[Mobilization of obese patients : Increasing demands on personnel and equipment]. / Mobilisation des adipösen Patienten : Steigende Anforderungen an Personal und Ausstattung.

The number of overweight people in Germany is constantly increasing, thus, forcing nurses and therapists to adjust to new challenges in patient care. Therefore, it is necessary to redefine the methods and goals in treating obese people. Working in an interprofessional team, using state of the art techniques, seems to be of crucial importance in facing the complex treatment that is associated with these patients. The occupational safety and health of personnel is of utmost importance.In this article, the problems associated with patient care and consequences for medical staff are considered. Finally, possibilities to facilitate work in treating obese patients are discussed.

Urinary CD4 T cells identify SLE patients with proliferative lupus nephritis and can be used to monitor treatment response.

OBJECTIVES: Proliferative lupus nephritis (LN) is one of the major concerns in the treatment of systemic lupus erythematosus (SLE). Here we evaluate urinary CD4 T cells as a biomarker of active LN and indicator of treatment response. METHODS: Urinary CD3CD4 T cells were quantified using flow cytometry in 186 urine samples from 147 patients with SLE. Fourteen patients were monitored as follow-up. Thirty-one patients with other nephropathies and 20 healthy volunteers were included as controls. RESULTS: In SLE, urinary CD4 T cell counts ≥800/100 ml were observed exclusively in patients with active LN. Receiver operator characteristic analysis documented clear separation of SLE patients with active and non-active LN (area under the curve 0.9969). All patients with up-to-date kidney biopsy results showing proliferative LN had high urinary CD4 T cell numbers. In patients monitored under therapy, normalisation of urinary CD4 T cell counts indicated lower disease activity and better renal function. In contrast, patients with persistence of, or increase in, urinary T cells displayed worse outcomes. CONCLUSIONS: Urinary CD4 T cells are a highly sensitive and specific marker for detecting proliferative LN in patients with SLE. Furthermore, monitoring urinary CD4 T cells may help to identify treatment responders and treatment failure and enable patient-tailored therapy in the future.

Point-of-use water filtration reduces healthcare-associated infections in bone marrow transplant recipients.

Outbreaks of infection with gram-negative bacteria (GNB) have been linked to hospital water. We sought to determine whether point-of-use (POU) water filtration might result in decreased risk of infection in hospitalized bone marrow transplant (BMT) recipients in the absence of any recognized outbreak. Unfiltered water was sampled from taps in the BMT unit of a major US teaching hospital, and cultured at a reference laboratory. POU bacterial-retentive filters (0.2 mum) were installed throughout the unit, and replaced every 14 days. Infection rates were tracked over a 9-month period, and compared with rates for a 16-month period before POU filtration. Unfiltered water samples from 50% (2 of 4) outlets sampled grew P. aeruginosa (2 of 4) and Stenotrophomonas maltophilia (1 of 4). Clinical infection rates in the unit were significantly reduced from 1.4 total and 0.4 GNB infections per 100 patient days in the period before POU filtration to 0.18 total and 0.09 GNB infections per 100 patient days (P=0.0068 and 0.0431, respectively) in the 9-month period for which filters were in place. Infections during the POU filtration period were due to non-waterborne organisms. Point-of-use (POU) water filtration may significantly reduce infection rates in BMT recipients in the absence of any recognized outbreak.

Characterization and feeding deterrent effects on the aphid, Schizaphis graminum, of some derivatives of the sweet compounds, stevioside and rebaudioside A.

The intensely sweet compounds, stevioside [1] and rebaudioside A [2], and 15 of their derivatives, were tested for feeding deterrent activity against the aphid, Schizaphis graminum. Included with these compounds was steviol [4], the aglycone of stevioside and rebaudioside A that was one of the most active compounds in this investigation. Loss of feeding deterrent activity of steviol was observed on acetylation or glycosylation of the C-13 tertiary hydroxy group or on methylation of the C-19 carboxylic acid substituent. In contrast, the antifeedant activity of steviol was not greatly affected by modification of either the C-16 exomethylene group or the C/D-ring junction stereochemistry. 13C-nmr data have been obtained for 12 of the test compounds investigated.

1,8-Cineole (Eucalyptol), a mosquito feeding and ovipositional repellent from volatile oil ofHemizonia fitchii (Asteraceae).

The mosquito feeding and ovipositional repellency of the major monoterpenoid present in the volatile oil ofHemizonia fitchii (Asteraceae), i.e., 1,8-cineole, was investigated. Although 1,8-cineole did not exhibit any significant mosquito larvicidal activity, it was moderately effective as a feeding repellent and highly effective as an ovipositional repellent against adultAedes aegypti (yellow fever mosquito). The ovipositional repellency of 1,8-cineole, coupled with the presence of severalHemizonia chromenes previously shown to possess mosquito larvicidal activity, may therefore account in large part for the observed suppression of local mosquito populations which was associated withH. fitchii plants in northern California.

Natural plant chemicals: sources of industrial and medicinal materials.

Many higher plants produce economically important organic compounds such as oils, resins, tannins, natural rubber, gums, waxes, dyes, flavors and fragrances, pharmaceuticals, and pesticides. However, most species of higher plants have never been described, much less surveyed for chemical or biologically active constituents, and new sources of commercially valuable materials remain to be discovered. Advances in biotechnology, particularly methods for culturing plant cells and tissues, should provide new means for the commercial processing of even rare plants and the chemicals they produce. These new technologies will extend and enhance the usefulness of plants as renewable resources of valuable chemicals. In the future, biologically active plant-derived chemicals can be expected to play an increasingly significant role in the commercial development of new products for regulating plant growth and for insect and weed control.

Growth inhibitory, insecticidal and antifeedant effects of some antileukemic and cytotoxic quassinoids on two species of agricultural pests.

Several quassinoids, obtained by isolation and derivatization from Simaba multiflora and Soulamea soulameoides, were evaluated for growth inhibitory and insecticidal effects against the tobacco budworm (Heliothis virescens) and for antifeedant effects against H. virescens and the fall armyworm (Spodoptera frugiperda). The relative activity of the quassinoids as insect growth inhibitors generally paralleled their known relative potency as antileukemic and cytotoxic agents.

Effects of diterpene esters of tigliane, daphnane, ingenane, and lathyrane types on pink bollworm,Pectinophora gossypiella saunders (Lepidoptera: Gelechiidae).

Twenty esters, representing the biogenetically related tigliane, daphnane, ingenane, and lathyrane series of diterpenes, were screened for growth-inhibitory and insecticidal effects on newly hatched larvae of the North American cotton pest,Pectinophora gossypiella (pink bollworm). Among the tigliane derivatives tested, only 12-O-tetradecanoylphorbol-13-acetate and 12-O-(2-methyl)butyrylphorbol-13-decanoate, of seven phorbol diesters isolated from croton oil by a new procedure involving droplet countercurrent chromatography, were active againstP.gossypiella as both growth inhibitors and insecticides. The effects of the former compound were not significantly diminished by acetylation of its C-20 primary hydroxy group. Three other croton oil phorbol diester constituents, as well as daphnetoxin and daphnetoxin-5,20-diacetate, exhibited activity as growth inhibitors, but not as insecticidal agents, at the doses used. None of the ingenane or lathyrane derivatives investigated was active in either respect. 12-0-Tetradecanoylphorbol-13-acetate was found to cause 100% mortality on second-stadium larvae ofCulex pipiens at 0.6 ppm, but exhibited less significant effects onOncopeltus fasciatus (second-stadium nymphs) andTribolium confusion (adults) when applied at higher doses.

Insecticidal chromenes from the volatile oil ofHemizonia fitchii.

Based on field observations of the effects of the resinous tarweedHemizonia fitchii A. Gray (Asteraceae) on mosquito populations in California, the volatile oil of this plant was investigated for insecticidal activity. Analysis of thé oil by TLC and capillary GC-MS showed the presence of five major constituents which were identified as the monoterpenoid 1,8-cineole, and the chromenes encecalin, eupatoriochromene (desmethylencecalin), 6-vinyl-7-methoxy-2,2-dimethylchromene, and desmethoxyencecalin. Trace amounts of several volatile fatty acids, alkanes,p-coumarate derivatives, additional chromene derivatives, and numerous mono- and sesquiterpenoids were also detected and identified by GC-MS. Fractionation of the oil by preparative TLC and column chromatography afforded the major chromenes, the identities of which were confirmed by NMR and IR spectral data. The chromenes exhibited weak to moderate toxicity againstCulex pipiens (house mosquito) larvae andOncopeltus fasciatus (large milkweed bug) nymphs. However, no antijuvenile hormone activity was observed for any of the compounds tested against these insect species.

Multichemical resistance of the coniferPodocarpus gracilior (Podocarpaceae) to insect attack.

Podocarpus gracilior is resistant in nature to insect attack. Apparently, the resistance ofP. gracilior is due to a multichemical defense mechanism. Chemicals identified as potential components of the multichemical defense are four norditerpenedilactones, including nagilactones, C, D, and F, which cause insect feeding deterrent activity ultimately coupled to an insecticidal activity, and podolide, an insecticide; two nonlethal growth-inhibiting biflavones, podocarpusflavone A and 7″,4'″-dimethylamentoflavone; and the ecdysis-inhibiting phytoecdysone, ponasterone A.

Zero-flow pressures and pressure-flow relationships during single long diastoles in the canine coronary bed before and during maximum vasodilation. Limited influence of capacitive effects.

The proposal that diastolic coronary flow is regulated by an intramyocardial "back-pressure" that substantially exceeds coronary venous and ventricular diastolic pressures has been examined in an open-chest canine preparation in which instantaneous left circumflex pressure and flow could be followed to cessation of inflow during prolonged diastoles. Despite correlation coefficients consistently >0.90, pressure-flow data during individual diastoles were concave to the flow axis before and during pharmacologically induced maximum coronary vasodilation. Data were better fitted (P < 0.01) by second-order equations than by linear equations in >90% of cases. Second-order pressure-axis intercepts (P(f=0))(1) averaged 29+/-7 (SD) mm Hg before vasodilation and 15+/-2 mm Hg during vasodilation; left and right atrial pressures were always substantially lower (8+/-3 and 5+/-2 mm Hg before vasodilation and 8+/-2 and 4+/-1 mm Hg during dilation). Values of P(f=0) before vasodilation varied directly with levels of coronary inflow pressure. A modification of the experimental preparation in which diastolic circumflex pressure could be kept constant was used to evaluate the suggestion that P(f=0) measured during long diastoles are misleadingly high because of capacitive effects within the coronary circulation as inflow pressure decreases. Decreases in P(f=0) attributable to capacitive effects averaged only 5.9+/-3.0 mm Hg before vasodilation and were smaller during dilation. We conclude that P(f=0) is a quantitatively important determinant of coronary driving pressure and flow, resulting from both factors related to, and independent of, vasomotor tone. Adjustments of flow during changing physiological situations may involve significant changes in P(f=0) as well as in coronary resistance.