[Effectively Preventing Eating Disorders with the School-Based Programs "PriMa" and "Torera" for Adolescents in the 6th and 7th Grades]. / Essstörungen wirksam vorbeugen mit den Schulprogrammen "PriMa" und "Torera" für Jugendliche in Klasse 6 und 7.

The aim of this study was to assess the effects of 2 German school-based primary prevention programmes for (pre)adolescents, aged 11-13 years, with 9 manual-guided lessons. 92 (PriMa, n=1,553 girls) and 22 (Torera, n=256 boys, 277 girls) Thuringian secondary schools participated in controlled trials with pre-post assessment. Girls and students at risk showed significant improvements of conspicuous eating behaviour and body self-esteem with small to medium effect sizes. Implementation costs were € 2.50 per student.

Effectiveness of reducing the risk of eating-related problems using the German school-based intervention program, "Torera", for preadolescent boys and girls.

Representative surveys indicate that eating disorders are an increasing problem, especially among (pre)adolescents. We assessed the effects of a German school-based primary prevention program ("Torera") for seventh graders. Torera especially relates to pathological eating behavior in the realm of bulimia nervosa or binge eating disorder. The program is built upon two previously evaluated modules for sixth graders with a gender-specific adaption. The coeducational intervention involves nine manual-guided lessons touching a wide range of eating-related problems. Twenty-two Thuringian secondary schools (n = 256 boys and 277 girls, aged 11-13 years at baseline) participated in a trial with 2 control groups (untreated and pretreated) with pre-post assessment. Primary outcomes were conspicuous eating behavior and body self-esteem, measured by standardized questionnaires (SCOFF, EAT-26D, and FBeK). Girls and students at risk showed significant improvement with small (d = 0.35) to medium (d = 0.66) effect sizes on eating behavior, significantly mediated by body self-esteem. Boys only improved with respect to eating attitudes, revealing a small effect size (d = 0.35). With relatively low implementation costs (about 2.50 per student), Torera provides an efficient model for reducing risky eating behavior and strengthening body self-esteem without negative side effects. To improve the effectiveness of the intervention, further research efforts focusing on at-risk groups (secondary prevention) and structural actions for prevention (e.g., offering healthy school catering) are needed.

[Effectiveness of the school-based prevention program TOPP on factors influencing adiposity in Thuringian schools]. / Evaluation der Wirkung des schulbasierten Präventionsprogramms TOPP "Teenager ohne pfundige Probleme" auf adipositasrelevante Faktoren an Thüringer Schulen.

The onset of puberty is considered a critical period for the development of overweight and obesity. For prevention purposes, we developed the school-based intervention program TOPP (Teenage Obesity Prevention Program), especially for boys. In order to test the effectiveness, we conducted a controlled study using a pre-post design. A total of 84 schools in Thuringian, Germany, with 1,199 boys participated in the study. Program effectiveness was analyzed with mostly standardized questionnaires referring to body-related self esteem, eating behavior, physical activity, teasing, and knowledge. The program was performed during the course of a school project within at least 3 weeks or during the regular school lessons for more than 6 weeks. After 9×90-minute, manual-based lessons, including interactive exercises and poster-based group discussions, significant improvement was only reached for nutritional knowledge. As a main outcome, it could be demonstrated how an area-wide prevention program with low costs could be successfully implemented. The school environment enables us to create a universal, socially equitable, and low-threshold access.

[Self-assessment of BMI data : verification of the practicability of a correction formula on a sample of 11- to 13-year-old girls]. / BMI-Selbstauskünfte : Überprüfung der Praktikabilität einer Korrekturformel an einer Stichprobe elf- bis 13-jähriger Mädchen.

The decision to measure or to ask about data concerning height and weight in order to calculate body mass index (BMI) has an influence on the economy and validity of the measurements. Although self-reported information is less expensive, this information may possibly have a bias on the determined prevalences of different weight groups. Using representative data from the KiGGS study with a comparison of directly measured and self-reported BMI data, Kurth and Ellert (2010) developed two correction formulas for prevalences resulting from self-reported information. The aim of the study was to examine the practicability of the proposed correction formulas on our own data concerning self-reported BMI data of 11- to 13-year-old girls (n=1,271) and to assess the plausibility of the corrected measurements. As a result, the prevalences of our own data changed in the expected direction both for underweight and for overweight. Both formulas were found to be practicable, the consideration of the subjective weight status (formula 2) resulted in a greater change in prevalences compared to the first correction formula.

Dieting and disordered eating in German high school athletes and non-athletes.

The purpose of this study was to examine weight concerns, dieting, body dissatisfaction as well as eating behavior of German high school athletes and to compare disordered eating behavior of these athletes with regular high school students. Five hundred and seventy-six young athletes of Elite Sports Schools in the German state of Thuringia and a reference group consisting of 291 non-athletes from regular high schools completed a questionnaire regarding eating behavior and attitudes, dietary history, body image and demographics. The Eating Attitude Test was used to measure disordered eating. Athletes did not show a higher frequency of disordered eating than non-athletes. A binary logistic regression analysis revealed that gender and dietary experience, but not group (athletes vs non-athletes), were significant predictors of disordered eating. It can be concluded that dietary experience and female gender proved to be important risk factors of disordered eating. Participation in sports seems to be protective for developing serious eating problems, especially in girls. Potentially, regular monitoring of athletic performance by coaches might be a reason for this finding.

Effective partnering of academic and physician scientists with the pharmaceutical drug development industry.

This manuscript briefly addresses the drug discovery and development process. It is a long road from the formulation of a good discovery idea to the acceptance of a new drug in the marketplace, and there are many challenges faced along the way to the patient. Collaborations and partnerships are an important part of this process. There are a variety of partnering opportunities, ranging from the discovery of novel technologies and drug targets to lead discovery, compound gifts, and external sourcing. These partnerships help increase confidence and improve decision making on issues of safety and efficacy preclinically, which can reduce attrition and expedite the provision of new quality drugs to patients more quickly and at lower costs. Collaborations involve addressing multiple issues that include infrastructure, safety, regulatory matters, intellectual property, technical and personnel considerations, source document capture and data analysis issues, and legal and strategic alliances. A number of success factors are identified as important for quality collaborations in the drug development process.

Endogenous substrates for cyclic AMP-dependent and calcium-dependent protein phosphorylation in rabbit peritoneal neutrophils.

As in other cells, cAMP-dependent (protein kinase A) and calcium-dependent protein kinases are present in the rabbit peritoneal neutrophil. The major substrates for protein kinase A in the cytosol of rabbit peritoneal neutrophil is a 43 kDa protein which appears to be actin (pI 5.7). The other substrates for protein kinase A in the cytosol are very acidic proteins with molecular weights of 135000 (pI 4.6) and 130 000 (pI 4.8). Two classes of calcium-dependent protein kinases are present in the rabbit peritoneal neutrophil: one is calcium, calmodulin-dependent, the other is calcium, phosphatidylserine-dependent. Phosphatidylserine appears to be much more effective than calmodulin in stimulating calcium-dependent protein kinase activity. The phospholipid-sensitive, calcium-dependent protein kinase (protein kinase C), present only in the cytosol fraction, exhibits much higher activity than the cAMP-dependent protein kinase from the same source. At least four substrates (Mr 130 000 (pI 4.6) 43 000 (pI 4.8), 41 000 (pI 6.3) and 34 000) of the protein kinase C in the cytosol were identified. Trifluoperazine, a compound which inhibits the degranulation, aggregation and stimulated oxygen consumption of rabbit peritoneal neutrophils. (Alobaidi, T., Naccache, P.H. and Sha'afi, R.I. (1981) Biochim. Biophys. Acta 675, 316-321), also inhibits the activity of protein kinase C. The possible role of cAMP-dependent and calcium-dependent phosphorylation system in neutrophil function is discussed.

The photoaffinity probe 8-N3[alpha-32P]ATP labels the ATP-binding sites of rabbit neutrophil and skeletal muscle actin.

8-Azido-[alpha-32P]ATP (8-N3-ATP) was used as a photoaffinity label for ATP binding sites in the subcellular fractions of rabbit peritoneal neutrophils. The radioactive 8-N3-ATP was specifically incorporated into one major protein of 43 kDa. The isoelectric point, molecular mass and subcellular distribution of this labeled protein closely resemble those of the actin. 8-N3-[alpha-32P]ATP was further tested as a photoaffinity label for the ATP binding site in the purified rabbit skeletal muscle G-actin. The radioactive 8-N3-ATP was specifically incorporated into the actin band in SDS-polyacrylamide gel. The results indicate that 8-N3-ATP can be used as a photoaffinity label for actin.

Effect of deoxycoformycin and Val-boroPro on the associated catalytic activities of lymphocyte CD26 and ecto-adenosine deaminase.

CD26 and ecto-adenosine deaminase (ADA) are found associated on the plasma membrane of T lymphocytes and each possess distinct catalytic activities. CD26 has a proteolytic activity identical to dipeptidylpeptidase IV (DPPIV; E.C. 3.4.14.5), and ecto-ADA (E.C. 3.5.4.4) degrades extracellular adenosine. The cell surface expression of CD26 and ecto-adenosine deaminase (ecto-ADA) is regulated on stimulated T lymphocytes, and ADA binding to CD26 produces a synergistic costimulatory response with T cell receptor activation. This study addresses the potential regulation by allosteric interactions of the catalytic activities of CD26 associated with ecto-ADA, which could define the mechanism of the synergism observed in T cell signaling. Cell lines genetically deficient in ADA, ligands for ADA such as adenosine, and a specific inhibitor of ADA, deoxycoformycin, were used to define the effect of ADA activity on CD26 DPPIV activity and affinity for dipeptide substrate. Conversely, a recombinant Chinese hamster ovary cell line expressing human CD26 with or without a mutation in the DPPIV catalytic domain, and the boronic acid inhibitor Val-boroPro, were used to determine the effect of DPPIV activity on ecto-ADA activity and association with CD26. These studies found no significant allosteric interaction between the catalytic activities of CD26 and ecto-ADA when associated. Therefore, signaling events in T cells involving costimulation with CD26 and ecto-ADA and the synergism observed upon ADA binding to CD26 occur independently of the catalytic activities of these cell surface molecules.

Influence of PEEP ventilation immediately after cardiopulmonary bypass on right ventricular function.

Ventilation with positive end-expiratory pressure (PEEP) is often the appropriate therapy for treating patients with impaired pulmonary function after cardiac surgery procedures. Circulatory depression, however, sometimes limits the level of PEEP. This study was conducted to investigate the effects of PEEP ventilation (+15 cmH2O) immediately after weaning from cardiopulmonary bypass 1) period of PEEP application and 45 min thereafter; 2) period of PEEP application on right ventricular hemodynamics using a new thermodilution technique for measuring right ventricular ejection fraction (RVEF), right ventricular end-diastolic and end-systolic volumes (RVEDV, RVESV). Forty patients undergoing aortocoronary bypass grafting were retrospectively divided into two groups: group 1 (n = 24) in which RVEF was reduced significantly (40----28 percent), and group 2 (n = 16) in which RVEF remained almost unchanged. In patients in group 1, stenosis of the right coronary artery (RCA) was significantly more pronounced in comparison to the others and was detected to be responsible for the different reaction of RVEF (analysis of co-variance). Application of PEEP immediately after weaning from CPB was followed by an increase in RVESV (+4 percent; RVEDV -1 percent) in group 1, whereas patients of group 2 differed significantly (RVESV -14 percent; RVEDV -15 percent). Cardiac index was decreased only in group 1 (-32 percent). During the second period of PEEP application, no further difference could be observed between the groups. We conclude that hemodynamic changes related to PEEP ventilation are minimal in the intact right ventricle. Abnormalities in right ventricular function due to stenosis of the RCA, however, have had marked clinical influence on the circulatory response. Monitoring of right ventricular function seems to be of benefit for cardiac surgery patients in this situation.

Age and cardiac surgery. Influence on extravascular lung water.

This study was designed in order to evaluate the influence of advanced age on extravascular lung water (EVLW) content. Forty patients undergoing aortocoronary bypass grafting were prospectively divided into two groups according to age below 45 years (group 1; n = 20) and above 65 years (group 2; n = 20). The EVLW was measured using the double indicator dilution technique with indocyanine green as the nondiffusible indicator. Starting from similar baseline values before extracorporeal circulation (ECC), EVLW significantly increased after ECC only in the elderly patients (max + 1.51 ml/kg), whereas lung water content in the other group remained almost unchanged. No significant differences in left ventricular filling pressure (PCP) could be observed. Regression analysis revealed a strong positive correlation between age and increase in EVLW after ECC. Simultaneously, PaO2 was decreased (-114 mm Hg) and intrapulmonary shunt fraction (Qs/Qt) was increased only in this group. Within the next five hours after ECC, lung water returned nearly to baseline values and pulmonary function was normalized. It is concluded that increasing age was associated with a transient increase in EVLW after ECC due to a more pronounced fragility of the pulmonary endothelial membrane or/and to depressed left ventricular performance.

New membrane oxygenator (LPM 50): influence on extravascular lung water and pulmonary function in comparison to bubble oxygenator.

A prospective, randomized, clinical study involving 30 patients undergoing aorta-coronary bypass grafting was designed to compare the influence of a new membrane oxygenator and a commonly used bubble oxygenator on extravascular lung water and pulmonary function after extracorporeal circulation. Although membrane oxygenators might have some advantages from the biochemical and biophysical points of view, in this clinical study no differences in lung water accumulation and pulmonary gas exchange could be detected between bubble and membrane oxygenators after extracorporeal circulation.

Blood conservation in cardiac operations. Cell separation versus hemofiltration.

The effects of hemoconcentration performed during and after extracorporeal circulation by either centrifugation (cell separation group, n = 20) or hemofiltration (n = 20) were investigated in 40 patients undergoing elective aorta-coronary bypass grafting. Interest was focused on the quality of the blood concentrated from the blood remaining in the extracorporeal circuit and on the reaction of the patients after retransfusion of the concentrated products. Hemofiltration was easy to perform and produced whole blood quicker than the cell separation technique. Coagulation studies revealed no significant differences in heparin concentration, levels of fibrinogen and antithrombin III, or platelet counts. Various coagulation parameters tended to normalize completely and more quickly after hemofiltration than after centrifugation. None of the patients had severe bleeding postoperatively. Free hemoglobin levels were not affected by hemofiltration; elastase concentration was higher only immediately after retransfusion of the concentrated blood, with no effect on organ function. We conclude that both methods were effective means of hemoconcentration during extracorporeal circulation and in salvaging the diluted pump blood after extracorporeal circulation. Loss of plasma fraction is an important disadvantage in the centrifugation technique, which can be avoided by hemofiltration; derangement in colloid osmotic pressure and coagulation parameters was less pronounced after hemofiltration. Costs were lower, as well. Therefore, when a high volume of cardioplegic solution and two-stage cannulation are used, hemofiltration seems to be the method of choice for blood conservation during cardiac operations.

Influence of nimodipine and nifedipine on intrapulmonary shunting--a comparison to other vasoactive drugs.

This study was assigned to investigate the influence of calcium channel blockers (nimodipine and nifedipine) in comparison to other vasoactive drugs (nitroglycerin, dopamine) on pulmonary shunting (Qs/Qt). Fifty anesthetised patients scheduled for aortocoronary bypass operation were randomly allocated to 5 groups receiving one of the following drugs: nimodipine 1.0 microgram X kg-1 X min-1; nifedipine 0.7 microgram X kg-1 X min-1; nitroglycerin (TNG) 0.5 microgram X kg-1 X min-1; dopamine; micrograms X kg-1 X min-1; placebo (0.9% NaCl). Nimodipine as well as nifedipine led to a significant increase in cardiac output (+44%; +39%), pulmonary vascular resistance simultaneously decreased (-25%; -28%). PaO2 increased significantly (+16%; +13%), too, whereas Qs/Qt remained almost unchanged. In contrast, the increase in cardiac output induced by dopamine (+27%) was accompanied by a significant increase in shunting (+34%). TNG application did not alter Qs/Qt, but pulmonary artery pressure (PAP) decreased markedly (-19%).

Influence of cardiac output on thermal-dye extravascular lung water (EVLW) in cardiac patients.

The influence of varying cardiac output (CO) on thermal-dye extravascular lung water (EVLW) was investigated in a total of 40 cardiac surgery patients before the onset of the operation. EVLW was measured by means of the double indicator dilution technique with indocyanine green as the non-diffusible indicator and a microprocessed lung water computer 15 min and 30 min after change of CO. CO was varied from -45% to +70% of the baseline value by nifedipine infusion (CO increases, n = 20) or halothane application (CO decreases, n = 20), respectively. CO was measured from the femoral artery instream thermistor tipped lung water catheter and, simultaneously, from the pulmonary artery. In spite of a highly significant decrease (-45%) and increase (+70%) in CO no change in EVLW could be observed. CO estimation was comparable for both methods used. Regression analysis revealed no relationship between CO and EVLW as well as between EVLW and various hemodynamic parameters. We conclude that thermal-dye technique for estimation of EVLW may be accurate in spite of changing cardiac output over a wide range.

Enhancement of myocardial energy potentials in man by glucose-insulin treatment before and after ischaemic heart arrest.

Thirty-six patients undergoing aortic valve replacement were investigated to ascertain whether the addition of glucose-insulin before and after ischaemic heart arrest could aid to the functional recovery of hearts following global ischaemia. One group of patients (n = 14) received glucose plus insulin from the onset of anaesthesia until crossclamping of the aorta (1 g + 1.5 U/kg bw X h). A second dose (0.5 g + 1.0 U/kg bw) was given at the end of ischaemia. 22 patients, serving as control received glucose in the same manner but without insulin. Needle biopsies from the left ventricular apex region were obtained: before starting cardiopulmonary bypass; at the end of ischaemia; and after 10 minutes of reperfusion and analyzed for its content of ATP, CP ADP and lactate. In both groups ATP and CP were significantly decreased after ischaemia and increased after reperfusion. ADP and lactate levels were elevated after ischaemia and decreased after reperfusion in the insulin-group but not in the control-group. During the total investigation period ATP- and CP-concentrations in the insulin-group were higher compared to the control-group, whereas ADP and lactate of the control-group were above the insulin-group.