Current directions in the treatment of obesity.

Evaluates the effectiveness of various treatments in producing weight reduction and long-term weight maintenance. The literature indicates that treatment results with traditional weight loss procedures are no more effective now than they were 15 yrs ago. Behavior modification techniques have shown more promising results in weight loss maintenance, with the most efficient techniques those which directly teach the modification of eating patterns. However, the weight losses reported have generally not been very large, and there may be individual differences in the effectiveness of the particular behavioral techniques employed. Intestinal bypass surgery has produced substantial weight reduction, but the physical side effects and complications are numerous. (31/4 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Muscular intolerance of exercise. Current data

Our knowledge of the mechanisms leading to exercise intolerance is constantly expanding. Since the discovery of the glycolysis pathway block caused by phosphorylase deficiency as the cause of McArdle's disease, several other glycolysis blocks have been identified constituting a first group of exercise intolerance syndromes. A second group involves mitochondrial anomalies. More recently diverse exercise intolerance syndromes have been associated with insufficient regulation of calcium flow through the sarcoplasmic reticulum, particularly in sporadic cases of malignant hyperthermia with or without hyperthermia. A discrete form of dystrophinopathy is expressed by exercise-induced myalgia with myoglobinuria. Proximal myotonic myopathy also produces pain at exercise. The specificity of other syndromes such as AMP deaminase deficiency or myopathy with tubular aggregates remains debatable. Our understanding of these different syndromes, and their recognized or yet to be elucidated causes, is of practical significance for developing exploration protocols for patients with exercise intolerance with or without myoglobulinuria.     

From cholesterol to oxysterols. Current data

Oxysterols, a class of cholesterol oxidation products exhibit several important biological activities. Some of these natural compounds are potent inhibitors of the enzyme HMG-CoA reductase, a key enzyme in the cholesterol biosynthetic pathway. Many studies have been directed towards to the verification of the hypothesis that some oxysterols are endogenous intracellular regulators of cholesterol homeostasis. In adition to oxysterols derived directly from oxidation of cholesterol, several others are formed from squalene dioxide. It is presently well established that, in addition to the classical cholesterol biosynthetic pathway, there exists an alternate bifurcation from squalene oxide. The cyclisation of squalene dioxide leads to a series of new oxysterols. Thus, several types of oxysterols and several molecular targets are involved in the regulation of steroid biosynthesis. Many oxysterols, particularly those obtained from the oxidations of phytosterols and tetracyclic triterpenes are potent cytotoxic agents. They are selectively cytotoxic against tumorous cells. This cytotoxicity depends markedly on the specific structure of each oxysterol. Some structures are very cytotoxic, while their stereoisomers are inactive. The activity depends on the tumor cells which are used in the assay system: some compounds display inhibitory activity towards hepatoma cells but are inactive against lymphoma cells while others act in the opposite manner. Free oxysterols do not depress tumor growth in living animals. However, several water soluble prodrugs of oxysterols are able to depress different type of tumors in vivo. Clinical trial studies are presently conducted in order to learn the therapeutic values of these oxysterols.     

Drugs prescribed for chronic heart failure. Current data on their effectiveness

VARIABLE EFFICACY: Prognosis in patients with chronic heart failure remains poor. Certain drugs can lower mortality and improve quality of life. DRUGS WITH PROVEN EFFICACY: Converting enzyme inhibitors (CEI) have proven efficacy and should be used in all stages of heart failure outside contraindications. High-dose regimens are recommended when tolerated. Certain beta-blockers have also been added to the list of effective drugs for heart failure. Positive data have been reported for metroprolol, bisoprolol and carvedilol. Improved function has been demonstrated only with carvedilol allowing a clear reduction in mortality; it is currently indicated in combination with CEI and diuretics for patients with symptomatic heart failure. DRUGS WITH INSUFFICIENTLY PROVEN EFFICACY: Certain drugs which have been used for many years can improve heart function but data clearly proving lower mortality are lacking. These include diuretics and nitrate derivatives for symptomatic patients and digitalics which are useful not only for patients with complete arrhythmia due to atrial fibrillation but also for symptomatic patients with sinus rhythm. According to preliminary studies, aldosterone antagonists appear to have a positive effect on mortality due to heart failure. DRUGS WITH LIMITED INDICATIONS: Other drugs have been found to have no effect on mortality. Amiodarone, amlodipine and felodipine can thus be used for patients with associated diseases. Finally anticoagulant therapy should be reserved for patients with atrial fibrillation or a history of thromboembolism.     

Treatment of mild, moderate, and severe obesity in children.

This paper examines treatment alternatives for children and adolescents as a function of degree of obesity. Treatment for mild obesity (20-40% overweight) should be preventive, emphasizing long-term changes in eating and activity patterns with the goal of weight maintenance and relative weight reduction. Short-term behaviour modification programmes, which include parental support, are effective in achieving these goals. Outpatient clinics or schools where social support is available are appropriate treatment settings. More comprehensive behavioural programmes are needed for treating moderate obesity (41-100% overweight). Such programmes include extended treatment periods, depositrefund contracts, direct parental involvement, and increased emphasis on lifestyle exercise. Outpatient clinics and schools remain optimal treatment settings, but more research is needed on camp settings. Radical treatments such as surgery, drugs, and very low calorie diets cannot be recommended for moderate childhood obesity. Severe obesity (> 100% overweight) requires consideration of radical interventions, and evidence to date supports the experimental use of very low calorie diets (protein-sparing modified fasts) together with behaviour modification. Such dietary treatment must be conducted in hospitals under strict medical supervision. Neither drugs nor surgery can be recommended for severe obesity in children and adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On Schachter on obesity.

Argues that the characteristics of the obese behavior syndrome identified by S. Schachter (see record 1971-24450-001) are suited to the survival of the predator. Two types of hypothalamic ventral nuclei (HVN) are suggested: the predator-facilitating HVN and the vegetarian-facilitating HVN. It is proposed that obese individuals are misplaced hunters programmed for an environment that does not exist in most parts of the modern world. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The status of neurologic intensive care in Germany. Current data]

In 1994 this journal published the results of a survey undertaken on behalf of the Working Association for Neurological Intensive Care Medicine (ANIM) in the winter of 1992/93. In the winter of 1996/97 a continuation of this analysis was performed. With the help of a questionnaire the data of 62 intensive care units with a total of 420 beds were established. This is 11 intensive care units and 83 beds more than 1992/93. The intensive care units were again classified into three groups (ventilation units, monitoring units, interdisciplinary units) relating to their equipment and structure. The questions concerned structural organisation, such as the number of beds, type of clinic, number and training of physicians and nurses, technical equipment and availability of large and high-tech apparatus or access to other facilities, such as neurosurgery. Of great interest were data about whether and to what extent special measures of intensive medicine can be taken on the one hand and performance parameter data e.g. days of ventilation and duration of in-patient treatment on the other hand. Detailed data were provided concerning the frequency of each diagnosis of patients treated in those intensive care units. Evaluating the data a positive development in the last four years of the neurological intensive care can be found in most of the areas investigated. It has also been found that neurological intensive care in the new lander has reached equal standard both in quality and quantity. Now a single physician is responsible for 2,3 beds compared to 3,6. Today 78 per cent of the beds in ventilation units are equipped with a ventilator. The overall time of ventilation increased to 48 per cent. Overall there are, however, considerable differences between individual units as well as regions. The data presented can serve as a means to monitor the quality of neurological intensive care.     

含铬废水的处理现状

冶金、化工、电镀等行业的生产过程会产生大量的含铬废水，对生态环境和人类健康造成危害。文章介绍了几种含铬废水的治理技术，包括化学还原法、电解法、吸附法、离子交换法、膜分离法以及生物法，阐述了各技术的优缺点，并展望了含铬废水处理技术的发展趋势。生物处理技术具有成本低、效益高和不造成二次污染等优点，在含铬废水处理方面具有很大的发展潜力。     

Validity of notified anthropometric data for determining the prevalence of obesity

BACKGROUND: The aim of this study was to evaluate the validity of the anthropometric data declared by participants in the Survey of Nutrition and Health in the Community of Valencia, Spain in 1994 to estimate the prevalence of obesity using the values obtained by direct measurement in the participants themselves as a reference. METHOD: The characteristics of the people who did not declare their weight and/or height were analyzed. Complete information on self declared and measured weight and height was collected in 1,387 subjects (700 males and 687 females). The mean values and proportion of indexes declared and measured were compared and the sensitivity (S), specificity (SP) and predictive values (PV) of a Quetelet Index (QI) QI >or= 30 kg/m2 were estimated to detect obesity in reference to the measured values. RESULTS: Those who did not declare their weight and/or height demonstrated a higher prevalence of obesity than those who did; 27.9% versus 13.1%, the difference being statistically significant (p < 0.001). The subjects who did declare were found to underestimate their weight, overestimate their height and thus, underestimate their relative weight (RW). This phenomenon was found to be greater in women and in older subjects. The prevalence of undeclared obesity was 10% versus 16.3% in that measured. The S of QI >or= 30 kg/m2 for screening obesity was 66.5%, being 69.3% in women and 63% in men, with a SP of 98.7% and positive PV of 92.4%. CONCLUSIONS: The estimation of the prevalence of obesity from a Quetelet Index >or= 30 kg/m2 based on self-reported data leads to a considerable underestimation of this problem at population level therefore questioning its validity.