[Physical medicine in hospital. Minimum standards in a physical medical department in acute inpatient areas in rheumatology]. / Physikalische Medizin im Krankenhaus. Minimalstandards in einer physikalisch medizinischen Abteilung im akutstationären Bereich in der Rheumatologie.

Standards for what should be available in terms of equipment and services in a department of physical medicine caring for acute inpatients do not exist in Germany. The profile of a department determines the therapeutic services it focuses on and hence the technical facilities required. The German catalogue of operations and procedures defines minimum thresholds for treatment. In the opinion of the authors a department caring for inpatients with acute rheumatic diseases must, as a minimum, have the facilities and equipment necessary for offering thermotherapeutic treatment. Staff trained in physical therapeutic procedures and occupational therapy is also crucial. Moreover, it is desirable that the staff should be trained in manual therapy.

[Effect of clothing on sphygmomanometric and oscillometric blood pressure measurement in hypertensive subjects]. / Der Einfluss von Bekleidung auf die sphygmomanometrische und oszillometrische Blutdruckmessung bei Hypertonikern.

BACKGROUND AND OBJECTIVE: The few studies published on this subject have shown that blood pressure measurements give similar results whether the patients' arm is covered by clothing or not. But it has not been clarified whether this is also true in the case of hypertensive persons, Yet, in practice the correct measurement is of critical importance in the diagnosis of hypertension. METHODS: 203 hypertensive patients were examined with the auscultatory sphygmomanometry and the automatic oscillometry by measuring the pressure three times with each method. These tests were carried out in a randomized sequence on a covered arm (the patient's own clothing of maximally 2 mm thickness), the bare arm and the arm covered with a standardized cotton sleeve (2 mm). The auscultatory sphygmomanometry was done blinded (non-sleeved, sleeved, standardized). RESULTS: Calculation of confidence intervals for the mean differences of the three settings (bare, clothing and standard sleeve) and equivalence testing demonstrated that a garment or cloth on the arm under the manometer cuffs did not significantly effect the blood pressure within the predefined interval of equivalence of +/- 4 mm Hg. Thus, measuring blood pressure with the cuff over the person's sleeve does not significantly effect the result. CONCLUSION: This study shows that measuring blood pressure in hypertensive persons with or without a cloth sleeve (maximally 2 mm thick) does not result in any statistically significant difference. This simplifies the blood pressure measurement that have to be taken frequently on hypertensive persons.

CD8(+) lymphocytes from simian immunodeficiency virus-infected rhesus macaques recognize 14 different epitopes bound by the major histocompatibility complex class I molecule mamu-A*01: implications for vaccine design and testing.

It is becoming increasingly clear that any human immunodeficiency virus (HIV) vaccine should induce a strong CD8(+) response. Additional desirable elements are multispecificity and a focus on conserved epitopes. The use of multiple conserved epitopes arranged in an artificial gene (or EpiGene) is a potential means to achieve these goals. To test this concept in a relevant disease model we sought to identify multiple simian immunodeficiency virus (SIV)-derived CD8(+) epitopes bound by a single nonhuman primate major histocompatibility complex (MHC) class I molecule. We had previously identified the peptide binding motif of Mamu-A*01(2), a common rhesus macaque MHC class I molecule that presents the immunodominant SIV gag-derived cytotoxic T lymphocyte (CTL) epitope Gag_CM9 (CTPYDINQM). Herein, we scanned SIV proteins for the presence of Mamu-A*01 motifs. The binding capacity of 221 motif-positive peptides was determined using purified Mamu-A*01 molecules. Thirty-seven peptides bound with apparent K(d) values of 500 nM or lower, with 21 peptides binding better than the Gag_CM9 peptide. Peripheral blood mononuclear cells from SIV-infected Mamu-A*01(+) macaques recognized 14 of these peptides in ELISPOT, CTL, or tetramer analyses. This study reveals an unprecedented complexity and diversity of anti-SIV CTL responses. Furthermore, it represents an important step toward the design of a multiepitope vaccine for SIV and HIV.

Tat-specific cytotoxic T lymphocytes select for SIV escape variants during resolution of primary viraemia.

Human immunodeficiency virus (HIV) and simian immunodeficiency virus (SIV) infections are characterized by early peaks of viraemia that decline as strong cellular immune responses develop. Although it has been shown that virus-specific CD8-positive cytotoxic T lymphocytes (CTLs) exert selective pressure during HIV and SIV infection, the data have been controversial. Here we show that Tat-specific CD8-positive T-lymphocyte responses select for new viral escape variants during the acute phase of infection. We sequenced the entire virus immediately after the acute phase, and found that amino-acid replacements accumulated primarily in Tat CTL epitopes. This implies that Tat-specific CTLs may be significantly involved in controlling wild-type virus replication, and suggests that responses against viral proteins that are expressed early during the viral life cycle might be attractive targets for HIV vaccine development.