bluuebunny/crossref_metadata_2025 huggingface dataset:
Combination Chemotherapy of Cisplatin, Ifosfamide, and Irinotecan with rhG-CSF Support in Patients with Brain Metastases from Non-Small Cell Lung Cancer
Authors: Fujita Akihisa , Fukuoka Seiji , Takabatake Hirotsugu , Tagaki Shigeru , Sekine Kyuhichiro
Published: April 2003

Background: Brain metastases develop frequently in patients with non-small cell lung cancer (NSCLC), and the prognosis for these patients is very poor. We evaluated the role of chemotherapy for patients with brain metastases from NSCLC. Methods: We analyzed 30 patients who were discovered to have brain metastases during the diagnosis of 121 patients enrolled in three consecutive clinical trials on advanced NSCLC assessing combination chemotherapy of cisplatin, ifosfamide and irinotecan with rhG-CSF support. Response in the brain lesions was evaluated by contrast-enhanced MRI scans after at least two courses. Results: Fourteen patients achieved a partial response (PR) but there was no change (NC) in 13 patients and progressive disease (PD) in 1. Among patients with extracranial lesions, 18 had a PR and 11 had NC. The response rate in brain metastases was 50.0%, and that in extracranial primary and metastatic lesions was 62.1%. The median duration of response for intra- and extracranial lesions was 140 and 147 days, respectively. After completing chemotherapy, Gamma Knife radiosurgery was performed on 2 patients in remission and 8 patients at disease progression. The median survival time and 1-year survival rate were 382 days and 56.1%, respectively. Conclusions: Both the response rate and survival data in this retrospective study suggest a high degree of activity of this combination chemotherapy in patients with brain metastases from NSCLC.
What Is the Role of Psychotherapy in the Treatment of Bipolar Disorder?
Authors: Colom F. , Vieta E. , Martínez A. , Jorquera A. , Gastó C.
Published: April 2003

Background: The authors review and criticize the different roles developed by psychotherapy in the treatment of bipolar disorder, from psychodynamic conceptions to a biopsychosocial model. Methods: The main computerized database (Medline, Current Contents, Psychological Abstracts) have been consulted, using the terms ‘psychotherapy’, ‘psychosocial’ and ‘bipolar disorder’ as key words. Results: Psychoanalysis, psychoeducation, family therapy, cognitive-behavioral therapy and interpersonal therapy have been used in the treatment of bipolar patients. To date, none have established efficacy in controlled clinical trials regarding aspects such as hospitalization, recurrences or suicidal behavior, as medication alone does. Research on this issue usually undergoes methodological pitfalls. Nonetheless, the psychoeducative approach combined with several cognitive-behavioral techniques, either in group or individually, seem to be the most promising, focusing on information, treatment compliance, and illness management skills. Conclusions: There is a need for systematic clinical research on psychotherapy applied to bipolar disorder in order to show its true usefulness. Psychoeducation should prove its positive influence on the course and outcome of bipolar disorder.
Reliability of the Karolinska Psychodynamic Profile (KAPP) among Patients with and without Psychoactive Substance Abuse Disorders
Authors: Weinryb Robert M. , Busch Monica , Gustavsson J. Petter , Saxon Lars , Skarbrandt Eva
Published: April 2003

Background: The Karolinska Psychodynamic Profile (KAPP) is a rating instrument, based on psychoanalytic theory, that assesses different aspects of character from clinical interviews. The aim of the present study was to examine interrater reliability of the KAPP in a sample of patients with and without psychoactive substance abuse disorders, using interviewers and a reliability judge who had not been trained by the developers of the instrument. Methods: The sample comprised 47 consecutive patients with and without psychoactive substance abuse disorders, who were referred to an outpatient psychotherapy unit specializing in the treatment of substance abuse and dependence. The two interviewers and the reliability judge had not been trained by the developers of the KAPP, and they worked outside the setting where it was constructed. Results: The intraclass correlations were satisfactory for the total sample (mean 0.84, median 0.89, range 0.62–0.95), as well as for various subsamples, such as males and females, and patients with and without substance abuse disorders. Conclusions: The results show that interviewers and a reliability judge who had not been trained by the developers of the KAPP can attain high interrater reliability in a sample of patients with substance abuse disorders. Some recommendations for conducting KAPP interviews are given.
Stress-Induced Endocrine and Immunological Changes in Psoriasis Patients and Healthy Controls
Authors: Schmid-Ott Gerhard , Jacobs Roland , Jäger Burkard , Klages Sabine , Wolf Joana , Werfel Thomas , Kapp Alexander , Schürmeyer Thomas , Lamprecht Friedhelm , Schmidt Reinhold E. , Schedlowski Manfred
Published: April 2003

Background: Clinical observations suggest that psychological stress can induce exacerbation of psoriasis. It is hypothesized that these stress effects on the course and outcome of psoriasis are caused by neuroendocrine modulation of immune functions. Therefore we investigated the cardiovascular, endocrine and immunological response to a laboratory stressor in psoriasis patients and healthy controls. Methods: Untreated (n = 7) and PUVA-treated (n = 4) psoriatics and healthy controls (n = 7) were exposed to a brief laboratory stressor (public speaking and mental arithmetic). Heart rate and blood pressure, catecholamine, cortisol, and DHEA plasma concentration, as well as distribution of T and NK lymphocytes were analyzed before, immediately after and 1 h after stress exposure. Results: Heart rate and blood pressure increased in all three groups during stress exposure with the most pronounced changes in PUVA-treated patients. Psoriasis patients displayed higher adrenaline values but diminished cortisol and DHEA plasma concentrations compared to controls. NK cell numbers (CD16+, CD56+), but not T lymphocyte subsets, increased immediately after stress exposure in untreated patients and controls. This effect was significantly diminished in PUVA-treated patients. Conclusions: The data of this pilot study indicate an enhanced stress-induced autonomic response and diminished pituitary-adrenal activity in psoriasis patients. PUVA treatment seems to interfere with the cardiovascular and NK cell response to acute psychological stress. Future studies will analyze the stress-induced neuroimmunological mechanisms in psoriatics in more detail.
Assessment of Patients by DSM-III-R and DSM-IV in a Japanese Psychosomatic Clinic
Authors: Nakao Mutsuhiro , Nomura Shinobu , Yamanaka Gaku , Kumano Hiroaki , Kuboki Tomifusa
Published: April 2003

Background: The aim of this study was to investigate the clinical features of psychosomatic disorders in Japan. Methods: A total of 1,432 outpatients (515 males and 917 females; 9–95 years of age, mean age 36) attending a psychosomatic clinic for the first time were assessed by the DSM-III-R or DSM-IV semistructured interview. Results: Major ICD-10 diagnoses found were eating disorder, other anxiety disorders, autonomic nervous dysfunction, somatoform disorders, and irritable bowel syndrome. The most frequent diagnosis on the DSM-III-R and DSM-IV axis I was ‘somatoform disorders not otherwise specified’, followed by bulimia nervosa, ‘depressive disorder not otherwise specified’, anorexia nervosa, conversion disorder, major depression or depressive disorder, ‘panic disorder with agoraphobia‘, and ‘psychological factors affecting physical or medical condition’. On axis II, 11–17% of the patients met the criteria for personality disorder. On axis IV, 78–80% had mild or moderate psychosocial stress; major psychosocial and environmental problems classified by the DSM-IV were the problems with primary supports and occupation. Conclusions: The results seem to reinforce the belief that the diagnoses on the DSM-III-R and DSM-IV axis I are inadequate for describing psychosomatic phenomena. A new diagnostic system in combination with the multidimensional assessments by the DSM-III-R and DSM-IV is needed to form the common guidelines of diagnoses and therapies in psychosomatic medicine.
Trichotillomania: Current Issues in Conceptualization and Treatment
Authors: Keuthen Nancy J. , O’Sullivan Richard L. , Sprich-Buckminster Susan
Published: April 2003

Trichotillomania is a little-known disorder with wider prevalence and more significant consequences than previously believed. While sharing similarities with obsessive-compulsive disorder, compelling differences from it have also been noted. This fact, coupled with recognized overlap with other obsessive-compulsive spectrum disorders, has resulted in the ongoing evolution of our conceptualization of this illness. While empirical evidence supports the use of behavioral treatment and pharmacotherapy, considerable research is still needed before we can promise highly effective interventions tailored to the individual hairpuller. This review will summarize the evidence supporting, as well as challenging, a hypothesized link with obsessive-compulsive disorder. Current treatment approaches will be reviewed, as well as evidence for their efficacy. Suggestions will be made for future directions in this field.
Outcome Definitions and Predictors in Depression
Authors: Tedlow Joyce , Fava Maurizio , Uebelacker Lisa , Nierenberg Andrew A. , Alpert Jonathan E. , Rosenbaum Jerrold
Published: April 2003

Background: The definition of outcome in antidepressant treatment studies may be a crucial factor influencing the relationship between possible treatment variables and treatment response. We therefore wanted to investigate possible relationships between baseline severity of depression and anxiety, and different definitions of outcome among outpatients with major depressive disorder undergoing antidepressant treatment. Methods: Two hundred and forty-eight patients diagnosed with major depression with the Structured Clinical Interview for DSM-III-R Diagnosis – Patient Edition were treated with fluoxetine 20 mg/day for 8 weeks. Patients were evaluated both pretreatment and posttreatment with the 17-item Hamilton Rating Scale for Depression (Ham-D-17), the Clinical Global Impressions Scales for Severity (CGI-S) and Improvement (CGI-I). We chose four continuous definitions of response using a linear regression method to analyze the relationship to baseline anxiety and depression. We used a logistic regression analysis for the relationship between seven categorical definitions of response and baseline severity of depression and anxiety. Results: Greater endpoint severity was significantly positively related to greater baseline severity of depression and anxiety. Lesser baseline severity of depression or anxiety predicted a greater degree of response on either the endpoint CGI-I score (with lower scores indicating greater improvement) or the percent change in HAM-D-17 score (with higher percent change indicating greater improvement). For all seven categorical definitions of response, lower baseline scores were significantly related to the probability of being a responder. Conclusions: These findings support the impression that how outcome is defined affects the strength and direction of observed relationships with predictive variables. Methodological implications are discussed.
Quality of Life in Individuals with Physical Disabilities
Authors: Viemerö Vappu , Krause Christina
Published: April 2003

Background: The quality of life among individuals with severe physical disabilities has greatly improved during the last two decades, partly as a result of well-planned intervention programmes. However, some individuals with physical disabilities do not cope well in their everyday life, no matter how long they have had the disability. It has been suggested that those individuals who adjust well do so regardless of the degree of their physical impairment. Methods: The subjects were 45 adults with physical disabilities from both Finland and Sweden. The participants filled in a questionnaire and were also interviewed individually. Results: The quantitative analyses revealed that satisfaction with one’s life situation is a function of the handicapped person’s occupation or meaningful occupational activities, social integration and his/her sense of the meaning of life. Further, the length of time since the onset of the disability was a risk factor for the person’s feeling of satisfaction. The qualitative analyses of the interviews verified the results of the quantitative analyses. Conclusions: The disability per se did not decrease the disabled individual’s quality of life. The individual’s capacity to cope with everyday life was of great importance. Occupation or meaningful occupational activities as well as social integration at different stages of life should be taken into account when planning intervention programmes in the future.
Psychophysiological Reactions to International Adjustment
Authors: Anderzén Ingrid , Arnetz Bengt B.
Published: April 2003

Background: This controlled prospective study examines psychophysiological reactions in employees during their first and second year abroad to identify individual as well as work-related factors predictive of positive adjustment. Methods: Employees (n = 47) relocating from Sweden to a foreign country on a work-related assignment were followed. The subjects completed a questionnaire before relocation and after 1 and 2 years abroad. Blood samples were collected for determination of the stressor-related hormones prolactin, cortisol and testosterone. A matched non-moving reference group of employees (n = 35) responded to the questionnaire at similar time periods, and also provided blood samples. Results: During the years abroad, the expatriate employees experienced increased psychosocial stress as well as negative adjustment as reflected in circulating levels of prolactin and testosterone, worse mental well-being and worsening subjective work environment, as compared with the non-moving group. The greatest change occurred during the first year. Individual factors such as social support, internal locus of control, self-esteem and sense of coherence modified the stress response and predicted employees’ ability to adjust to foreign assignments. Negative changes in the psychosocial work environment explained to a large degree the decrease in work adjustment during the first year and these findings were also reflected in physiological stress indicators. Conclusions: The study emphasises the importance for multinational organisations to look at these individual characteristics before sending employees abroad. They also need to get more involved in supporting employees to manage stressors characteristic of the first year of foreign work.
Slow-Release Lanreotide Treatment in Acromegaly: Effects on Quality of Life
Authors: Sonino N. , Scarpa E. , Paoletta A. , Fallo F. , Boscaro M.
Published: April 2003

Background: It is not known whether medical treatment to lower growth hormone (GH) and insulin-like growth factor (IGF)-1 levels may improve the compromised quality of life of patients with acromegaly. Methods: We studied the effects on quality of life of the slow-release somatostatin analogue lanreotide, 30 mg i.m., every 14 days for 2 months in 10 patients with active acromegaly (8 females/2 males, mean age 57.3 ± 11.4). Hormone measurements and psychometric evaluation by means of self-rating scales were carried out in baseline conditions and after 1 and 2 months. The Symptom Questionnaire (SQ), the Cognitive Scale of the Screening List for Psychosocial Problems by Kellner and the Social Situation Questionnaire by Marks were employed. Results: Together with a significant decrease in GH and IGF-1, treatment with lanreotide significantly improved SQ psychological distress, SQ well-being and Social Situation Questionnaire social fears. Conclusion: Medical treatment with lanreotide may improve the quality of life of patients with acromegaly. Being an open trial, changes could be due to nonspecific effects. However, they did not fade at 2 months. Improvement involved fears of social situations that have been linked to GH abnormalities.
Measuring Psychotherapeutic Change with the Symptom Checklist SCL 90 R
Authors: Schauenburg Henning , Strack Micha
Published: April 2003

Background: Despite a long tradition of discussions on the evaluation of psychotherapy, there is still a lack of agreement for measuring change after psychological treatment. In this paper we describe the concept of statistical and clinical significance of change. We use the Symptom Checklist 90 R as a commonly administered instrument to propose conventions and cutoff points for psychological symptoms and their change after therapy. Method: A German norm population and several psychotherapy samples have been aggregated to calculate cutoffs and confidence intervals (reliable change indices) for statistically and clinically significant changes after psychotherapy. Results: The cutoff point between a ‘functional’ and a ‘dysfunctional’ population was calculated as C = 0.57 (Global Severity Index, GSI). Patients above this score need a change of at least RCI = 0.43 (GSI difference) for a statististically significant change. Below this score the RCI = 0.16. The use of multiple clinical groups (e.g. inpatients and outpatients) for a more realistic determination of a ‘stepwise’ clinically significant change, as proposed by Tingey et al. in the USA, is not possible in the German samples collected so far. Initial SCL 90-R scores in these groups do not show enough differences to call a move from one group to the other a clinically significant change. Conclusion: In the German samples investigated the move from a ‘functional’ to a ‘dysfunctional’ population and vice versa has to be taken as the criterion for a clinically significant change up to now.
Subclinical Symptoms of Panic Disorder: New Insights into Pathophysiology and Treatment
Authors: Fava Giovanni A. , Mangelli Lara
Published: April 2003

The aim of this review was to survey the available literature on prodromal and residual symptoms of panic disorder. Both a computerized (Medline) and a manual search of the literature were performed. In a substantial proportion of patients with panic disorder with agoraphobia a prodromal phase can be identified. Most patients report residual symptoms despite successful treatment. Residual symptoms upon remission have a prognostic value. There appears to be a relationship between residual and prodromal symptomatology (the rollback phenomenon). Appraisal of subclinical symptomatology in panic disorder has important implications as to the pathophysiological model of disease, its conceptualization and treatment.
Emotional Distress and Occupational Burnout in Health Care Professionals Serving HIV-Infected Patients: A Comparison with Oncology and Internal Medicine Services
Authors: López-Castillo J. , Gurpegui M. , Ayuso-Mateos J.L. , Luna J.D. , Catalan J.
Published: April 2003

Background: The present paper examines the levels of emotional distress and professional burnout among health care professionals working with HIV patients in two different settings, Infectious Disease (ID) Units and a Haemophilia (H) Unit, and compares them with those of professionals working in Oncology (O) or General Internal Medicine (IM) Units, all at public hospitals. Methods: Cross-sectional anonymous survey assessing their psychological condition, occupational stress, work and social adjustment, and providing information about stressors, supports and coping methods, using the General Health Questionnaire, the Maslach Burnout Inventory, the Modified Social Adjustment Scale, and other self-administered instruments. Results: Perceived stress was higher in both O and IM, and the number of stressful circumstances was especially higher in O. No significant differences in psychological morbidity were found among the groups, with these exceptions: a better status among the H staff, who also showed less overall burnout; emotional exhaustion was lower in both ID and H than in the two other groups; the ID staff showed less personal accomplishment. Using a multiple regression model, a series of variables – including work adjustment, social/leisure adjustment, and having chosen to work in their position – was able to predict outcome. Conclusions: Our results highlight the presence of substantial levels of emotional distress and work-related difficulties in a significant number of health care workers. The mental health services could play an important role in conducting further research in this field and in providing practical help to deal with staff’s difficulties.
Personality Disorders and Depressive Symptoms in Late Luteal Phase Dysphoric Disorder
Authors: De Ronchi Diana , Muro Ambra , Marziani Alba , Rucci Paola
Published: April 2003

Background: Although many significant studies of late luteal phase dysphoric disorder (LLPD) have been carried out, some conflicting findings on the relationships between personality disorders, depressive symptoms, hostility and LLPD deserve further investigation. Methods: Forty-three LLPD patients and 85 control subjects, evaluated by prospective daily ratings during two symptomatic cycles, received a detailed psychiatric evaluation, including the sections for psychotic, affective and anxiety disorders of the Structured Clinical Interview for DSM-III-R nonpatient version and the section for personality disorders; the Buss Durkee Inventory for Assessing Different Kinds of Hostility and the Montgomery-Åsberg Depression Rating Scale. Results: The odds of suffering from LLPD are about nine-fold (crude odds ratio, OR = 9.23, 95% confidence interval, CI 3.98–21.39) among women with mild or moderate depressive symptoms. When two age strata (below and above 30) are analyzed separately, the association between LLPD and depressive symptoms is strong and positive in both strata, while the association between LLPD and avoidant personality disorder is found only among older women (adjusted OR = 8.26, p < 0.05, 95% CI 1.03–66.35). Conclusions: The major finding from this preliminary study is the association between LLPD and depressive symptoms. Conversely, the association between LLPD and avoidant personality disorder remains controversial and seems to be dependent on age. Our findings support the hypothesis that LLPD and avoidant personality disorder may be considered as part of the spectrum of recurrent mood disorder rather than as qualitatively distinct nosological entities. Future studies are needed, adopting prospective, longitudinal assessments of personality prior to the onset of LLPD.
Cardiovascular Reactivity in Adolescent Boys of Low Socioeconomic Status Previously Characterized as Anxious, Disruptive, Anxious-Disruptive or Normal during Childhood
Authors: Dobkin Patricia L. , Treiber Frank A. , Tremblay Richard E.
Published: April 2003

Background: The purpose of the study was to compare cardiovascular reactivity, a potential mechanism underlying the development of cardiovascular disease (CVD), in boys with different behavioral characteristics. Method: Eighty-nine adolescent boys with low socioeconomic status who were classified as anxious, disruptive, anxious-disruptive or boys without these characteristics (i.e. control) during childhood were observed during a laboratory stress experiment. Result: No significant group differences were found for resting levels of diastolic or systolic blood pressure (SBP). Anxious and anxious-disruptive boys exhibited greater SBP reactivity to the social stressor (Social Competence Interview) compared to the disruptive and control boys. The disruptive boys tended to engage in compromising behaviors which are associated with health problems. The anxious boys were significantly more likely to have a positive family history of hypertension. Conclusions: Boys with different behavioral problems (anxiety, disruptiveness) may be at risk for CVD via different mechanisms.
Attachment Representation and Cortisol Response to the Adult Attachment Interview in Idiopathic Spasmodic Torticollis
Authors: Scheidt C.E. , Waller E. , Malchow H. , Ehlert U. , Becker-Stoll F. , Schulte-Mönting J. , Lücking C.H.
Published: April 2003

Objective: The study investigates individual differences in the mental representation of attachment and their impact on the cortisol response to psychosocial stress in idiopathic spasmodic torticollis (IST). It was hypothesized (a) that in IST insecure attachment is more prevalent than in a non-clinical control group and (b) that subjects with dismissing attachment respond with higher physiological arousal to a specific stimulus activating the attachment behavioural system than subjects with secure attachment. Method: 20 patients with IST and 20 healthy controls matched for age and sex underwent the Adult Attachment Interview, an hour-long, semiclinical interview on attachment experiences. During the interview salivary cortisol levels were monitored. The subjects’ mental state with regard to attachment was classified using the attachment Q-sort method. Anxiety and depression were measured as potential covariates of the adrenocortical stress response. Results: Compared to the non-clinical group, dismissing attachment was strongly overrepresented in IST. In IST, but not in the healthy control group, dismissing attachment correlated with an elevated cortisol response to the interview. Conclusion: In clinical, but not in non-clinical samples dismissing attachment may be associated with increased vulnerability to psychosocial stress. The factors contributing to this interaction are not yet fully elucidated.
A Clinical Index for Rating Severity in Cushing’s Syndrome
Authors: Sonino N. , Boscaro M. , Fallo F. , Fava G.A.
Published: April 2003

Background: In assessing the clinical response to medical and/or surgical treatments in patients with established Cushing’s syndrome, the need for an instrument that could measure the magnitude of changes in the most common symptoms was felt. We therefore tested the usefulness of a simple clinical index, the Cushing’s syndrome severity index (CSI), based on clinimetric principles. Eight clinical features were selected. Each one was graded on an ordinal 3-point scale (0–2) with specification of anchor points based on severity. The total score ranged from 0 to 16. Methods: Interrater agreement, construct validity and concurrent validity of the index were evaluated. Fourteen patients with Cushing’s syndrome were evaluated independently by 2 endocrinologists before and after successful treatment. The CSI and two global scales of illness severity were administered. Urinary cortisol measurements were also performed. Results: The intraclass correlation coefficient of the CSI was 0.95 before treatment and 0.87 after treatment. The CSI significantly discriminated (p < 0.001) the effects of treatment and paralleled the changes in urinary cortisol. There were significant correlations between CSI and global scales of illness severity and change after treatment. Conclusion: The results indicate that the CSI is a valid and reliable clinimetric method to evaluate severity in Cushing’s syndrome. It may provide a tool for better assessing the complex array of signs and symptoms in this condition. The index is suitable for descriptive studies, outcome investigations and treatment trials.
Coping and Cognitive Processing Style in HIV-Positive Subjects
Authors: Novara Caterina , Casari Salvatore , Compostella Silvia , Dorz Stella , Sanavio Ezio , Sica Claudio
Published: April 2003

Background: People’s reactions to traumatic events are mediated by their subjective style of coping. This is of particular importance for HIV+ patients, mainly in the first phases of the disease. This work aimed at examining whether an ‘acceptance’ style of coping, as opposed to a ‘mental disengagement’ style, selectively influences the first stages of the processing of neutral, emotional and HIV-related information. Method: Two groups of 11 HIV+ asymptomatic subjects were chosen according to their coping strategies, acceptance or mental disengagement, as measured by Coping Orientations to the Problems Experienced (COPE). Twenty-two patients completed the Emotional Stroop Task and an incidental memory recognition task containing neutral, emotional and HIV-related stimuli. Results: Analysis of reaction times (RTs) on the Emotional Stroop Task showed that HIV+ subjects have longer RTs for emotional and HIV-related than for neutral words. Instead, no effect was found as regards interaction with style of coping. Conclusion: Results confirmed a processing bias of emotional information, whereas Acceptance and Mental disengagement strategies, as measured by the COPE scales, did not appear to influence information processing.
Physiological Effects of a Pea Protein Isolate in Gnotobiotic Rats: Comparison with a Soybean Isolate and Meat
Authors: Lhoste Evelyne F. , Mouzon Bernadette , Andrieux Claude , Gueugneau Anne-Marie , Fiszlewicz Michèle , Corring Tristan , Szylit Odette
Published: April 2003

Pea proteins have been considered for the introduction into the human diet only recently. This protein source was tested on nutritional and digestive parameters in heteroxenic male Fischer rats inoculated with a human faecal microflora from a methane producer. Compared to soybean proteins, pea proteins have similar effects on the rat’s endogenous and bacterial digestive patterns. Compared to the pea proteins, a diet containing a standard meat meal enhanced the pH and the production of ammonia, while a lyophilized beef meat enhanced that of urea. The diet containing the standard meat decreases short-chain fatty acids and modifies the ratio of caecal short-chain fatty acids. Both animal diets decreased the specific activities of pancreatic proteases such as chymotrypsin (EC 3.4.21.1), trypsin (EC 3.4.21.4), and carboxypeptidase A (EC 3.4.17.1) when compared to the diet containing the pea isolate. In conclusion, the whole composition of the diet, more than the origin of the dietary protein, influences the rat’s digestive pattern.
Fat Sources in the Belgian Diet
Authors: Staessen L. , de Henauw S. , de Bacquer D. , de Backer G. , van Peteghem C.
Published: April 2003

Food consumption data from the Belgian Interuniversity Research on Nutrition and Health study (n = 11,302) were analyzed with regard to fat intake. Intakes of macronutrients were compared between several subgroups in the population. The major objective was to quantify the contribution of food groups and individual food items to the intake of total fat, polyunsaturated (PUFA), monounsaturated (MUFA) and saturated (SFA) fat in the Belgian diet. These results are compared to nutritional guidelines and Italian, US and Dutch data. Major sources of fat are butter (16% of the total intake) and baking margarine (8%). Major sources of SFA are butter (24%) and cheese (8%), of MUFA butter (13%) and baking margarine (9%), and of PUFA diet margarine (23%) and mayonnaise (11%).
Lipid Emulsions in Parenteral Nutrition
Authors: Adolph M.
Published: April 2003

Lipid emulsions containing a physical mixture of medium and long chain triglycerides (MCT/LCT) are a well-proven concept in parenteral nutrition of critically ill patients. Having a demonstrably higher utilization rate, MCT/LCT emulsions do not impair liver function, produce less immune and no reticuloendothelial system function compromise, and do not interfere with pulmonary hemodynamics or gas exchange. A reduced content of n–6 polyunsaturated fatty acids can also be obtained by using newer preparations based on structured triglycerides or olive oil. Further studies are necessary in order to investigate these new lipid emulsions versus the physical mixture of MCT/LCT. A promising substrate in the development of lipid emulsions can be seen in fish oils. With regard to current literature, fish oils have a beneficial influence on the pathophysiological response to endotoxins and exert important modulations on eicosanoid and cytokine biology. Furthermore their intravenous use may improve organ perfusion in different critical situations.
Macronutrient Intake of 3- to 36-Month-Old German Infants and Children: Results of the DONALD Study
Authors: Alexy Ute , Kersting Mathilde , Sichert-Hellert Wolfgang , Manz Friedrich , Schöch Gerhard
Published: April 2003

The intake of macronutrients (protein, fat, fatty acids, carbohydrates, added sugars, fiber) was assessed in 354 healthy German infants and children aged 3–36 months from 3-day weighed diet records. The intake of protein ranged between 7 and 14% of energy intake. Fat intake decreased from 3 months (breast-fed boys and girls, 48%; formula-fed boys/girls, 41/44%) to 12 months (boys/girls, 33/36%) due to the increasing consumption of commercial weaning foods, and then increased again up to 36 months (boys/girls, 40/43%). Intake of added sugars decreased during the first 12 months and then increased again, but only slightly exceeded the limit of 10%. Intake of dietary fiber was highest at the age of 1 year (boys/girls, 2.7/2.3 g/MJ). The macronutrient intake was in accordance with other German and European surveys, but deviated considerably from the respective recommendations.
Influence of Calcium Intake on Gestational Hypertension
Authors: Ortega Rosa M. , Martínez Rosa M. , López-Sobaler Ana M. , Andres Pedro , Quintas M. Elena
Published: April 2003

Calcium intake during the third trimester of pregnancy was determined in 82 pregnant women by recording the consumption of foods over a 5-day period and by calculation of the quantity of this element provided by dietary supplements. For each subject, blood pressures were measured once per week using an aneroid sphygmomanometer, to detect and analyze differences in calcium intake between those with normal blood pressure and those suffering from gestational hypertension (7.3%). Calcium intake was significantly lower amongst subjects with high blood pressure (757.7 ± 154.5 compared to 986.4 ± 502.3 mg/day in normotensive subjects). The relationship between calcium intake and blood pressure was independent of other variables such as body mass index, number of previous pregnancies, weight gain, subject age or hematocrit levels. Though further investigation is needed, the results obtained seem to support the idea that pregnant women should try to maintain an optimal calcium intake.
Effects of Caffeine on the Bones of Aged, Ovariectomized Rats
Authors: Ohta Mitsuhiro , Cheuk Gina , Thomas Kevin A. , Kamagata-Kiyoura Yusuke , Wink Carole S. , Yazdani Malektaj , Falster Alexander U. , Simmons William B. , Nakamoto Tetsuo
Published: April 2003

Caffeine is a substance which many people consume in their daily life. Caffeine’s effects on bone are still controversial. Using ovariectomized rats, the present study was conducted to determine to what extent caffeine intake affects the mechanical properties, bone minerals and histology. Aged rats were divided into 2 groups after ovariectomy. Group 1 was fed a 20% protein diet as a control, and group 2 was fed a 20% protein diet supplemented with caffeine (2 mg/100 g body weight). The respective diets were fed to the rats of each group for 90 days. Rats were then killed by heart puncture, blood was collected, and femurs were removed. In 1 group of femurs paraffin cross-sections were made at the midshaft of each bone. Total width, cortical width, total cross-sectional bone area of the midshaft, and the number of osteocytes in randomly selected areas were measured. Another group of bones was subjected to three-point bending testing until failure. Bones were then pulverized and Ca, P, Mg, Zn, Sr, Si, hydroxyproline and hexosamine contents and crystallite size were measured. Various mechanical properties, except modulus of elasticity, in the caffeine group were consistently 7–23% lower than the noncaffeine controls. Yield strain in the caffeine group was significantly less than in the noncaffeine controls. Zinc, Sr, and crystallite size of bone showed a significant decrease in the caffeine group, whereas Si contents significantly increased. Our current results indicate that routine intake of caffeine in the elderly should be regarded with some caution.
Undernutrition Decreases Serine Palmitoyltransferase Activity in Developing Rat Hypothalamus
Authors: Rotta LianeN. , daSilva CristianiG. , Perry MarcosL.S. , Trindade VeraM.T.
Published: April 2003

Background/Aims: Undernutrition reduces the hypothalamic ganglioside concentration. This may be attributed to some modifications in the contents of precursors of sphingolipid biosynthesis in undernourished rats. The present study evaluated the serine palmitoyl transferase activity (SPT; EC 2.3.1.50) during the development of the rat hypothalamus. This work also shows the L-[3-14C]serine metabolic labeling of hypothalamic sphingolipids in normal and undernourished rats at weaning. Methods: The SPT activity was determined in microsomal fractions obtained from the hypothalamus of normal rats (diet: 25% protein) and pre- and postnatally undernourished rats (diet: 8% protein since pregnancy) at 21 days of gestational age and at 7, 14, and 21 days of postnatal life. Results: The enzymatic activity was lower in the hypothalamus of undernourished than in the hypothalamus of control rats since the 7th postnatal day. Incorporation of the precursor L-[3-14C]serine into sphingolipid fraction was lower in the hypothalamus of undernourished rats than in the hypothalamus of control rats on the 21st postnatal day which coincided with the age of the highest difference in SPT activity between normal and undernourished rats. Conclusion: These results indicate that undernutrition reduces the biosynthesis of the main sphingolipids during the period of brain growth spurt.
Follow-Up Procedures in EPIC-Germany – Data Quality Aspects
Authors: Bergmann M.M. , Bussas U. , Boeing H.
Published: April 2003

With 475,000 participants throughout Europe, EPIC is one of the largest cohort studies investigating the association between diet and cancer and other chronic diseases. The German part of EPIC comprises about 53,000 participants in Potsdam (n = 27,616) and in Heidelberg (n = 25,546). In the German study centers, follow-up started in 1998 and will be continued in 2-year intervals over the next 10–15 years. To ensure high follow-up data quality at an European level, an international working group developed guidelines for endpoint data collection in every country. A follow-up phase in Germany comprises mailing of a questionnaire, tracing of individuals to whom mail could not be delivered, obtaining information on deceased participants including cause of death, and verifying self- reported diagnoses. Furthermore, activities aimed at motivating study participants are part of the follow-up. The first round of follow-up of those who entered the study in 1994 and 1995 included 8,706 participants in Potsdam and 6,289 in Heidelberg. Due to a comprehensive and intensive reminder and tracing system, vital status of the study subjects is known from almost 100% in Potsdam and 99% in Heidelberg. Two years after baseline examination, and with twice as many addresses in Potsdam as in Heidelberg, addresses had to be traced or checked via population registry (13 versus 6%). Tracing, the application of different mailing strategies, and intensive reminder activities resulted in a 95% return of the questionnaire in Potsdam and 90% in Heidelberg. The system of follow-up data entry and control, including completion of missing information via telephone, verification of self-reports and causes of death, has been set up for EPIC-Germany and works efficiently and successfully. The aim of this paper is to describe the follow-up procedures in EPIC-Germany with a focus on the generation of valid and complete outcome data.
Dietary Habits in the German EPIC Cohorts: Food Group Intake Estimated with the Food Frequency Questionnaire
Authors: Brandstetter Birgit R. , Korfmann Andrea , Kroke Anja , Becker Nikolaus , Schulze Matthias B. , Boeing Heiner
Published: April 2003

In the baseline assessment of the two EPIC-Germany cohorts Heidelberg and Potsdam, dietary information was obtained with an identical food frequency questionnaire (FFQ). The optically readable FFQ was designed to assess the usual food and nutrient intake of individuals during the past 12 months. The present analysis was based on dietary data from 25,212 participants in Heidelberg (11,776 men, 13,436 women) and 26,270 participants in Potsdam (10,249 men, 16,021 women). This paper presents the first results of a descriptive dietary analysis on a food group level based on 16 food groups and selected subgroups. Each of these food groups and subgroups was divided into quintiles, and the age-adjusted mean intake for each quintile was calculated. The comparison of dietary habits between the two cohorts, as well as the comparison between men and women within each cohort showed clear differences both in the quintiles of most food groups as well as in the range between the lowest and highest quintile. Except for the food groups non-alcoholic and alcoholic beverages, sugar and confectionery, sauces, and soups, men and women participating in Potsdam reported higher intakes of all the other food groups. The amount of food intake was generally lower in women than in men, with the exception of vegetables, fruit, dairy products, and non-alcoholic beverages. Further differences between the study centers were observed regarding the use of cooking fat for meat and vegetable preparation. In conclusion, the dietary variation, e.g. the exposure variation, was increased by recruiting two geographically distinct cohorts, instead of only one, in Germany.
Changes of HDL Subfractions by Eicosapentaenoic Acid Intake and Physical Load in 20- to 25-Year-Old Men
Authors: Sakamoto Naomasa , Yoshimoto Sachiko , Nishiike Tamako , Iguchi Hiroshi , Sakamoto Kunihiro
Published: April 2003

The effects of daily eicosapentaenoic acid (EPA) intake and physical activity on high-density lipoprotein (HDL) subfraction, which may be an index of health status, were examined. The HDL subfraction, triglyceride and T-chol levels in the serum of 10 male volunteers aged 20–25 were examined before, immediately after and 1 h after being subjected to a physical load by bicycle ergometer at 90 W for 20 min. Subjects were then given 1.25 g EPA/day for 2 weeks, and the above test was repeated. By EPA intake, the distribution of HDL3b and 3c decreased significantly by 16.8 and 15.3%, respectively, and that of 2b increased significantly by 17.9%. The rate of change of subfraction of the 29th part (2b) of 30 parts in the total range of HDL increased by 67%, and decreased by 47% in 7th part (3c). By physical load, the distribution of HDL2a increased significantly by 15.4%, while 3b tended to decrease. By physical load after EPA intake, the distribution of 2a decreased significantly by 9.7%, and those of 3b and 3c increased significantly by 20.5 and 5.4%, respectively, and that of the 7th part (3c) increased by 37%. Thus, the physical load after EPA intake is effective to prevent arteriosclerosis as increasing the rate of change of HDL3c and as showing the longevity pattern of the HDL subfraction. Concentration of TG in a modal HDL pattern group increased by 95% after EPA intake, but that of a bimodal group did not show any change. HDL-cholesterol level in the bimodal group was higher than that in the modal group, especially after EPA intake. Two type III subjects changed to type IV by the load and the EPA intake, respectively. Thus, it seemed that the transformation from a modal pattern to a bimodal pattern by a certain lifestyle, especially regular physical activity and proper food intake, is a very important trial for the prevention of cerebrovascular diseases.
Studies on the Pathogenesis of Hypokalemia in Gitelman’s Syndrome: Role of Bicarbonaturia and Hypomagnesemia
Authors: Kamel Kamel S. , Harvey Elizabeth , Douek Karen , Parmar Malvinder S. , Halperin Mitchell L.
Published: April 2003

Objective: Hypokalemia and renal potassium (K) wasting are hallmarks of the group of disorders called Bartter’s syndrome. The presence of hypomagnesemia and a low rate of excretion of calcium are currently used to characterize a subgroup of these patients as having Gitelman’s syndrome (GS) in which the molecular lesion is a defect in the thiazide-sensitive NaCl cotransporter in the distal convoluted tubule. This study was undertaken to examine whether bicarbonaturia or hypomagnesemia exacerbates the kaliuresis in patients with GS. Methods: Six patients with most of the diagnostic features of GS were examined. To examine the role of bicarbonaturia, the transtubular K concentration gradient (TTKG) was assessed before and after an oral load of NH4Cl which caused the urine pH to be <6. To evaluate the role of hypomagnesemia, the TTKG was examined after an infusion of enough magnesium (Mg) to achieve normal levels of Mg in plasma for close to 24 h. Results: The TTKG remained very high even when the pH of the urine was <6.0. An infusion of Mg caused the TTKG to approach expected values for hypokalemia in 4 of 6 patients. The infusion of Mg was extended in 1 patient who had a sustained high TTKG for 24 h; the TTKG remained elevated for 96 h despite normal plasma Mg levels. Conclusions: Bicarbonaturia does not play a critical role in maintaining the very high TTKG in these patients. The K wasting in 4 of 6 of these patients could largely be attributed to hypomagnesemia and/or Mg depletion. The plasma aldosterone level tended to be higher in patients who did not respond to the infusion of Mg. Therefore, these patients may not represent a homogeneous group with regard to the pathophysiology of their renal K wasting.
Proteinuria and Renal Tubular Damage: Urinary N-Acetyl- β-D-Glucosaminidase and Isoenzymes in Dissimilar Renal Disease
Authors: Rustom Rana , Costigan Michael , Shenkin Alan , Bone J. Michael
Published: April 2003

Markers of renal tubular injury are difficult to interpret in patients with proteinura. The 24-hour urinary N-acetyl-β-D-glucosaminidase (NAG) concentration was measured in 167 patients with dissimilar renal disease, function, and proteinuria. NAG isoenzymes were also separated in 69 patients, using a modified fast protein liquid chromatography technique. The ‘A2’ isoenzyme predominated at all levels of renal function and in all diagnostic groups. Urinary NAG and proteinuria were well correlated at all levels of renal function, as was NAG ‘A2’ isoenzyme. Proteinuria and urinary NAG were similarly correlated in patients with different glomerulonephritides, hypertensive nephrosclerosis, and chronic pyelonephritis, but not in those with diabetic nephropathy.