Exercise prescription for the overweight and the obese: how to quantify and yet keep it simple.

An activity point system (APS) is presented that assists healthcare providers and health professionals with a way to prescribe exercise in a semiquantitative manner and to motivate their patients to begin an exercise programme. Activity points are specific to one's body weight, body mass index and activity intensity for 10-minute bouts of activity performed. With a goal of accumulating 100-300 activity points per week, the APS provides a simple yet quantitatively accurate way to prescribe exercise for overweight and obese adults.

Comparison of intra-arterial thrombolysis with conventional treatment in patients with acute central retinal artery occlusion.

BACKGROUND: Several case series and a recent meta-analysis indicate that intra-arterial thrombolysis (IAT) is effective for the treatment of acute central retinal artery occlusion (CRAO). METHODS: A total of 37 patients with acute monocular blindness because of unilateral thromboembolic CRAO were treated with IAT using urokinase within six hours of the onset of symptoms. Visual outcome was compared with a control group of 19 patients, also seen within six hours, who did not undergo thrombolytic treatment. In both groups some patients were treated by paracentesis and/or acetazolamide. Predictors of visual outcome were evaluated. RESULTS: Visual improvement was more likely with IAT (p = 0.01) as were the chances to regain visual acuity of >0.6 significantly better (p = 0.04): 8/37 patients (22%) regained visual acuity of >0.6 in the IAT group and none (0/19) in the control group. Younger patients were more likely to regain some vision with (p = 0.012) or without IAT (p = 0.026). Three patients had minor treatment related cerebral ischaemic events, two had transient ischaemic attacks and one a minor stroke. There were no haemorrhagic complications. CONCLUSIONS: This series of patients with CRAO demonstrated that IAT enhanced the chances of visual improvement compared with conventional treatment only. Furthermore, younger patients have a better chance to achieve some visual recovery.

Selective intra-arterial fibrinolysis of acute central retinal artery occlusion.

BACKGROUND AND PURPOSE: Occlusion of the central retinal artery (CRAO) causes a sudden decrease of monocular vision. Because early restoration of blood flow may improve outcome, we attempted to treat CRAO with selective intra-arterial fibrinolysis. METHODS: Intra-arterial fibrinolysis was performed within 6 hours after symptom onset in 17 patients with thromboembolic CRAO. Symptoms were painless, acute and severe decrease of vision. Urokinase (100 000 to 900 000 IU) was given through a microcatheter into the ophthalmic artery over 10 to 90 minutes. For comparison, the history and visual outcome of 15 control patients who did not receive fibrinolytics were evaluated. In both groups some of the patients underwent paracentesis and/or received carboanhydrase inhibitors. RESULTS: Patients who underwent fibrinolysis fared better than control patients (P=0.01). Three patients (17.6%) recovered completely after fibrinolysis and regained visual acuity of 20/20 (n=2) to 25/20 (n=1). Two additional patients (11.8%) showed a marked improvement to a visual acuity of 20/30. In 6 patients (35. 3%) vision improved slightly. They were able to count fingers, detect hand movements, or perceive light. In 6 patients (35.3%), fibrinolytic treatment was without effect. Among control patients, 1 patient (6.7%) showed partial, 4 patients (26.7%) minimal, and 10 (66.7%) no improvement of vision. CONCLUSIONS: A complete or marked improvement of visual acuity was achieved in one third of intra-arterial fibrinolysis patients but in none of the control patients. Intra-arterial fibrinolysis seems to have the potential to "lighten" the spontaneously poor outcome of CRAO.

Ethics in reproductive medicine in the German Democratic Republic.

The paper discusses the practice of genetic counseling and elective abortion in the German Democratic Republic.

Policy positions on in vitro fertilization and embryo transfer in human individuals (German Democratic Republic, 1985).

Recommendations have been formulated in 1985 with reference to socialist morality and law and as a result of interdisciplinary discussion by the IAME (Interdisciplinary Working Party on Medical Ethics at the GDR Academy of Postgraduate Medical Education) for clinical application of in vitro fertilization and for the use of human oocytes and early embryonic stages.

Inhibition of homotypic aggregation of a human Burkitt-lymphoma cell line.

The molecules involved in homotypic aggregation of the human Burkitt-lymphoma cell line Raji were investigated by inhibition of reaggregation with carbohydrates and glycoconjugates, by inhibition of glycosylation, and enzyme treatment of the cell surface. Complete inhibition of reaggregation was achieved with bovine submaxillary mucin. Asialomucin, on the other hand, was not effective in this assay. Another potent inhibitor of reaggregation was the ganglioside GMI. The common carbohydrate structure of these molecules is NeuNAc-(gal)-galNAc. Lactosamine, fucosyllactosamine, sialyllactosamine, complex mannose type, or Thomsen-Friedenreich antigen sequences are not involved in aggregation. Neuraminidase and chloroquine also abolished agglutination of cells. The finding that mucin, but not asialomucin, inhibits the reaction, demonstrates the importance of sialic acid in this process. Homotypic aggregation was shown to be resistant to trypsin. Using the glycosylation inhibitor tunicamycin we show that N-glycosidically linked carbohydrate chains are involved in aggregation. Swainsonine or castanospermine, which inhibit processing of terminal sialyllactosamines to the mannose core, did not interfere with the reaction supporting the results of the inhibition assay. The data presented suggest the involvement of 2 molecules in homotypic aggregation of human Burkitt-lymphoma cells. One component is a lectin-like molecule containing N-linked carbohydrate chains. The other component carries the neuraminidase-sensitive and trypsin-resistant determinant NeuNAc-(gal)-galNAc and, therefore, appears to be a glycolipid. This proposed lectin-carbohydrate interaction in homotypic aggregation is further supported by the frequently observed dependence of lectins on divalent cations as indicated by inhibition of aggregation with EDTA and EGTA.

Characterization of Thomsen-Friedenreich antibody subpopulations from normal human serum.

Thomsen-Friedenreich (TF) antibodies were prepared from human serum by different enrichment procedures. This resulted in three antibody preparations all of which agglutinated neuraminidase-treated erythrocytes. On the other hand, each of the three antibody populations showed a distinct specificity pattern. Anti-TF1 antibodies could be inhibited in the hemagglutination inhibition assay by asialofetuin, asialotransferrin, asialoglycophorin and asialomucin. The sialylated form of these glycoproteins showed no inhibition. No significant inhibition could be achieved with several mono- or disaccharides. This suggests that anti-TF1 recognizes common structures on glycoproteins normally hidden by sialic acid. Anti-TF2 antibodies showed specificity for asialofetuin, bovine submaxillary mucin, asialomucin, asialoglycophorin, the disaccharide gal-beta (1-3)N-acetyl-galactosamine (galNAc) and nitrophenyl-beta-galactoside. Because asialotransferrin or unbound lactosamine were not inhibitory, we suppose that the residual common structure of the inhibitors is (gal)-galNAc-O-Ser/Thr, which is present in high amounts in submaxillary mucin. Anti-TF3 antibodies were inhibited by asialoglycophorin but not by asialomucin or asialofetuin. Strong saccharide inhibitors were gal-beta (1-3)galNAc, nitrophenyl-beta-galactoside, as well as galactose. Therefore, both of the antibody preparations, anti-TF2 and anti-TF3, could be inhibited by gal-beta-(1-3)galNAc, but showed preference to one or the other sugar component of the disaccharide resulting in a differential recognition of glycoconjugate inhibitors. Anti-TF2 and anti-TF3 seem to recognize the carbohydrates in the context of a protein backbone, because gal-beta-(1-3)galNAc in connection with a ceramide backbone (GM1) was not inhibitory. When tested on three human breast cancer cell lines, only anti-TF2 recognized epitopes exposed on the cell surface. We, therefore, conclude that human serum contains at least three subpopulations of TF antibodies with distinct specificities. Only anti-TF2 can detect cryptic erythrocyte epitopes which are also exposed on human breast cancer cell lines.

Specificity of reagents directed to the Thomsen-Friedenreich antigen and their capacity to bind to the surface of human carcinoma cell lines.

The Thomsen-Friedenreich antigen (T-antigen) is a cryptic disaccharide structure on human erythrocytes and is supposed to be expressed in an unhidden form on carcinoma cells. We tested the ability of four anti-T reagents (i.e., peanut agglutinin, human and rabbit anti-T antisera, and monoclonal anti-T antibodies) to agglutinate neuraminidase treated human erythrocytes and compared their capacity to bind to the surface of human carcinoma cell lines or neuraminidase treated lymphocytes. We found that all of the reagents strongly agglutinated neuraminidase treated erythrocytes. In contrast, only peanut agglutinin and the monoclonal antibody bound to the surface of carcinoma cell lines and to neuraminidase treated lymphocytes. Peanut agglutinin was inhibited by D-galactose and is known to be specific for the T-disaccharide. The determinants on erythrocytes, lymphocytes, and carcinoma cells, recognized by peanut agglutinin, are resistant to trypsin treatment. The monoclonal antibody was specifically inhibited by phenyl-beta-D-galactoside. The binding sites on erythrocytes and lymphocytes for the monoclonal antibody can be removed by treatment with trypsin or Pronase. On the other hand, the binding sites on carcinoma cells are resistant to trypsin but can be removed with Pronase. In contrast to the peanut agglutinin binding sites on carcinoma cells the structures recognized by the monoclonal antibody cannot be further increased by neuraminidase treatment. Human and rabbit anti-T antisera did not bind to tumor cell surface or to neuraminidase treated lymphocytes. Hemagglutination of human anti-T could be inhibited by asialofetuin; the specificity of rabbit anti-T could not be established in this study. Hemagglutination with both antisera is resistant to trypsin but partially sensitive to Pronase treatment. These results indicate that each of the reagents has a distinct specificity and recognizes different antigenic determinants on different molecules. Only peanut agglutinin and monoclonal anti-T antibodies are able to detect common structures on the surface of neuraminidase treated erythrocytes and carcinoma cell lines.

Diabetic retinopathy study. Data acquisition and its reliability.

The documentation of ophthalmologic data of patients with diabetic retinopathy (DR) is described. Special attention has been paid to the standardized grading of opacities of the dioptric media as well as to the assessment of classified arteriolar abnormalities. The reproducibility of these judgments was determined by a double evaluation test. The reliability of the assessment of classified retinal lesions on panorama fundus photographs was reported elsewhere. A further section of the questionnaire that concerns the documentation of the patient's history, of general medical and laboratory findings, and of reasons why individual patients "drop out" from the study, is described in this contribution.

Diabetic retinopathy study. Assessment and comparison of retinal lesions for computer analysis.

A method of documentation of a diabetic retinopathy (dR) is described. Panorama fundus photographs (PPhs) of each eye are taken every 3-6 months. The retinopathy is classified according to qualitative, quantitative, and topographic criteria. The retinal lesions are assessed according to a subjective grading scale. Data of direct readings and of comparisons between two PPhs of one eye are transferred to punch cards for storage and computer processing. In a double evaluation of 200 PPhs, the overall reliability of readings was found to be approximately 95%.

Diabetic retinopathy study. Preliminary results from 215 patients treated uniocularly with photocoagulation.

Preliminary results of a controlled study on diabetic retinopathy are reported. Two hundred and fifteen patients with proliferative (PDR) and nonproliferative (NPDR) retinopathy were uniocularly treated by Xenon photocoagulation and followed for a minimum of 6 months--6 years. Intra- and epiretinal new vessel formations (RNF) decreased in treated but increased in untreated eyes at a high statistical significance. A transition of background retinopathy into the proliferative stage was significantly retarded after photocoagulation. An improvement of new vessel formations on the disc (DNF) was not evident after 3 years of follow-up. The progression of preretinal neovascularization (PRNF) was significantly reduced only for 1--2 years after treatment. The incidence of massive vitreous hemorrhages, however, which showed the highest quotient of contingency with PRNF was much lower in treated eyes also after 3 years. The difference was significant only in extensively photocoagulated eyes with more than 100 lesions on average. The effect of photocoagulation on diabetic maculopathy with preservation of a useful visual acuity was highly significant only in diabetics under 60 years of age, the effect increasing with time as the control eyes fared worse. By contrast, in patients over 60 years of age, the course of maculpathy was not influenced, and a linear decrease of visual acuity occurred in both treated and untreated eyes.