Historical development of root analogue implants: a review of published papers.

The timetable for placing a dental implant can be crucial in the reduction of resorption of the socket after an extraction. The association of immediate implantation with an implant that copies the anatomy of the extracted root seems to add benefits in limiting the hard and soft tissue changes that may occur. The purpose of this paper is to provide an overview of the historical development of all types of root analogue implants from their beginning to the present day. To our knowledge the first individualised ones were described in 1969. Later, the use of titanium instead of the polymers that were used to start with offered better bony integration, and showed that the selection of materials was a key factor in their success. Root analogue implants made from zirconia were also described when attempts were being made to improve aesthetics in the anterior regions. The more recent introduction of digital technology such as DICOM has allowed the fabrication of these implants in less time, and the combination with digital diagnostic options such as cone-beam computed tomography facilitated the fabrication of some types of implants before extraction that could be inserted immediately into the alveolar socket with optimal and safe 3-dimensional positioning. Currently digital planning allows the clinician to design the ideal implant and abutment, which reduces the need for tissue grafting in the surgical phase and gingival conditioning in the prosthetic phase.

Locating human splenic capillary sheaths in virtual reality.

Stromal capillary sheath cells in human spleens strongly express CD271, the low affinity nerve growth factor receptor p75. Serial sections of a representative adult human spleen were double-stained for CD271 versus smooth muscle alpha actin (SMA) plus CD34 to visualise capillary sheaths, the arterial tree and endothelial cells by transmitted light. Preliminary three-dimensional (3D) reconstructions of single regions were inspected in virtual reality (VR). This method showed that a large number of CD271+ sheaths occur in a post-arteriolar position often surrounding capillaries located close to divisions of arterioles. The length and diameter of capillary sheaths are rather heterogeneous. Long sheaths were observed to accompany one or two generations of capillary branches. We hypothesise that human splenic capillary sheaths may attract recirculating B-lymphocytes from the open circulation of the red pulp to start their migration into white pulp follicles along branches of the arterial tree. In addition, they may provide sites of interaction among sheath macrophages and B-lymphocytes. Our innovative approach allows stringent quality control by inserting the original immunostained serial sections into the 3D model for viewing and annotation in VR. Longer series of sections will allow to unequivocally localise most of the capillary sheaths in a given volume.

Potential export of soluble reactive phosphorus from a coastal wetland in a cold-temperate lagoon system: Buffer capacities of macrophytes and impact on phytoplankton.

The main pathways for phosphorus flux from land to sea are particle-associated (erosion) and dissolved runoff (rivers, groundwater, and agricultural drainage systems). These pathways can act as diffused sources for aquatic systems and support primary production, therefore, counteracting the efforts aimed at reducing phosphorus input from point sources such as sewage treatment plants. Phosphorus supports primary production in the water column and can elevate phytoplankton and macrophyte growth. Coastal wetlands with emerged (Phragmites australis) and submerged (Stuckenia pectinata and Chara sp.) macrophytes can affect phosphorus fluxes in the land-water transitional zone. The macrophytes have the potential to act as a buffer for phosphorus run-off. The aim of this study was to determine the phosphorus stocks in the transitional land-sea zone of a cold temperate lagoon at the southern Baltic Sea. Phosphorus in macrophytes, water samples, and phytoplankton growth were analyzed along a gradient moving away from the wetland. The phosphorus stocks in the above ground biomass of the Phragmites plants were the highest at the end of August and with more than 8000mgPm-2 in the interior zone of the wetland, threefold the amount of P in Phragmites plant tissue at the wetland fringe. The submerged macrophytes stored only 300mgPm-2, close to the wetland. Concentrations of soluble reactive phosphorus in the water column were higher in the zones of emerged macrophytes than in the zones of submerged macrophytes and decreased along the land-sea transect. Phytoplankton could grow proximal to the wetland during all seasons, but not further away. This study indicates that macrophytes can act as phosphorus sinks. However, short-term releases of phosphate within the Phragmites wetland have the potential to lead to phytoplankton growth. Phytoplankton can use these nutrient pulses either immediately or later, and support high biomass and turbidity within the system.

The Impact of Multimorbidity on Resting Metabolic Rate in Community-Dwelling Women over a Ten-Year Period: A Cross-Sectional and Longitudinal Study.

OBJECTIVES: Ageing has been associated with increasing multimorbidity. This study investigated whether the number of diseases is a predictor of resting metabolic rate (RMR) and its long-term changes in community-dwelling elderly women. SUBJECTS AND DESIGN: Cross-sectional and longitudinal data, obtained over ten years with repeated follow-ups, from 180 women aged 60 - 86 years and with a BMI of 18 - 43 kg/m2 at baseline were analyzed. MEASUREMENTS: RMR was measured using indirect calorimetry and body composition by bioelectrical impedance analysis. Diagnosed diseases were assessed by a questionnaire comprising 23 disease categories. Subjects with 0 - 2 diseases were classified as relatively healthy and with > 2 diseases as multimorbid. RESULTS: At baseline, relatively healthy (N = 75) and multimorbid (N = 105) women did not differ in RMR. During the ten-year follow-up, the median (range) number of diseases increased from 2 (0 - 2) to 4 (0 - 8) in relatively healthy and from 5 (3 - 11) to 7 (3 - 15) in multimorbid women. In the longitudinal analyses, only women who were multimorbid at baseline showed a significant increase in RMR of 31 kJ/d per additional disease (P = 0.015), adjusted for fat-free mass, fat mass, waist circumference and age. CONCLUSION: Increasing multimorbidity in community-dwelling women is associated with an increase in RMR independently of body composition and age.

No Associations of 25-Hydroxycholecalciferol and Parathyroid Hormone Concentrations with Calcaneal Bone Characteristics in Community-Dwelling Elderly Subjects: A Cross-Sectional Study.

OBJECTIVE: This study examined the associations of 25-hydroxycholecalciferol [25(OH)D3] and intact parathyroid hormone (iPTH) concentrations with bone status parameters in elderly subjects. DESIGN/SETTING: Cross-sectional data based on the follow-up 2008 of the longitudinal study on nutrition and health status of senior citizens in Giessen, Germany. PARTICIPANTS: One hundred eighty-eight independently living subjects aged 66-96 years. MEASUREMENTS: Serum concentrations of 25(OH)D3, iPTH, N-terminal propeptide of type 1 collagen (P1NP) and activity of alkaline phosphatase (ALP) were assessed. Broadband ultrasound attenuation, speed of sound and stiffness index were determined by calcaneal quantitative ultrasound (QUS). Multiple linear regression analyses were performed to analyse associations of 25(OH)D3 and iPTH with bone status parameters. RESULTS: Median (range) 25(OH)D3 and iPTH concentrations were 62.8 (29.9-106.7) nmol/L and 4.6 (1.3-21.0) pmol/L, respectively. Neither 25(OH)D3 nor iPTH was associated with calcaneal bone characteristics measured by QUS, whereas negative associations between 25(OH)D3 and bone formation markers (P1NP and ALP) were found. In a sub analysis, 25(OH)D3 was negatively associated with ALP only in subjects with iPTH concentrations > 4.59 pmol/L. CONCLUSION: The present study provides no evidence for independent associations of 25(OH)D3 and iPTH with calcaneal bone characteristics in community-dwelling elderly subjects with 25(OH)D3 concentrations between 30 and 107 nmol/L. However, 25(OH)D3 interacts with bone formation markers, particularly in subjects with high iPTH concentrations.

Multiplex component-based allergen microarray in recent clinical studies.

During the last decades component-resolved diagnostics either as singleplex or multiplex measurements has been introduced into the field of clinical allergology, providing important information that cannot be obtained from extract-based tests. Here we review recent studies that demonstrate clinical applications of the multiplex microarray technique in the diagnosis and risk assessment of allergic patients, and its usefulness in studies of allergic diseases. The usefulness of ImmunoCAP ISAC has been validated in a wide spectrum of allergic diseases like asthma, allergic rhinoconjunctivitis, atopic dermatitis, eosinophilic esophagitis, food allergy and anaphylaxis. ISAC provides a broad picture of a patient's sensitization profile from a single test, and provides information on specific and cross-reactive sensitizations that facilitate diagnosis, risk assessment, and disease management. Furthermore, it can reveal unexpected sensitizations which may explain anaphylaxis previously categorized as idiopathic and also display for the moment clinically non-relevant sensitizations. ISAC can facilitate a better selection of relevant allergens for immunotherapy compared with extract testing. Microarray technique can visualize the allergic march and molecular spreading in the preclinical stages of allergic diseases, and may indicate that the likelihood of developing symptomatic allergy is associated with specific profiles of sensitization to allergen components. ISAC is shown to be a useful tool in routine allergy diagnostics due to its ability to improve risk assessment, to better select relevant allergens for immunotherapy as well as detecting unknown sensitization. Multiplex component testing is especially suitable for patients with complex symptomatology.

The MARK-AGE extended database: data integration and pre-processing.

MARK-AGE is a recently completed European population study, where bioanalytical and anthropometric data were collected from human subjects at a large scale. To facilitate data analysis and mathematical modelling, an extended database had to be constructed, integrating the data sources that were part of the project. This step involved checking, transformation and documentation of data. The success of downstream analysis mainly depends on the preparation and quality of the integrated data. Here, we present the pre-processing steps applied to the MARK-AGE data to ensure high quality and reliability in the MARK-AGE Extended Database. Various kinds of obstacles that arose during the project are highlighted and solutions are presented.

Lung transplantation: a treatment option in end-stage lung disease.

BACKGROUND: Lung transplantation is the final treatment option in the end stage of certain lung diseases, once all possible conservative treatments have been exhausted. Depending on the indication for which lung transplantation is performed, it can improve the patient's quality of life (e.g., in emphysema) and/ or prolong life expectancy (e.g., in cystic fibrosis, pulmonary fibrosis, and pulmonary arterial hypertension). The main selection criteria for transplant candidates, aside from the underlying pulmonary or cardiopulmonary disease, are age, degree of mobility, nutritional and muscular condition, and concurrent extrapulmonary disease. The pool of willing organ donors is shrinking, and every sixth candidate for lung transplantation now dies while on the waiting list. METHOD: We reviewed pertinent articles (up to October 2013) retrieved by a selective search in Medline and other German and international databases, including those of the International Society for Heart and Lung Transplantation (ISHLT), Eurotransplant, the German Institute for Applied Quality Promotion and Research in Health-Care (Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen, AQUA-Institut), and the German Foundation for Organ Transplantation (Deutsche Stiftung Organtransplantation, DSO). RESULTS: The short- and long-term results have markedly improved in recent years: the 1-year survival rate has risen from 70.9% to 82.9%, and the 5-year survival rate from 46.9% to 59.6%. The 90-day mortality is 10.0%. The postoperative complications include acute (3.4%) and chronic (29.0%) transplant rejection, infections (38.0%), transplant failure (24.7%), airway complications (15.0%), malignant tumors (15.0%), cardiovascular events (10.9%), and other secondary extrapulmonary diseases (29.8%). Bilateral lung transplantation is superior to unilateral transplantation (5-year survival rate 57.3% versus 47.4%). CONCLUSION: Seamless integration of the various components of treatment will be essential for further improvements in outcome. In particular, the follow-up care of transplant recipients should always be provided in close cooperation with the transplant center.

Evaluation of demineralized bone and bone transplants in vitro and in vivo with cone beam computed tomography imaging.

OBJECTIVES: The objective of this study was to determine the ability of two flat panel cone beam CT (CBCT) devices to identify demineralized bone and bone transplants in vivo and in vitro. METHODS: Datasets from patients with autologous bone grafts (n = 9, KaVo 3DeXam (KaVo, Biberach, Germany); n = 38, Accuitomo 40 (Morita, Osaka, Japan)) were retrospectively evaluated. Demineralized and non-demineralized porcine cancellous bone blocks were examined with the two CBCT devices. A SawBone skull (Pacific Research Laboratories, Vashon, WA) was used as a positioning tool for the bone blocks. Descriptive evaluation and image quality assessment were conducted on the KaVo 3DeXam data (voxel size 0.3 mm) using the OsiriX viewer as well as on the Morita Accuitomo data (voxel size 0.25 mm) using proprietary viewer software. RESULTS: Both in vivo and in vitro, the descriptive analysis of the images of the two devices showed well-visualized bone transplants with clearly defined cancellous bones and well-defined single bone trabeculae in all cross-sections. In vitro, demineralized samples showed lower radiographic opacity but no significant loss of quality compared with fresh bone (P = 0.070). Single cancellous bone trabeculae were significantly better visualized with the Morita 3D Accuitomo device than with the KaVo 3DeXam device (P = 0.038). CONCLUSION: Both the KaVo 3DeXam and Morita 3D Accuitomo devices produce good-quality images of cancellous bones in in vivo remodelling as well as after in vitro demineralization.

Changes in resting metabolic rate in an elderly German population: cross-sectional and longitudinal data.

BACKGROUND/OBJECTIVES: This study investigates age-dependent changes in resting metabolic rate (RMR) considering changes in body composition and fat distribution within the longitudinal study on nutrition and health status in an aging population in Giessen (GISELA), Germany, using three different approaches. SUBJECTS/METHODS: In approach 1 cross-sectional data from 358 female and 155 male participants of the GISELA study were evaluated (mean age of 67.4 +/- 5.9 and 66.9 +/- 5.2 y, respectively). In approach 2 longitudinal data of 107 female and 55 male subjects who participated over a follow up period of 10 years were analysed. In approach 3 all data obtained at a total of 3033 visits from 363 women and 153 men between 1994 and 2006 were evaluated. The mean duration of follow-up was eight years. RMR was assessed by indirect calorimetry. RESULTS: Approach 1: RMR correlates significantly negatively with age in women and men. Considering fat free mass, fat mass, and WHR, age proved to be a significant predictor of RMR in both sexes in multiple regression analysis; RMR falls by 11.2 kJ/d and 34.1 kJ/d per year in females and males, respectively. Approach 2: In males but not in females RMR decreases significantly in the course of the follow up. After ten years measured RMR is significantly lower than expected RMR predicted on the basis of body composition and fat distribution in females and males. Deviations correspond to a decline in RMR by 11.4 and 27.5 kJ/d per year independently of changes in body composition and fat distribution. Approach 3: Results of the mixed linear model show that RMR decreases in the course of aging in both women and men; after considering changes in body composition and fat distribution respective decreases were 8.7 and 30.7 kJ/d per year. CONCLUSIONS: These results indicate that the decline in RMR with advancing age cannot be totally due to changes in body composition.

Longitudinal changes in energy expenditure in an elderly German population: a 12-year follow-up.

BACKGROUND/OBJECTIVES: This study investigates age-dependent changes in different components of energy expenditure (EE) within the longitudinal study on nutrition and health status in an aging population in Giessen, Germany (GISELA). SUBJECTS/METHODS: Between 1994 and 2006, data obtained at a total of 3033 visits from 363 women and 153 men with a mean initial age of 67.4+/-5.9 and 66.9+/-5.2 years, respectively, were evaluated. The mean duration of follow-up was 8 years. Resting metabolic rate (RMR) was assessed by indirect calorimetry and physical activity patterns were assessed by questionnaire. EE of physical activity and total EE (TEE) were calculated using multipliers for RMR. Energy intake was determined through a validated 3-day estimated dietary record. Linear mixed models were used to analyze the influence of age on EE adjusted for covariates. RESULTS: Resting metabolic rate decreased in women and men by 158 and 326 kJ/d per decade, respectively; after considering changes in body composition and fat distribution, respective decreases were 81 and 286 kJ/d per decade. EE of physical activity decreased similarly in both sexes (472 kJ/d per decade). TEE dropped in women and men by 540 and 823 kJ/d per decade, respectively. No statistically significant changes in energy intake and body weight were observed in the course of follow-up. CONCLUSIONS: The age-dependent decrease in TEE is mainly due to a decrease in physical activity. The stable energy intake and body weight of the GISELA subjects may be indicators for a relatively good health status.

Altered NMDA receptor expression and behavior following postnatal hypoxia: potential relevance to schizophrenia.

The present study investigated the effects of chronic, repeated hypoxia during a postnatal vulnerable period. Acoustic startle response in adult rats was measured along with NMDA receptor binding and mRNA expression of subunits at postnatal days (PND) 11 and 120. Rats at PND 120 exhibited a deficit in prepulse inhibition of acoustic startle response. In PND 11 rats, chronic hypoxia decreased NMDA receptor binding and increased transcript expression of NR1 subunit in frontal and temporal regions, nucleus accumbens and hippocampus, while NR2A subunit expression was downregulated in hippocampal subregions. At PND 120, gene expression of NR1 was still increased in hippocampal, frontal and temporal subregions as well as nucleus accumbens. A prepulse inhibition deficit points to schizophrenia-like behavior in adult (PND 120) rats. Compensatory upregulation of NR1 expression may occur due to NMDA receptor hypofunction. We discuss this animal model to further analyze effects of hypoxia as a factor of obstetric complications in the pathophysiology of schizophrenia.

Intake of vitamin and mineral supplements in an elderly german population.

AIM: To assess the prevalence of vitamin and mineral supplement use in a free-living elderly population and the contribution of these supplements to usual dietary intake. METHODS: Analyses are based on data obtained from 388 subjects (>or=60 years) participating in the longitudinal study on nutrition and health status in an ageing population in Giessen (GISELA), Germany, in 2002. Nutrient intake from food was assessed by means of a 3-day estimated dietary record. Supplement use was recorded over a period of 3 days using a self-administered questionnaire. RESULTS: Nearly half of the study population consumed at least 1 supplement within these 3 days. The use of supplements was more prevalent among women than among men (51.5 vs. 33.9%). On average women consumed 2.03+/-1.30 products and men 1.65+/-1.07 products. Magnesium, vitamin C and vitamin E were supplemented most often by men, while women supplemented magnesium, vitamin E and calcium most often. Most of the supplemented nutrients did not distinctly increase the average intake of the respective nutrients from the diet in this population. However, supplement use markedly decreased the proportions of elderly subjects with an intake below the current reference values for certain nutrients, particularly for vitamin E. CONCLUSION: Results indicate that the intake of supplements is a common behavior in the population under investigation and therefore has to be considered when nutrient intake is evaluated.

Lower resting metabolic rate in the elderly may not be entirely due to changes in body composition.

OBJECTIVE: To investigate whether or not the lower resting metabolic rate (RMR) in the elderly is entirely due to changes in body composition. DESIGN: Cross-sectional data of 132 female (age 69.9+/-5.5 y, body mass index (BMI) 26.5+/-4.0 kg/m(2)) and 84 male (age 68.9+/-5.1 y, BMI 26.1+/-2.8 kg/m(2)) participants of the longitudinal study on nutrition and health status in an aging population of Giessen, Germany, as well as that of 159 young women (age 24.8+/-3.0 y, BMI 21.1+/-2.5 kg/m(2)) and 67 young men (age 26.8+/-3.4 y, BMI 23.3+/-2.4 kg/m(2)) were analysed. RMR was measured by indirect calorimetry after an overnight fast and body composition was estimated by bioelectrical impedance analysis and predictive equations from the literature. Analysis of covariance was used to adjust RMR for body composition, body fat distribution and smoking habits. Additionally, RMR that is to be expected theoretically, was calculated on the basis of the subjects' body composition and the specific metabolic rate of the different organs and was compared to measured RMR. RESULTS: Compared to young subjects adjusted RMR was significantly lower in elderly women (5432+/-82 vs 5809+/-70 kJ/day, P<0.01) and men (6971+/-99 vs 7558+/-121 kJ/day, P<0.001). In both elderly women and men, measured RMR was markedly lower than calculated RMR (-625+/-404, -515+/-570 kJ/day). By contrast, measured and calculated RMR were nearly the same in young men (159+/-612 kJ/day); in young women the difference between measured and calculated RMR was only -300+/-457 kJ/day. In both sexes, these differences are significantly larger in the elderly when compared to young adults. CONCLUSION: These results support the point of view that the decline in RMR with advancing age cannot be totally due to changes in body composition.

Physical activity in young and elderly subjects.

AIM: In the current recommendations for energy intake of different countries as well as in the international WHO recommendations for energy intake it is assumed that the elderly are less physically active than young adults. Therefore, the aim of the present study was to compare physical activity patterns and physical activity level (PAL) of young and elderly subjects. METHODS: In 178 female (age 67.8+/-5.7 y, BMI 26.4+/-3.7 kg/m(2)) and 107 male (age 66.9+/-5.1 y, BMI 26.3+/-3.1 kg/m(2)) participants of the longitudinal study on nutrition and health status in an aging population of Giessen, Germany as well as in a young age group consisting of 154 women (age 24.8+/-3.0 y, BMI 21.0+/-2.2 kg/m(2)) and 68 men (age 26.8+/-3.4 y, BMI 23.3+/-2.4 kg/m(2)) different activities like occupational work, housework, gardening, walking and sports were assessed by a questionnaire. Energy expenditure of the different activities was calculated using multipliers for resting metabolic rate (RMR) according to the WHO. The same multipliers were used for young and elderly subjects. RMR was measured by indirect calorimetry after an overnight fast. PAL of the subjects was calculated as total energy expenditure divided by RMR. RESULTS: Young adults did more occupational work and performed more sports than elderly subjects. In contrast elderly women did more housework in comparison to young women, and elderly men walked more than young men. Both elderly women and men did more gardening than young women and men. In elderly women, PAL was significantly higher in comparison to young women, whereas PAL of young and elderly men did not differ significantly. CONCLUSION: The results indicate that despite different activity patterns, the young-old do not necessarily show a lower PAL than young subjects.

Are the equations published in literature for predicting resting metabolic rate accurate for use in the elderly?

PURPOSE: Equations published in literature for predicting resting metabolic rate (RMR) in older individuals were derived from studies with small samples of this age group or extrapolated from data of younger adults. The aim of the present investigation was therefore to validate various predictive equations by comparing calculated RMR with measured RMR in a large group of elderly subjects. SUBJECTS AND METHODS: RMR was measured by indirect calorimetry after an overnight fast in 225 female (age 67.7 +/- 5.7 y, BMI 26.7 +/- 3.9 kg/m2) and 130 male (age 67.4 +/- 5.4 y, BMI 26.7 +/- 3.2 kg/m2) participants of the longitudinal study on nutrition and health status in an aging population of Giessen, Germany, who were at least 60 years old. RESULTS: In females and males RMR was on average underestimated by 3.3% and 7.5% with the Schofield equation based on body weight, by 2.4% and 4.5% with the Schofield equation based on both weight and height, by 0.7% and 5.0% with the WHO equation based on body weight, and by 2.6% and 4.6% with the Harris-Benedict equation, respectively. RMR calculated with the WHO equation based on body weight and height was 1.8% higher in females and 3.9% lower in males compared to measured RMR. Regarding all predictive equations the difference between predicted and measured RMR were negatively correlated with measured RMR and were partly more pronounced in smokers and obese subjects than in non-smokers and subjects with a BMI < 30 kg/m2. CONCLUSION: At the group level all predictive equations used provide a valid estimation of RMR. However, on an individual basis estimation errors may be high. Thus in individuals RMR should be measured instead of being estimated. If measurements cannot be taken, population specific equations should be used for predicting RMR.

Cloning of a novel orphan G protein-coupled receptor (GPCR-2037): in situ hybridization reveals high mRNA expression in rat brain restricted to neurons of the habenular complex.

The family of G protein-coupled receptors (GPCRs) is one of the largest protein families in the mammalian genome. Receptors belonging to this class mediate the effects of very diverse ligands and are responsible for signaling events by affecting the activities of enzymes and ion channels. Here we describe the cloning and identification of GPCR-2037, a novel and previously not identified member of the large family of GPCRs. This orphan GPCR displays several typical features of family A type of GPCRs and shows highest homology with the galanin receptors 2 and 3. In rat brain, in situ hybridization showed that expression of GPCR-2037 mRNA was exclusively localized to neurons of the habenular complex. The expression was particularly prominent in the medial habenular nucleus, whereas the lateral habenular nucleus exhibited a lower number of labeled cells. The restricted and unique expression pattern of GPCR-2037 in the rat brain suggests a role for this orphan GPCR in the habenular complex, a brain structure implicated in the modulation of various physiological functions. Further studies involving the identification of the GPCR ligand will enable the functional characterization of this orphan receptor and its role in regulating the habenular complex.

Underreporting of energy intake in an elderly German population.

OBJECTIVES: Within the longitudinal study on nutrition and health status in an aging population in Giessen, Germany (GISELA), the underreporters of energy intake (EI) were identified and characterized. METHODS: EI was assessed in 238 female and 105 male participants of the GISELA study (age range = 60-89 y) by means of a 3-day estimated dietary record developed especially for this study. Resting metabolic rate (RMR) was measured by indirect calorimetry after an overnight fast. EI was expressed as a multiple of RMR and subjects with an EI:RMR ratio below 1.073 were classified as underreporters. RESULTS: Mean EI:RMR was 1.62 +/- 0.46 in females and 1.53 +/- 0.46 in males; 7.6% of the females and 16.2% of the males were identified as underreporters. They showed lower levels of education and significantly greater body weight, body mass index, and fat mass than the adequate reporters. Further, underreporters stated more often than adequate reporters that they want to lose weight. Except for beta-carotene in males, reported nutrient intakes were significantly lower in underreporters than in adequate reporters. Carbohydrate and fat intake in both sexes, protein intake in females calculated as a percentage of EI, and vitamin and mineral densities were not affected by underreporting. CONCLUSIONS: The results indicate that underreporting of EI is related to a low educational level and greater body weight, body mass index, and fat mass and affects all nutrients. These findings should be considered when the association between nutrition and health status is investigated in the elderly.

Effects of fat mass and body fat distribution on resting metabolic rate in the elderly.

The aim of the present study was to investigate the relationship between resting metabolic rate (RMR) and fat-free mass, fat mass, and body fat distribution in 164 women (age 60 to 85 years; body mass index [BMI], 18.5 to 35.6 kg/m(2)) and 98 men (age 60 to 85 years; BMI, 18.3 to 36.5 kg/m(2)). After an overnight fast, RMR was assessed by indirect calorimetry and body composition by bioelectrical impedance analysis. Waist-to-hip ratio (WHR) was used to determine fat distribution. Results from linear regression analysis showed that most of the variance in RMR could be attributed to fat-free mass in women (R(2) = 0.54) and men (R(2) = 0.44), respectively. Fat mass explained an additional 3% and 2% of the variability in RMR in women and men, respectively. In stepwise multiple regression analysis, considering body composition and fat distribution, only fat-free mass and WHR were significant predictors of RMR in both sexes. In addition to fat-free mass, in women 6% and in men 8% of the variability in RMR was attributable to WHR. Grouping subjects according to their WHR, RMR, and RMR adjusted for fat-free mass and fat mass showed a significant increase with increasing WHR in both sexes. Results indicate that RMR not only depends on fat-free mass but also is influenced by fat mass, especially by fat distribution. These findings support our hypothesis of an elevated RMR with increasing abdominal body fat as a direct consequence of its greater metabolic activity.

Knowledge-based and data-driven models in arrhythmia fuzzy classification.

OBJECTIVES: Fuzzy rules automatically derived from a set of training examples quite often produce better classification results than fuzzy rules translated from medical knowledge. This study aims to investigate the difference in domain representation between a knowledge-based and a data-driven fuzzy system applied to an electrocardiography classification problem. METHODS: For a three-class electrocardiographic arrhythmia classification task a set of fifteen fuzzy rules is derived from medical expertise on the basis of twelve electrocardiographic measures. A second set of fuzzy rules is automatically constructed on thirty-nine MIT-BIH database's records. The performances of the two classifiers on thirteen different records are comparable and up to a certain extent complementary. The two fuzzy models are then analyzed, by using the concept of information gain to estimate the impact of each ECG measure on each fuzzy decision process. RESULTS: Both systems rely on the beat prematurity degree and the QRS complex width and neglect the P wave existence and the ST segment features. The PR interval is not well characterized across the fuzzy medical rules while it plays an important role in the data-driven fuzzy system. The T wave area shows a higher information gain in the knowledge based decision process, and is not very much exploited by the data-driven system. CONCLUSIONS: The main difference between a human designed and a data driven ECG arrhythmia classifier is found about the PR interval and the T wave.