bluuebunny/crossref_metadata_2025 huggingface dataset:
Brain Activation in Response to a Tactile Stimulation: Functional Magnetic Resonance Imaging (fMRI) Versus Cognitive Analysis
Authors: Querleux B. , Gazano G. , Mohen‐Domenech O. , Jacquin J. , Burnod Y. , Gaudion P. , Jolivet O. , Bittoun J. , Benali H.
Published: March 2003

Objective. The aim of this study was to compare fMRI analysis of somatosensory areas activated by passive touch, to cognitive analysis of the psychological profile of human subjects. Methods. The study was carried out on 21 females, after informed consent. Two artificial textures (smooth and rough), and two natural textures (the skin of an operator modified or not by a cosmetic product), were applied on the fingers of the subjects. A period of imagination to be touched was also included in the study. MR images of the somatosensory cortex were acquired on a 1.5T MRI system during the different behavioral conditions. Series of images were first processed to compensate for the inter‐frame motions and then activation was assessed with a statistical method based on conditional analysis. After the MRI protocol, each subject was interviewed following a questionnaire from which psychological descriptors were extracted. Results. 1) Activations were quite similar for all textures in the contralateral sensory areas 2) In the ipsilateral sensory areas, activations were more important in response to a stimulation with the skin of an operator than with artificial textures. The activation was even more important after application of a cosmetic product on the skin. 3) Imagination of the tactile stimulation resulted in an activation mostly localized in the ipsilateral cortex. 4) A PLS analysis assessed that 2 psychological descriptors, rationality and sensorial reactivity, were related to an activation in the contralateral cortex, while 2 others, imagination and sensitivity, were related to ipsilateral areas activation. Conclusion. fMRI and cognitive analysis allowed us to map the physical component of the tactile perception in the contralateral cortex. This study also gave rise to a better understanding of the activation in ipsilateral areas, which was found to be mainly related to the subjective component of the stimulation.
Evaulation of Irritation Potential of Surfactant Mixtures
Authors: Turkoglu M. , Pekmezci E. , Sakr A.
Published: March 2003

Irritation potential of sodium laureth sulfate (SLES) alone, and in combination with lauryl glucoside (LG), polysorbate 20 (PS) and cocoamidopropyl betaine (CAPB) was tested in 13 human subjects. Four main and six sub‐formulations were prepared and evaluated. Formulations were applied to the forearm as a 24 h close patch study. Irritation was scored by two different methods using an in vivo clinical protocol based on visual scoring and on the stratum corneum capacitance measurement. Irritation was found to be dose dependent. At 2 mg/patch level ten subjects did not show any skin reaction. At 20 mg/patch level eleven subjects showed a broad range of skin irritation. The highest irritation was observed with the formula that contained SLES, LG, and cocamide DEA together. Among the sub‐formulations, cocamide DEA showed the highest irritation grade. A statistically significant correlation was observed between visual, clinical and corneometer scores. It was concluded that the irritation potential of surfactants was related to the total surfactant concentration, application mode, and the thermodynamic activity of molecules in the solution as well as the chemical structure of the surfactant molecules.
Biologically active peptides: from a laboratory bench curiosity to a functional skin care product
Authors: Lintner  , Peschard
Published: March 2003

Synopsis

Small, biologically active peptides (short sequences of amino acids) were first described about 40 years ago: TRH, angiotensin, vasopressin, oxytocin, bradykinin. Since then, many more peptides have been isolated from mammalian tissue and organs, and their activity investigated. Essentially, these molecules play a hormonal (messenger) role: released at one point in the body, they act at specific receptor sites at different locations in the organism. Mostly the peptides are transported from the site of release to the site of biological activity through the blood or lymphatic fluid.

The use of these molecules in cosmetics does not appear obvious, as the topical application of these highly soluble, fragile and extremely expensive molecules seems inappropriate, and systemic effects (blood transport) are not desired.

This paper shows that the obstacles to using highly specific, powerful peptides as ‘actives’ in cosmetic products can be overcome. Cosmetically interesting activities such as stimulation of collagen synthesis, chemotaxis, anti‐stinging effects and others, can be observed and substantiated with chemically modified peptide sequences. Long chain fatty acid conjugates improve skin penetration, specific activity and economic feasibility of these molecules.

Résumé

De petits peptides (séquences courtes d’acides aminés), biologiquement actifs, ont été décrits pour la première fois il y a environ 40 ans: TRH, angiotensine, vasopressine, oxytocine, bradykinine. Depuis, beaucoup d’autres peptides ont été isolés à partir de tissus et organes de mammifères, et leur activité a étéétudiée. Ces molécules jouent principalement un rôle hormonal (messager): libérées en un point de l’organisme, elles agissent en des sites récepteurs spécifiques à différents endroits de l’organisme. La plupart du temps, les peptides sont transportés du site de libération au site d’activité biologique par le sang ou le liquide lymphatique.

L’utilisation de ces molécules en cosmétique ne semble pas évidente car l’application topique de ces molécules fortement solubles, fragiles et extrêmement coûteuses, semble inappropriée et les effets systémiques (transport par le sang) ne sont pas souhaités.

Cet article montre que les obstacles à l’utilisation de peptides puissants, fortement spécifiques comme ‘principes actifs’ dans des produits cosmétiques peuvent être surmontés. On peut observer (et démontrer) des activités intéressantes pour la Cosmétique (stimulation de la synthèse du collagène, guérison de lésions, chimiotactisme, effets apaisants et autres) avec des séquences de peptides chimiquement modifiés (produits conjugués lipophiles à chaîne longue) lorsque les paramètres de pénétration dans la peau, d’activité spécifique et de faisabilitééconomique s’associent pour donner de nouveaux principes actifs, tant qu’aucun effet systémique ni pharmacologique (thérapeutique) n’est généré. Des exemples spécifiques de peptides concernant la peau sont donnés.
In vitro and in vivo evaluation of ellagic acid on melanogenesis inhibition
Authors: Shimogaki  , Tanaka  , Tamai  , Masuda
Published: March 2003

Synopsis

The efficacy of ellagic acid (EA), one of the naturally occurring polyphenols, in inhibiting melanogenesis was examined in vitro and in vivo. When mushroom‐derived tyrosinase, a metaloprotein containing copper, was incubated with EA, enzymatic activity tended to decrease with decreasing copper concentration. Enzyme activity partially recovered when copper was added to the inactivated enzyme. Tyrosinase activity in the B16 melanoma cells was observed to recover in a dose‐dependent manner when copper ions were added to the medium containing EA. Based on these results, EA is thought to react specifically with the copper located at the active centre of the tyrosinase molecule.

Furthermore, when EA was applied for 6 weeks to brownish guinea‐pigs, which have melanocytes in their skin, at the same time as irradiating for 2 weeks with ultra‐violet light, skin pigmentation was clearly suppressed and the skin to which EA had been applied showed features similar to that of non‐irradiated skin. These areas were irradiated again when the application of EA had been completed, and skin pigmentation occurred at the former site of EA application. In similar studies with hydroquinone, re‐pigmentation did not occur on the sites at which hydroquinone (1%) had been applied. Based on the results reported here, EA is thought to suppress melanogenesis by reacting with activated melanocytes and without injuring cells.

Résumé

Le pouvoir inhibiteur de la melanogenese par l’acide élagique (AE), un polyphénol naturel, a étéétudiéin vitro et in vivo. Nous avons fait incuber avec l’AE la tyrosinase extraite de champignons. C’est une métallo‐protéine contenant du cuivre dont l’activité enzymatique tend à diminuer proportionnellement à la diminution de concentration en cuivre. Mais l’activité enzymatique se restaure partiellement, lorsque du cuivre est ajouté au milieu. Par ailleurs, l’activité de la tyrosinase dans des cellules de mélanome B16 s’exprime de façon dependante des ions cuivre ajoutés au milieu contenant l’AE. Sur la base de ces résultats, on peut penser que l’AE réagit de manière spécifique vis à vis du cuivre situé au centre actif de la molécule de tyrosinase.

De plus, l’AE a été appliqué sur la peau de cochons d’Inde bruns durant 6 semaines. Ces animaux possèdent des mélanocytes cutanés, et suite à irradition simultanée aux UV pendant 2 semaines, la pigmentation cutanée disparait clairement. La peau sur laquelle on a appliqué l’AE montre des caractères similaires à ceux de la peau non‐irradiée. Lorsque ces surfaces furent irradiées à leur tour en fin de période d’application, on observa la re‐pigmentation de la peau à l’endroit de l’application de l’AE. Par des experiénces comparables avec de l’hydroquinone, le phénomène de re‐pigmentation aux points d’application d’hydroquinone (en solution a 1%) n’a pas été observé. A la base de ces résultats, on peut penser que l’AE inhibe la mélanogénèse par réaction avec les mélanocytes activés, sans endommager les cellules.
Evaluation of commercial herbal shampoos
Authors: Mainkar  , Jolly
Published: March 2003

Synopsis

Selecting the evaluation parameters of a shampoo is a challenging task, simply because of the multitude of both subjective and instrumental test methodologies available for this purpose. The present paper focuses on the evaluation of herbal shampoos using some of these parameters. Commonly used test protocols for foam test, detergency, etc. are discussed. The commercial herbal shampoos are evaluated on the basis of these tests. The results of these tests also give an idea about what standards should be met by a shampoo formulated in the laboratory to be comparable with the commercial shampoos.

Résumé

Le choix des paramètres d’évaluation d’un shampoing n’est pas une tâche aisée, tout simplement en raison de la multitude de méthodologies de tests qu’ils soient subjectifs ou instrumentaux. Cet article s’attache à l’évaluation des shampoings à base de végétaux en utilisant certains de ces paramètres. Les protocoles de tests couramment utilisés concernant la mousse, la détergence, etc., sont commentés. Les shampoings commerciaux à base de végétaux sont évalués par ces tests. Les résultats donnent aussi une appréciation des normes auxquelles devrait satisfaire un shampoing formulé en laboratoire afin d’être comparable aux shampoings commerciaux.
Formulation of natural shampoos¶
Authors: Mainkar A.R. , Jolly C.I.
Published: March 2003

Synopsis

Formulating cosmetics using completely natural raw materials is a difficult task. The challenge lies in selecting materials that can be rationally justified as ‘natural’ and formulating them into cosmetics whose functionality is comparable with their synthetic counterparts.

The present paper focuses on the formulation of completely natural shampoos, their evaluation and comparison with commercial herbal shampoos. Attention is drawn to the fact that, due to the ambiguous definition of the word ‘natural’, several so‐called natural cosmetics are available in the Indian market. It is up to the cosmetic chemists themselves to promote and encourage the development and use of truly natural cosmetics.

Résumé

La formulation de produits cosmétiques utilisant des matières premières complètement naturelles est une tâche difficile. La difficulté réside dans le choix de matières qui peuvent rationellement être démontrées comme “naturelles” et de les formuler en produits cosmétiques dont l’utilisation est comparable à celle de leurs contreparties synthétiques.

Le présent article s‘intéresse à la formulation de shampoings entièrement naturels, à leur évaluation et à la comparaison avec les shampoings végétaux du commerce. On attire l’attention sur le fait que, en raison de la définition ambiguë du mot “naturel”, plusieurs produits cosmétiques dits naturels sont disponible sur le marché Indien. C’est aux chimistes cosmétiques eux‐mê,es de promouvoir et encourager le développement et l’utlisation de produits cosmétiques réellement naturels.
Progress report on hair keratin research
Authors: Zahn H.
Published: March 2003

Les progrès de la recherche sur les kératines du cheveu humain sont décrits en commentant quatre exemples tirés de la littérature scientifique récente:
In vivo and in vitro assessment of UVA protection by sunscreen formulations containing either butyl methoxy dibenzoyl methane, methylene bis‐benzotriazolyl tetramethylbutylphenol, or microfine ZnO
Authors: Herzog B. , Mongiat S. , Deshayes C. , Neuhaus M. , Sommer K. , Mantler A.
Published: March 2003

Synopsis

The UVA‐attenuating properties of the three UVA filters butyl methoxy dibenzoyl methane (BMDBM), methylene bis‐benzotriazolyl tetramethylbutylphenol (MBBT), and microfine zinc oxide (ZnO), are compared. For this purpose persistent pigment darkening (PPD) as an in vivo method as well as different in vitro approaches like the UVA/UVB ratio, the critical wavelength, and the Australian standard have been used. For the case of the UVA/UVB ratio and the critical wavelength the behaviour was also assessed after irradiation with 10 minimal erythemal doses (MED). Sunscreen formulations were manufactured containing either one of these UVA filters or combinations of one UVA filter and a constant amount of UVB filter. The concentration of the respective UVA filter was varied. BMDBM was dissolved in the oil phase of the formulations. MBBT, which is produced as particulate organic UVA‐filter dispersion with average particle size smaller than 200 nm, was added to the aqueous phase. The microfine ZnO was incorporated into the oil phase. If no additional UVB filters were present, UVA/UVB ratio and critical wavelength stayed almost constant, independent of UVA‐filter content. With constant levels of additional UVB filters these parameters increased with UVA‐filter concentration. In contrast to the behaviour of the UVA/UVB ratio, which appeared to be a sensitive measure for the UVA protection in relation to UVB protection in almost the whole ranges of UVA‐filter concentrations, the critical wavelength approached saturation already at low UVA‐filter levels. The UVA‐protection factors (UVA‐PF) obtained from the in vivo studies increased with the concentration of the UVA filter in the formulations. Formulations, which showed UVA‐PFs ≥ 4 in most cases met also the conditions of the Australian Standard. An irradiation dose of 2.5 kJ m−2 (10 MED) induced significant decreases of UVA/UVB ratio or critical wavelength only with some BMDBM formulations, indicating a loss of UVA protection in those cases.
Children talking about healthy eating: data from focus groups with 300 9–11‐year‐olds
Authors: Dixey Rachael , Sahota Pinki , Atwal Serbjit , Turner Alex
Published: March 2003

Summary The aim of this project was to gain insight into children's understanding of healthy eating, and to explore the barriers and facilitating factors for dietary behaviour change in children. The ‘Apples’ project is concerned with obesity prevention, and an understanding of children's perceptions of healthy eating, fatness and thinness are vital in order for school‐based programmes to be appropriately designed and delivered. This paper presents data from focus groups with 300 children (aged 9–11 years) in 10 schools in Leeds, England, carried out in June 1998. Analysis of the transcripts shows that children understood the concept of a balanced diet as described by the Health Education Authority's ‘Balance of Good Health’ model. They were also aware of the relationship between their diet and health, both present and future. ‘Fat’ played a prominent role, with a healthy diet being one that did not contain too much fat. Moreover, they considered that it was fat that caused heart problems, the key consequence of not eating healthily. It was also important for social reasons not to be too fat, although children were also very aware of the health implications of being too thin, and of eating disorders. Children used a number of strategies to take control of their own eating, and the conclusions for nutrition education programmes in schools are that children need to be seen as more active participants in their own health education, and that help is needed to resist the pressures to be a socially desirable body weight.
Does physical activity prevent weight gain – a systematic review
Authors: Fogelholm M. , Kukkonen‐Harjula K.
Published: March 2003

This paper is a systematic review of research data on associations between physical activity and weight gain, with or without prior weight reduction. The selected studies were restricted to Caucasian (white) adults. Most studies with data on physical activity collected at follow‐up, found an inverse association between physical activity and long‐term weight gain. This finding was present in studies both with and without prior weight reduction. Prospective studies with physical activity measured at baseline, and randomized weight reduction interventions, gave inconsistent results regarding the effects of increased physical activity on weight change. The weighted mean weight regain in randomized studies with or without exercise training was 0.28 and 0.33 kg/month, respectively. Based on observational studies, it seemed that an actual increase in energy expenditure of physical activity of approximately 6300–8400 kJ/week (1500–2000 kcal/week) is associated with improved weight maintenance. This is more than was prescribed in most randomized trials, and certainly more than the participants actually achieved. Adherence to a prescribed exercise programme remains a big challenge. Before new methods to improve exercise adherence are found, the role of prescribed physical activity in prevention of weight gain remains modest.
Biological determinants of spontaneous physical activity
Authors: Thorburn A. W. , Proietto J.
Published: March 2003

A decline in daily physical activity levels is clearly a major factor contributing to the current obesity epidemic affecting both developed and developing countries in the world. This escalating problem is associated with increased morbidity and mortality and reduced psychosocial health. Thus, increasing physical activity has become the strategy of choice in public health strategies to prevent obesity. Efforts to improve levels of physical activity in the population rely upon an accurate understanding of the determinants of physical activity. Most research has focused on environmental and social influences, while the potential for physical activity to be controlled by intrinsic biological processes has been largely overlooked. This review presents some of the compelling and diverse evidence that has emerged recently showing that physical activity energy expenditure is a critical factor in both the successful regulation of energy balance in normal individuals, as well as the abnormal regulation of energy balance that characterizes obesity. Although the metabolic and genetic factors involved in these regulatory processes remain mostly unidentified, some novel discoveries have been made in this area recently and these are described within this review.
The peripheral sympathetic nervous system in human obesity
Authors: Baak M. A. van
Published: March 2003

The peripheral sympathetic nervous system is a key factor in the regulation of energy balance in humans. Differences in sympathetic nervous system activity may contribute to variations in 24 h energy expenditure between individuals. β‐Adrenoceptors play a more important role than α‐adrenoceptors in this regulation. The involvement of both β1‐and β2‐adrenoceptor subtypes has been demonstrated, the role of the β3‐adrenoceptor subtype is not yet clear. Normal or increased levels of sympathetic nervous system activity and reduced reactivity appear to be present in established obesity. Furthermore, the sensitivity for β‐adrenoceptor stimulation is impaired in obesity. The blunted reactivity and sensitivity may contribute to the maintenance of the obese state. There are data to suggest that they may also play a role in the aetiology of obesity, because the impairments often remain after weight reduction. Furthermore, a negative correlation between baseline sympathetic nervous system activity and weight gain during follow‐up has been found in Pima Indians. Recently, genetic evidence about the involvement of adrenoceptors in obesity has become available. Although the results of association and linkage studies on polymorphisms in the β2‐, β3‐ and α2‐adrenoceptor genes are inconsistent, the functional correlates of some of these polymorphisms (changes in agonist‐promoted down‐regulation, protein expression levels, lipolytic sensitivity, basal metabolic rate, sympathetic nervous system activity) suggest that they may be important in the aetiology of obesity.
Obesity and health‐related quality of life
Authors: Fontaine K. R. , Barofsky I.
Published: March 2003

Although it is well documented that obesity is strongly associated with morbidity and mortality, less is known about the impact of obesity on functional status and health‐related quality of life (HRQL). However, in recent years research has been conducted to estimate the impact of obesity on HRQL, and to determine the effects of weight reduction on HRQL. The majority of published studies indicate that obesity impairs HRQL, and that higher degrees of obesity are associated with greater impairment. Obesity‐associated decrements on HRQL tend to be most pronounced on physical domains of functioning. Studies of the effect of obesity surgery among morbidly obese patients indicate that this procedure produces significant and sustained improvements in the majority of HRQL indices; among mild‐to‐moderately obese persons, modest weight reduction derived from lifestyle modification also appears to improve HRQL, at least in the short term. Additional research is needed to (1) further characterize the effect that obesity has on HRQL; (2) estimate the short‐ and long‐term effects of various methods of weight reduction (e.g. surgery, lifestyle modification) on HRQL; (3) improve both the conceptualization and measurement of HRQL to incorporate the personal preferences and values of the patient; and (4) develop ways to enhance and sustain positive changes in HRQL, even if weight maintenance is elusive.
The importance of physical activity in the prevention of overweight and obesity in childhood: a review and an opinion
Authors: Steinbeck K. S.
Published: March 2003

The prevalence of childhood obesity is increasing and there are a number of theoretical reasons as to why intervention may be more effective in childhood. There are certain risk times for the development of obesity in childhood, which provide a basis for targeted intervention. In addition, tracking data supports the persistence of obesity, at least in later childhood, as well as cardiovascular risk factors. Physical activity is the discretionary component of energy expenditure and there is evidence that falling levels of physical activity are contributing to the obesity epidemic. Physical activity in children is related to developmental stage, is reduced with increasing age and is influenced by parental physical activity. While there is debate about the immediate health benefits of physical activity to children, there are data to support that lower physical activity levels and sedentary behaviours are associated with a higher prevalence of obesity in children. Physical activity is an accepted strategy in the treatment of established obesity (tertiary prevention). The role of physical activity in the prevention of obesity (primary and secondary prevention) is less clear. However a number of recent school‐based interventions directed at either increasing physical activity and/or decreasing sedentary behaviours, have shown encouraging results. On balance, increasing physical activity in children is an attractive and non‐restrictive approach to obesity prevention. To adopt this approach requires the support and involvement of many community sectors other than health.
Quality of life and obesity
Authors: Kolotkin R. L. , Meter K. , Williams G. R.
Published: March 2003

Interest in the quality of life of patients with different diseases continues to grow. Recent years have witnessed a dramatic rise in the prevalence of obesity worldwide, stimulating interest in the health and quality of life consequences of this phenomenon. The body of research on the quality of life of obese individuals has grown to a point that a review of this literature is warranted. Numerous studies have demonstrated that obese persons experience significant impairments in quality of life as a result of their obesity, with greater impairments associated with greater degrees of obesity. Weight loss has been shown to improve quality of life in obese persons undergoing a variety of treatments. Further research is needed to clarify whether quality of life differs among subsets of obese persons. Until recently, there has been little standardization of quality of life measures in obesity. The SF‐36 has been used in a number of studies of obese persons. Several obesity‐specific instruments have also been developed and have shown great promise. The quality of life of obese individuals is an important issue that should be included in weight management treatment and research.
Use of beta‐blockers in obesity hypertension: potential role of weight gain
Authors: Pischon T. , Sharma A. M.
Published: March 2003

Beta‐blockers are the most frequently used drugs for the treatment of hypertension. Apart from concerns regarding potential adverse metabolic effects on lipids or insulin sensitivity, beta‐blockers can also cause weight gain in some patients. This fact appears little known to clinical practitioners and trialists. Thus, only a minority of clinical trials with beta‐blockers report weight changes during treatment. In trials that do report weight changes, beta‐blockers are associated with a weight gain of 1.2 (range −0.4–3.5) kg. This may be attributable to the fact that beta blockade can decrease metabolic rate by 10%. Beta‐blockers may also have other negative effects on energy metabolism. Obesity management in overweight hypertensive patients may therefore be more difficult in the presence of beta‐blocker treatment. We therefore question the use of beta‐blockers as first‐line therapy for overweight or obese patients with uncomplicated hypertension.
Effects of free fatty acids on insulin secretion in obesity
Authors: Zraika S. , Dunlop M. , Proietto J. , Andrikopoulos S.
Published: March 2003

The prevalence of obesity in Western society has reached epidemic proportions and its aetiological role in the development of type 2 diabetes has made finding an effective treatment for the condition of crucial importance. Of the many consequences of obesity, derangements in glucose metabolism present one of the greatest problems to health. While the role of obesity in causing insulin resistance has received much attention, the effect of obesity on β‐cell failure and the consequent development of type 2 diabetes requires re‐emphasis. In this review, the current understanding of the effects of elevated free‐fatty acids on β‐cell function will be examined, including a discussion of potential mechanisms. In particular, dysregulation of biochemical pathways and alterations in key enzymes, proteins and hormones will be considered as grounds for the progression to a diabetic phenotype.
Obesity, coronary heart disease risk factors and diabetes in Chinese: an approach to the criteria of obesity in the Chinese population
Authors: Li G. , Chen X. , Jang Y. , Wang J. , Xing X. , Yang W. , Hu Y.
Published: March 2003

The aim of this work was to study the relationship between excess body weight and the risks of hypertension and diabetes in the population of northeastern China. Subsections of a cross‐sectional survey in Da Qing City were used to assess the relationship of excess weight to risk factors for coronary heart disease (CHD). A 6‐year prospective study also assessed the probability of developing Type 2 diabetes. A total of 2856 adults (25–70 years of age) were assessed cross‐sectionally and 629 non‐diabetic subjects of similar age were followed‐up for 6 years. Blood pressure, plasma fasting glucose, triglycerides, high‐density lipoporotein (HDL) cholesterol and fibrinogen levels were measured as well as weight, height and waist and hip circumferences. About 45% of adults had a body mass index (BMI) of ≥25.0. Risk factors increased with increasing BMI from a baseline value of 21.0: at a BMI of 23.0–24.9, the risk of hypertension and hypertriglyceridaemia doubled; the risk increased threefold at a BMI of 25.0–26.9. The prevalence of Type 2 diabetes increased progressively in women within the normal BMI range and in men from a BMI of 25.0. Type 2 diabetes was four times as common if the BMI was >27.0. Increasing waist measurements predicted 10‐fold increases in hypertension and a three‐to‐five times increased risk of diabetes. Suitable waist cut‐off points were 85 cm for men and 80 cm for women, with statistical analysis showing waist as the more dominant predictor of risk than age, waist‐to‐hip ratios or BMIs. Hence, small increases in BMI, and particularly in waist circumference, predict a substantial increase in the risk of diabetes and risk for CHD, especially hypertension, in Chinese adults.
Differences in body mass index and waist : hip ratios in North Indian rural and urban populations
Authors: Reddy K. S. , Prabhakaran D. , Shah P. , Shah B.
Published: March 2003

Overweight could be a major factor in determining the increasing rates of coronary heart disease in the Indian population, by its influence on blood pressure, diabetes and insulin resistance. We studied the prevalence of overweight in north Indian urban and rural population samples. The urban sample population (n = 3050) was selected using a multistage sampling with stratification for geographical zone and the type of residential colony and cluster sampling of urban blocks in each stratum. The rural sample (n = 2487) was selected by random sampling of villages stratified for population size followed by coverage of all eligible persons in the village. All participating individuals were 35–64 years of age. Women constituted 52.2% (n = 1594) and 57% (n = 1417) of urban and rural samples, respectively. The study reveals that overweight is widely prevalent in the adult urban Delhi population, whereas underweight is a significant problem in the rural population. This was noted across all the age groups in both men and women. We estimated ‘comprehensive coronary risk estimates’ based on the New Zealand Heart foundation guidelines and noted that the proportion of high and very high risk subjects increased in a continuous manner even within the ‘normal’ ranges of BMI. This difference in prevalence in the urban population could represent the demographic transition in the Indian population.
Preventive strategies against weight gain and obesity
Authors: Swinburn B. , Egger G.
Published: March 2003

A well‐resourced, comprehensive, population‐based set of strategiesis needed to attenuate and eventually reverse the current trendsof increasing obesity prevalence now apparent in most countries.The Epidemiological Triad (host, vector, environment) has provento be a robust model for other epidemics and is applied to obesity. Host‐based strategies are primarily educational and these tend to bemost effective among people with higher incomes and higher educational attainment.The main vectors for a high‐energy intake are energy‐dense foodsand drinks and large portion sizes and, for low energy expenditure,machines that promote physical inactivity. Vector‐based strategiesthat alter food formulation can have a significant impact, particularlythrough influencing common, high‐volume foods. The increasingly ‘obesogenic’ environmentsare probably the main driving forces for the obesity epidemic. Thereare many environmental strategies that can influence the physical,economic, policy or socio‐cultural environments, but the evidencebase for these potentially powerful interventions is small. ­Childrenshould be the priority population for interventions, and improvingthe general socio‐economic conditions for disadvantaged, marginalizedor poor population sectors is also a central strategy for obesityprevention. The key settings for interventions are schools, homes,neighbourhoods, primary health care services and communities. Thekey macroenvironments for interventions are the transport and infrastructuresector, the media and the food sector.
Treatment of obesity: an update on anti‐obesity medications
Authors: Halpern A. , Mancini M. C.
Published: March 2003

The information presented in this article provides an overview of physiological agents, therapeutics in current use, and medications that have been extensively used in the past but are no longer available, or are not classically considered as anti‐obesity drugs. The authors present an extensive review on the criteria for anti‐obesity management efficacy, on physiological mechanisms that regulate central and/or peripheral action energetic homeostasis (nutrients, monoamines and peptides), and on β‐phenethylamine pharmacological‐derivative agents (fenfluramine, dexfenfluramine, phentermine, diethylpropion, fenproporex and sibutramine), tricyclic derivatives (mazindol), phenylpropanolamine derivatives (ephedrine, phenylpropanolamine), a phenylpropanolamine oxy‐tri‐fluor‐phenyl derivative (fluoxetine), a naftilamine derivative (sertraline) and a lipstatine derivative (orlistat). An analysis of all clinical trials longer than 10 weeks in duration is also presented for medications used in the management of obesity.
Weight loss causes increased mortality: pros
Authors: Sørensen T. I. A.
Published: March 2003

There are many good reasons to expect that weight loss in overweight and obese subjects should lead to reduced mortality, not least because the general risk factor profile of several diseases responsible for the excess mortality associated with overweight and obesity improves with weight loss. However, observational long‐term population studies have shown that weight loss in overweight subjects leads to increased long‐term mortality, even if the studies are well controlled with regard to known confounding factors, including hazardous behaviour and underlying diseases that may lead to both weight loss and increased mortality. It seems unfeasible to wait for the multiple randomized clinical trials of sufficient quality, size and duration that may resolve this question. Therefore, the recommendations about weight loss must be based on the weaker evidence that can be obtained in short‐term clinical trials and the observational population studies. Several studies have tried to address the problem by distinguishing intentional from unintentional weight loss, but only few do so by gathering information about the intention to lose weight before weight loss is observed. These studies suggest that intentional weight loss is associated with increased mortality. Recommendations to healthy overweight and obese subjects to lose weight must be based on an explicit weighing of the short‐term well‐documented benefits of weight loss, including improvement of quality of life, against the possible risk of an increased mortality in the long term
Childhood obesity: a societal problem to solve
Authors: Schwartz M. B. , Puhl R.
Published: March 2003

In contrast to other threats to American children's health, the treatment and prevention of childhood obesity are considered the responsibility of individual children and their parents. This pressure exists in the context of the societal stigmatization of overweight children and the powerful environmental inducements aimed directly at children to eat nutritionally poor foods. Parents of overweight children are left in the difficult position of fearing the social and health consequences of their child's obesity, and fighting a losing battle against the omnipotent presence of the media and constant exposure to unhealthy foods. This paper brings together several literatures to provide a comprehensive examination of the major challenges facing obese children and their families. In particular, this paper documents the extent of stigmatization towards overweight children and reviews evidence of the conflicting advice given to parents about how to help children develop healthful eating in the face of biological and learned food preferences. We conclude with a call for a shift in thinking about the role of our society in the aetiology, treatment and prevention of childhood obesity.
MANAGEMENTOF IMMUNE THROMBOCYTOPENIC PURPURAIN CHILDREN
Authors: Gadner Helmut
Published: March 2003

Immune thrombocytopenic purpura (ITP) is the most common acquired bleeding disorder occurring in previously healthy children and can be classified into two major forms. Acute and chronic ITP are benign conditions with a high probability of spontaneous recovery with or without therapy. Rates of 80–90% complete remission can be achieved irrespective of the treatment given. In only 10–20% of children thrombocytopenia persists for more than six months, showing a chronic course, which also has a high probability of remitting over time (up to 80% or more). The variability of the clinical course, and the lack of consistent clinical features, make the decision on whether and how to treat difficult. Most physicians are driven to treat all children with symptoms by concern over life‐threatening hemorrhage, although the risk of intracranial hemorrhage (ICH) is only 0.1–0.9%. The commonly used treatment regimens for acute ITP are corticosteroids, intravenous immunoglobulins (IVIgG), or intravenous anti‐D immunoglobulin (anti‐D). So far, there is no evidence that initial therapy can prevent ICH or a chronic course of the disease. In chronic ITP the same drugs are generally used and it seems that pulses with steroids may be just as effective as IVIgG. Anti‐D may also be considered a reliable and cheap alternative for chronic disease. A major problem in the management of chronic ITP is the question of whether repeated infusions of Ig (IVIgG or anti‐D) and/or corticosteroids can postpone or ultimately preclude splenectomy, which must be considered only for a small proportion of patients resistant to therapy. In these cases, a laparoscopic approach should be preferred. Children who fail to respond to splenectomy (< 20% of cases) warrant second line treatment with other drugs, like cyclophosphamide or azathioprine and deserve a revisit of diagnosis for exclusion of secondary ITP.
Receiving a positive HIV test result: the experience of patients in Europe
Authors: Schrooten W , Dreezen C , Fleerackers Y , Andraghetti R , Finazzi R , Caldeira L , Platteau T , Colebunders R ,   the Eurosupport Group
Published: March 2003

Objective To describe HIV‐infected people's experience of the HIV test procedure in Europe.

Methods Between August 1996 and September 1997, anonymous self‐administered questionnaires were distributed to HIV‐infected people in 11 European countries.

Results A total of 1366 people completed the questionnaire (50% response rate). Of these, 194 (16%) had more than five negative HIV tests before being diagnosed as HIV positive, 179 (14%) were tested without consent and 192 (15%) were informed about the HIV positive test result by mail or by telephone. Of the 963 people who received a positive test result during a consultation, 247 (26%) reported that this visit lasted less than 10 min, 336 (35%) between 10 and 20 min, and 289 (30%) more than 20 min. Over half the total respondents (591, 54%) felt they did not receive adequate support when they were informed about being HIV positive, with 249 (19%) experiencing feelings of rejection. People who were diagnosed as HIV positive after 1994 reported more frequently receiving adequate support, information and understanding when the positive test result was revealed compared with those diagnosed before 1990.

Conclusion A large number of our study participants did not endorse the way HIV tests were conducted and positive test results revealed. Although there was an improvement over time in the way HIV tests were conducted, they often did not conform to international guidelines.
Clinical lipoatrophy in HIV‐1 patients on HAART is not associated with increased abdominal girth, hyperlipidaemia or glucose intolerance
Authors: Worm D , Kirk O , Andersen O , Vinten J , Gerstoft J , Katzenstein TL , Nielsen H , Pedersen C
Published: March 2003

Objective

To compare information on body fat changes from questionnaire and clinical examination and to study lipoatrophy in HIV‐1 patients on highly active antiretroviral therapy (HAART).

Methods

The study was cross‐sectional within a randomized trial. One hundred and sixty‐eight male HIV‐1 patients were examined by questionnaire and clinical examination. Clinical lipoatrophy was studied and defined as fat wasting in the face, legs and/or arms. Fasting blood samples reflecting lipid and glucose metabolism were taken and the role of indinavir, ritonavir (RTV) and RTV/saquinavir (SQV) on lipoatrophy was investigated.

Results

After a median of 17 months on HAART, concordance rates between information on changes in body fat from questionnaire and clinical examination were significant and varied from 70 to 96%. With a positive criteria of lipoatrophy in both assessments, 14% of patients had lipoatrophy. These patients had lower weight (P = 0.0007), weight loss from baseline (P = 0.003), lower circumferences at all measurements (P < 0.01), lower plasma triglycerides and low‐density lipoprotein (LDL) (P < 0.05) and longer treatment with stavudine (P = 0.0009). Homeostasis model assessment (HOMA) estimates for insulin resistance and β‐cell function were comparable. Plasma cholesterol, triglycerides and very low‐density lipoprotein (VLDL) were higher in patients receiving RTV or RTV/SQV (P < 0.03).

Conclusion

Questionnaire and clinical assessment provide concordant information on changes in body fat. Lipoatrophic patients on HAART with neither increase in abdominal circumference, nor hyperlipidaemia nor glucose intolerance may have side‐effects to protease inhibitor treatment, to nucleoside reverse transcriptase inhibitor treatment (stavudine) or suffer from a drug‐independent condition.
Patterns of antiretroviral use in the United States of America: analysis of three observational databases
Authors: Ghani AC , Donnelly CA , Anderson RM
Published: March 2003

Objective

To characterize patterns of antiretroviral use in HIV‐infected patients and explore variation by patient characteristics and disease stage.

Methods

Three large patient databases recording information derived from routine clinical attendance were analyzed: HIV Insight (n = 10 873), Target Management Services (n = 2226) and Clinical Partners (n = 1505). Each database records the dates of starting and stopping individual antiretroviral agents over time, measurements of CD4 T‐cell counts and HIV‐RNA levels at approximately 6‐monthly intervals, and the demographic characteristics of patients. The number, frequency and duration of different antiretroviral combinations over time and their relationship to stage of HIV‐disease and demographic characteristics were explored.

Results

Over 2000 different combinations of antiretroviral agents are recorded. From 1987 onwards, the use of zidovudine increased, with 23% of patients receiving monotherapy by 1990. The majority of treated patients remained on monotherapy until the introduction of highly active antiretroviral therapy (HAART) in 1996. By 1999, the standard of care was HAART, with 84% of patients beginning antiretroviral therapy with HAART. Those of African American race (odds ratio 0.59) and funded by Medicaid (odds ratio 0.72) were significantly less likely to begin antiretroviral therapy on HAART. Until 1995, there was a significant decrease in CD4 T‐cell count when starting antiretroviral therapy. No significant trend was observed in either CD4 T‐cell count or viral load after this time. Those starting on HAART therapies were significantly less likely to stop or switch regimens than those on nucleoside reverse transcriptase inhibitor (NRTI)‐only therapies (P < 0.001).

Conclusions

Complex patterns of antiretroviral treatment are observed in this large population. Changes over time mirror the introduction of the new antiretroviral agents.
Treatment of recalcitrant ulcers in pyoderma gangrenosum with mycophenolate mofetil and autologous keratinocyte transplantation on a hyaluronic acid matrix
Authors: Wollina Uwe , Karamfilov Theodor
Published: March 2003

Pyoderma gangrenosum sometimes takes a recalcitrant course that is unresponsive to standard immunosuppression with corticosteroids and/or cyclosporin A. In these cases improvement of painful ulcerations is a therapeutic challenge. We report a 17‐year‐old boy with severe pyoderma gangrenosum treated successfully with mycophenolate mofetil and autologous keratinocyte transplantation using an esterified hyluronic acid delivery system.
Granulomatous mycosis fungoides. Report of two cases and review of the literature
Authors: Fischer M , Wohlrab J , Audring H , Sterry W , Marsch Wc
Published: March 2003

Background Granulomatous mycosis fungoides is an extremely rare type of cutaneous T‐cell lymphoma. Two cases are described and checked for clinical, histological and therapeutic differences to other variants of mycosis fungoides.

Case reports Case 1: a 52‐year‐old patient with livid plaques covering the whole integument. Histological findings showed granulomas with multinuclear giant cells in addition to a malignant lymphohistiocytic infiltrate (monoclonal T‐cell receptor (TCR) ‐γ rearrangement). Despite various chemotherapeutic regimens, progression to tumour stage was observed. Case 2: an 88‐year‐old man with plaques and ulcerating tumours on the trunk and head. Histological findings showed malignant T‐lymphocyte infiltrate (monoclonal TCR‐γ rearrangement) and granulomas with multinuclear foreign‐body giant cells. Complete regression of all lesions was achieved using both local psoralen‐ultraviolet A and electron radiotherapy.

Conclusions The diagnosis of a granulomatous mycosis fungoides depends exclusively on the histological demonstration of granulomas. Distinct clinical characteristics are not present. Apart from granuloma formation, no other noticeable histological features are evident. The presence of granulomas in mycosis fungoides does not have prognostic implications, as cases with aggressive, but also with a prolonged course have been described.