefore, the objective of this research was to assess and determine the bittering agents, essential oils, and antioxidants of R. prinoides. The leaves of R. prinoides were collected from eleven different sample sites and allowed to sun dry and then powdered. It was further dried in an oven at 60°C for 1 h, and then, total resin, essential oils, alpha acid, iso-alpha acid, beta acid, flavonoids, and polyphenols of R. prinoides were determined. All the data were analyzed using SPSS version 20.0. Based on this study finding, (16.03 ± 0.03–17.05 ± 0.04%) total resins, (10.00 ± 0.08–11.23 ± 0.07%) soft resins, (5.65 ± 0.11–6.40 ± 0.35%) hard resins, (1.82 ± 0.11–3.14 ± 0.02 mg/l) alpha acids, (2.26 ± 0.15–4.15 ± 0.10 mg/l) iso-alpha acids, (2.62 ± 0.04–4.29 ± 0.08 mg/l) beta acids, (7.74 ± 0.11–12.47 ± 0.13%) essential oils, (23.00 ± 0.14–25.01 ± 0.09%) flavonoids, and (2.11 ± 0.01–2.41 ± 0.02%) polyphenols were obtained in the leaves of R. prinoides. R. prinoides leaves taken from Tikledingay has shown statistically ( P ≤ 0.05 ) significant amount of soft resin (11.23 ± 0.07%), alpha acid (3.14 ± 0.02 mg/l), iso-alpha acid (4.15 ± 0.10 mg/l), essential oils (12.47 ± 0.13%), flavonoids (25.01 ± 0.09%), and polyphenols (2.41 ± 0.02%) in comparison with other samples. Generally, R. prinoides is a good source of bittering agents, essential oils, and antioxidants. However, the quantity of bittering agents, essential oils, and antioxidants in the leaves of R. prinoides was varied with sample collection sites. So R. prinoides can be used as a substitute for commercial hops used in the breweries, and promotion should be done to introduce the potential of Gesho as a bittering agent, source of aroma and flavor, and also antioxidant for beer and other alcoholic beverages.

Identification of the yeast responsible for Injera fermentation is important in order to be more consistent and for scale-up of Injera production. In this study, yeast were isolated and identified from fermenting teff dough sample collected from household, hotels, and microenterprises, Addis Ababa. Initially, the yeast obtained from fermenting teff dough of different sources were selected on the basis of their CO2 production potentials. Its DNA sequencing of isolated yeast identified Pichia fermentans, Pichia occidentalis, Candida humilis, Saccharomyces cerevisiae, and Kazachstania bulderi. The association of identified yeast to their sources indicated the presence of Pichia fermentans in fermenting dough samples collected from all sources whereas Kazachstania bulderi, Saccharomyces cerevisiae, and Candida humilis were shown to be present in samples collected from households, hotels, and microenterprises, respectively. The phenotypes and CO2 production potentials of this yeast were also documented. This study has confirmed the presence of different yeast species in the fermentation of teff dough and hinted the complex nature of Injera dough fermentation.

Injera is soft fermented baked product, which is commonly prepared from teff (Eragrostis tef(Zucc.)) flour and believed to be consumed on daily basis by two-thirds of Ethiopians.As it is a product of naturally fermented dough, the course of fermentation is done by consortia of microorganisms. The study was aimed at isolating and identifying some dominant bacteria from fermentingteff (Eragrostis tef)dough. A total of 97 dough samples were collected from households, microenterprises, and hotels with different fermentation stage from Addis Ababa. The bacterial isolates obtained from the fermentingteffdough samples were selected on the basis of their acid production potentials. A total of 24 purified bacterial isolates were found to be Gram-positive (they are coccus and rod under microscope) and were good acid producers. Genomic DNA of bacterial isolates were extracted using Invisorb® Spin DNA Extraction kit. 16S rRNA of bacterial isolates were amplified using the bacteria universal primers (rD1 and fD1). The amplified product was sequenced at Genewiz, USA. Sequence analysis and comparison with the resources at the database were conducted to identify the isolated microbes into species and strain levels. The bacterial isolates were identified asLactobacillus paracasei, Lactobacillus brevis, Enterococcus durans, Enterococcus hirae, Enterococcus avium,andEnterococcus faecium. All identified lactic acid bacteria were able to produce acid at 12 h time of incubation. This study has confirmed the presence of different bacterial species in the fermentingteffdough and also supports the involvement of various groups of bacterial species in the course of the fermentation.

Kocho and Bula are fermented product of Enset (Ensete ventricosum). It is the staple food for 20 million people in Ethiopia. The aim of study was to isolate, identify and characterize yeast species from fermented kocho and bulla by using Biolog Micro station. 300 Kocho samples were collected from Angacha District. 0.1ml of serially diluted samples were Streaked on yeast pepton dextrose agar and incubated at 280C. Pure yeast colony inoculum were prepared at 9ml distilled water at 49% +2 turbidometer and transferred in to YT micro plate. Incubated for 24-72 hours at 28oC and micro plate reading were carried out using MicroLog 3 Software version. 4.20.05. Seven yeast species were identified from study samples. Biolog Micro station 100% probability and >0.5 Similarity read identify Cryptococcus albidus Var aerus, Guilliermondella selenospora, Rhodotorula acheniorum and Trichosporon beigelii. 99% Cryptococcus terreus A, 98% Candida zylandase, 86% Kluyveramyces delphensis respectively. Characterization of yeast involved in kocho fermentation is very important for formulation of starter culture, improving, standardizing and modernizing quality of traditional Enset fermentation and preparation.