The genome of the social amoeba Dictyostelium discoideum.

The social amoebae are exceptional in their ability to alternate between unicellular and multicellular forms. Here we describe the genome of the best-studied member of this group, Dictyostelium discoideum. The gene-dense chromosomes of this organism encode approximately 12,500 predicted proteins, a high proportion of which have long, repetitive amino acid tracts. There are many genes for polyketide synthases and ABC transporters, suggesting an extensive secondary metabolism for producing and exporting small molecules. The genome is rich in complex repeats, one class of which is clustered and may serve as centromeres. Partial copies of the extrachromosomal ribosomal DNA (rDNA) element are found at the ends of each chromosome, suggesting a novel telomere structure and the use of a common mechanism to maintain both the rDNA and chromosomal termini. A proteome-based phylogeny shows that the amoebozoa diverged from the animal-fungal lineage after the plant-animal split, but Dictyostelium seems to have retained more of the diversity of the ancestral genome than have plants, animals or fungi.

Molecular analysis of aerobic phenylacetate degradation in Azoarcus evansii.

The Azoarcus evansii gene which codes for phenylacetate-CoA ligase, an enzyme involved in the aerobic degradation of phenylacetate, was isolated from a genomic library, using as the probe a fragment of the gene which encodes the isoenzyme that is induced under anaerobic conditions. By this means both the gene and its flanking sequences were recovered. The gene is homologous to the phenylacetate-CoA ligase genes of Pseudomonas putida U and Escherichia coli W. Induction by phenylacetate under aerobic growth conditions was demonstrated using lacZ fusions. Western analysis showed that phenylacetate-CoA ligase is involved in the degradation of the aromatic amino acid phenylalanine. Genes coding for the phenylacetate-CoA ligase and for the putative hydroxylating enzyme were expressed in E. coli. Detection of 2-hydroxyphenylacetate in the recombinant E. coli strain indicated hydroxylation of phenylacetyl-CoA. The gene pacL, which codes for the putative ring-opening enzyme was mutated to enable the isolation of intermediates in aerobic phenylacetic acid degradation, which were characterized by GC-MS and NMR analyses.

ACE and angiotensinogen gene genotypes and left ventricular mass in athletes.

BACKGROUND: Genetic factors may be important in modifying heart size due to long-term athletic training. The significance of polymorphisms of genes of the renin-angiotensin system in myocardial mass in a population of athletes participating in different disciplines is not known. METHODS: The angiotensin I-converting enzyme gene insertion/deletion (I/D) polymorphism, angiotensinogen gene M235T polymorphism and angiotensin II type 1 receptor gene A1166C polymorphism were determined in 83 male Caucasian endurance athletes and associated with left ventricular mass. RESULTS: No association with left ventricular mass was found for the polymorphisms of angiotensin I-converting enzyme gene I/D, angiotensinogen gene M235T and angiotensin II type 1 gene A1166C when studied separately. However, combined analysis of the angiotensin I-converting enzyme gene I/D polymorphism and angiotensinogen gene M235T polymorphism genotypes suggested an association with left ventricular mass (g m(-2)) (P = 0.023). Athletes with the angiotensin I-converting enzyme gene DD/angiotensinogen gene TT genotype combination had greater left ventricular mass compared with all other genotype combinations (179.8 +/- 26.1 g m(-2) vs. 145.2 +/- 27.3 g m(-2), P = 0.003). CONCLUSIONS: These results suggest an association of combined angiotensin I-converting enzyme gene I/D polymorphism genotypes, and angiotensinogen gene M235T polymorphism genotypes with left ventricular hypertrophy due to long-term athletic training. A synergistic effect of angiotensin I-converting enzyme gene DD genotype and angiotensinogen gene TT genotype on left ventricular mass in endurance athletes appears to occur.

Integrated effects of the vasodilating beta-blocker nebivolol on exercise performance, energy metabolism, cardiovascular and neurohormonal parameters in physically active patients with arterial hypertension.

OBJECTIVE: The present study was designed to investigate the integrated effects of the beta-1-selective blocker with vasodilator properties, nebivolol, on systemic haemodynamics, neurohormones and energy metabolism as well as oxygen uptake and exercise performance in physically active patients with moderate essential hypertension (EH). DESIGN AND METHODS: Eighteen physically active patients with moderate EH were included: age: 46.9 +/- 2.38 years, weight: 83.9 +/- 2.81 kg, blood pressure (BP): 155.8 +/- 3.90/102.5 +/- 1.86 mm Hg, heart rate: 73.6 +/- 2.98 min(-1). After a 14-day wash-out period a bicycle spiroergometry until exhaustion (WHO) was performed followed by a 45-min submaximal exercise test on the 2.5 mmol/l lactate-level 48 h later. Before, during and directly after exercise testing blood samples were taken. An identical protocol was repeated after a 6-week treatment period with 5 mg nebivolol/day. RESULTS: Nebivolol treatment resulted in a significant (P < 0.01) decrease in systolic and diastolic BP and heart rate at rest and during maximal and submaximal exercise. Maximal physical work performance, blood lactate and rel. oxygen uptake (rel. VO(2)) before and after nebivolol treatment at rest and during maximal and submaximal exercise remained unaltered. Free fatty acid, free glycerol, plasma catecholamines, beta-endorphines and atrial natriuretic peptide (ANP) increased before and after treatment during maximal and submaximal exercise but remained unaltered by nebivolol treatment. In contrast, plasma ANP levels at rest were significantly higher in the presence of nebivolol, endothelin-1 levels were unchanged. CONCLUSIONS: Nebivolol was effective in the control of BP at rest and during exercise in patients with EH. Furthermore, nebivolol did not negatively affect lipid and carbohydrate metabolism and substrate flow. The explanation for the effects on ANP at rest remain elusive. This pharmacodynamic profile of nebivolol is potentially suitable in physically active patients with EH.

Characterization of CD36/LIMPII homologues in Dictyostelium discoideum.

The CD36/LIMPII family is ubiquitously expressed in higher eukaryotes and consists of integral membrane proteins that have in part been characterized as cell adhesion receptors, scavenger receptors, or fatty acid transporters. However, no physiological role has been defined so far for the members of this family that localize specifically to vesicular compartments rather than to the cell surface, namely lysosomal integral membrane protein type II (LIMPII) from mammals and LmpA from the amoeba Dictyostelium discoideum. LmpA, the first described CD36/LIMPII homologue from lower eukaryotes, has initially been identified as a suppressor of the profilin-minus phenotype. We report the discovery and initial characterization of two new CD36/LIMPII-related proteins, both of which share several features with LmpA: (i) their size is considerably larger than that of the CD36/LIMPII proteins from higher eukaryotes; (ii) they show the characteristic "hairpin" topology of this protein family; (iii) they are heavily N-glycosylated; and (iv) they localize to vesicular structures of putative endolysosomal origin. However, they show intriguing differences in their developmental regulation and exhibit different sorting signals of the di-leucine or tyrosine-type in their carboxyl-terminal tail domains. These features make them promising candidates as a paradigm for the study of the function and evolution of the as yet poorly understood CD36/LIMPII proteins.

Theta power in the EEG of humans during ongoing processing in a haptic object recognition task.

Dynamic changes in spectral theta power (TP) in the EEG over frontal regions were reported previously during the processing of visually presented spatial and verbal tasks [Cereb. Cortex, 7 (1997) 374-385]. Lower TP was found at the beginning compared to the end of processing. In order to test another modality, we examined theta power during the exploration of haptic stimuli with different complexity. A linear correlation between theta power and mean exploration time (as a measure of stimulus complexity) was found at the end of exploration but not at its beginning. These data are in line with our hypothesis since one could expect minimal load of working memory independent of stimulus complexity at the beginning of exploration whereas working memory would have integrated the stimuli of differing complexity into a perceptual model at the end of exploration.

[Preventing coronary heart disease by physical activity. How much exercise is necessary?]. / KHK-Prävention durch körperliche Aktivität. Wie viel Sport muss sein?

The value of general measures, in particular physical exercise, for the prevention of cardiac disease has been unequivocally demonstrated. Meta-analyses done to investigate the preventive character of exercise have shown that the coronary risk of physically active persons is lower by a factor of 2 to 3. This reduction in risk is independent of the presence of other risk factors, and is not due to the better health awareness of those who are physically active. However, the amount or intensity of such training actually required remains uncertain. A number of studies report a protective effect only for intensive physical effort, while others claim a risk reduction independent of training intensity. In the last resort, however, any form of exercise is better than none at all, when it comes to lowering the coronary risk. Not only endurance sports, but also other types of sport, such as tennis, or daily activities, can be recommended.

Patients with dilated cardiomyopathy and less than 20% ejection fraction increase exercise capacity and have less severe arrhythmia after controlled exercise training.

The results of this pilot study suggest that patients with a diminished ejection fraction as low as 16% can safely perform an exercise program. A significant improvement in peak VO2 and maximal work rate was achieved. Moreover, this study suggests that exercise training might diminish the severity of asymptomatic ventricular arrhythmia; however a larger controlled study is needed to confirm these findings.

[Phase II ambulatory cardiac rehabilitation (Cologne model). 3 year results after conclusion of the intervention]. / Ambulante kardiale Rehabilitation der Phase II (Kölner Modell). Ergebnisse drei Jahre nach Abschluss der Massnahme.

UNLABELLED: BASELINE: Of a total of 101 patients with CAD who participated in an ambulatory cardiac rehabilitation program (ACR) ("Cologne model") between 1992 and 1994, 76 (75.2%) were examined 36 months after concluding ACR. RESULTS: The significant improvement in exercise tolerance from 118.4 +/- 30.1 to 131.9 +/- 34.1 W achieved with the ACR was maintained at the 3-year examination. ACR also significantly decreased plasma cholesterol levels from 228.9 +/- 48.3 to 211.7 +/- 37.0 mg%; 3 years after ACR the corresponding figures were 219.1 +/- 39.3 mg%. In the high-risk group the significant reduction in plasma cholesterol levels from 265 +/- 43.6 to 231.9 +/- 35.4 mg% observed immediately after ACR was maintained over the three-year period (234.6 +/- 37.7 mg%). Similar patterns were observed for other parameters of lipid metabolism. Before the cardiac event 63.2% of the patients smoked; at the 3-year examination the percentage was 30.3%. Before ACR, 73.7% of the patients were gainfully employed. Within the first 6 months after ACR, 71.4% returned to work, and this percentage increased to 73.2% after one year. Three years later, 64.3% were still working. DISCUSSION: The results demonstrate that the lifestyle changes achieved with 4-weeks of ACR may, at least in part, be maintained over a period of 36 months.

Reduction of the plasma concentration of C-reactive protein following nine months of endurance training.

An intense physical exercise induces an inflammatory reaction as demonstrated by the delayed increase in blood of acute phase proteins and among them of C-reactive protein (CRP). There is also evidence for a diminished acute phase reaction due to regular exercise suggesting a suppression of the inflammatory response through training. With this background CRP was measured by a sensitive enzyme immunoassay under resting conditions before and after 9 months of training in 14 subjects preparing for a marathon with the aim of studying the effect of training on the base-line CRP concentration. The mean distance run per week increased significantly from 31 +/- 9 km at the beginning to 53 +/- 15 km after 8 months of training (p < 0.01). The aerobic capacity rose significantly after training as demonstrated by the increase of running velocity during a maximal treadmill test from 3.82 +/- 0.29 m/s pre-training to 4.17 +/- 0.17 m/s post-training at a blood lactate concentration of 4 mmol/L (p < 0.01). In 10 of 12 runners base-line CRP was diminished after training in spite of a continuous increase of training intensity. The CRP median fell from 1.19 mg/L before to 0.82 mg/L after training (p < 0.05). Since intense physical exercise is known to be associated with an inflammatory reaction of muscles and tendons, the CRP decrease was unexpected. In 2 subjects the CRP concentration rose markedly because of a borrelia infection and a knee injury, respectively. These values were caused by a pathological condition and were not considered for the statistical evaluation. In 10 non-training control subjects the CRP median did not change significantly during the same 9 months period. The decrease of the CRP base-line concentration after training suggests that intensive regular exercise has a systemic anti-inflammatory effect. This is of particular interest with regard to several recent reports confering on the concentration of CRP in plasma a predictive value for the risk of cardiac infarction, venous thrombosis or stroke.

[Ambulatory cardiac phase II rehabilitation--"the Cologne model"--including 3-year-outcome after termination of rehabilitation]. / Ambulante kardiale Rehabilitation der Phase II-"Kölner Modell"--einschliesslich der Ergebnisse drei Jahre nach Abschluss der Rehabilitation.

From January 1992 until December 1994 the Cologne model of ambulant cardiac rehabilitation (ACR) in the greater area of Cologne, Germany, was performed and is still in progress. In Germany until 1992 the cardiac rehabilitation was exclusively performed stationary. The objective of the "Cologne model" was to evaluate, whether the transfer of the stationary cardiac rehabilitation programs into the ambulatory setting is achievable without deficits in efficiency, safety and overall quality. The results obtained are intended to serve for standardization and quality control of future ambulatory cardiac rehabilitation programs in Germany. From 1992 to 1994 108 patients (94 men, 14 women; 52.3 +/- 8.0 years old) with coronary artery disease (CAD) which were compatible with the criteria of the "Cologne model" (Table 1) participated in the 4-week ACR. The indications for inclusion into the ACR were in 74 cases a myocardial infarction (MI), in 34 cases CAD without MI, but with PTCA/stent-procedure (Table 3). Seven patients discontinued the ACR prematurely, 2 patients because of cardiovascular reasons. Reasons for the preference of the ambulatory over a stationary cardiac rehabilitation program were in 40.6% of the patients refusal of "hospital ambience", in 43.6% familiar or in 12.9% professional reasons. During the 4-week ACR patients participated in a mean of 72.9 +/- 6.7 hours of therapy (Table 4). As a result of the ACR exercise tolerance increased highly significantly (**) from 116.4 +/- 28.8 to 129.9 +/- 34.6 watt). This improvement was maintained at the 1- and 3-year control (128.7 +/- 35.8**) examinations (Tables 5 and 7). One year after ACR 77% of the patients stated to be physically active in ambulatory heart groups (AHG) (27.6%) or on their own (49.4%). Three years after ACR the rate of regularly physically active patients still was 59.2%. Furthermore, as a result of ACR the dietary behavior was changed significantly. There was a reduction in the consumption of lipids by 20.8%, saturated fatty acids by 30.7% and of cholesterol by 30.5%. The plasma concentrations of cholesterol decreased from 231 +/- 49.8 to 213.2 +/- 35.9 mg%**. Six (and 12) months after ACR they increased again to 225.6 +/- 39.4 mg%. Three years after ACR the mean cholesterol level was 219.1 +/- 39.3 mg%. In the high risk group (cholesterol at the initial visit > 220 mg%) cholesterol levels were reduced from 266 +/- 44 to 232 +/- 31.9 mg%**. Six and 12 months after ACR they were 239.7 +/- 35.8 mg% and 245.8 +/- 32.6 mg%, respectively, (Tables 6 and 7) and still significantly lower than before ACR, though only 19% of the patients were treated with lipid lowering agents. Three years after ACR cholesterol were 234.6 +/- 37.7 mg%** in the high-risk group. 34.2% of the patients received lipid lowering agents. Mean body weight remained unaltered over the 3-year period. Smoking behavior was not altered significantly during the 4-week ACR. However, before the cardiovascular event 67.3% of the patients had smoked cigarettes. At the beginning and at the end of ACR 20.8% of the patients still smoked. During the ACR the number of smoked cigarettes was reduced significantly from 32.4 +/- 15.2 to 6.9 +/- 5.2 cigarettes per day. One year after ACR 23% of the patients were smokers, 3 years after ACR the percentage of smokers increased to 30.3%. Before ACR 73.3% of the patients were still working. During the first 6 months after ACR 68.2% returned to work and the percentage increased to 73% in the following 6 months. The results demonstrate that it is achievable to transfer the contents of the established stationary cardiac rehabilitation programs into the ambulatory setting without loss of efficiency, safety and overall quality. It is further confirmed, that it is necessary to continuously evaluate the results of the cardiac rehabilitation program on a long-term basis. (ABSTRACT TRUNCATED)

[Clinical follow-up 6 months after ambulatory/partial inpatient after-care rehabilitation. Further results of the Cologne model of ambulatory cardiac phase II rehabilitation]. / Klinischer Verlauf sechs Monate nach einer ambulanten/teilstationären Anschlussrehabilitation. Erweiterte Ergebnisse aus dem Kölner Modell der ambulanten kardialen Rehabilitation der Phase II.

Three hundred and thirty patients with coronary artery disease (CAD) (288 men, 42 women, age of 55.5 +/- 10.0 years) participated in a 4-week ambulatory cardiac rehabilitation program (ACR) (Table 1). The cardiovascular indication for ACR was in 229 cases a myocardial infarction. In 101 patients a CAD with invasive revascularization but without a history of MI was present. In 92 patients with myocardial infarction additionally an invasive revascularization was performed. Eighty-three patients were included after a CABG-procedure (Tables 2 to 5). Six months after the ACR 290 (87.9%) patients presented for clinical reevaluation. In 235 (81.0%) of the 290 examined patients the cardiovascular diagnosis was unaltered. In the first 6 months after ACR in 76 (26.2%) patients a coronarography was performed, in 44 patients a restenosis was diagnosed. In 36 patients an additional invasive procedure (in 28 patients a PTCA, in 5 patients with additional stent-implantation, in 1 case with rotablation, in 8 patients CABG) was performed. In 1 patients a pace-maker was implanted. Since the ACR 1 patient experienced a myocardial infarction and 2 a recurrent myocardial infarction. In 1 patient myocardial fibrillation occurred. Totally, 70 patients (24.1%) required stationary-hospital treatment during the first 6 months after ACR (Table 6). In 11 cases an acute admission to hospital treatment because of cardiovascular reasons was documented. The majority of the hospital admission was elective, because of diagnostic or therapeutic procedures. In 6 patients a CABG-surgery was performed. In approximately 80% of the patients the cardiovascular status was stable during the first 6 months after ACR. Though 24.1% of the patients required stationary hospital treatment, the majority of the admissions was elective of interest, there was a high rate of hospital admissions in the PTCA-group in combination with recoronarographies and revascularization because of early reocclusion.

Neuroendocrine system and mental function in sedentary and endurance-trained elderly males.

Hypothalamic-pituitary-adrenal (HPAA) and -gonadal (HPGA) axis modification and cognitive impairments have been reported in elderly subjects and related to physical training status. The aim of this study was to investigate if HPAA and HPGA regulation are altered in elderly distance runners (RUN; n = 8; age: 68.9+/-4.2 yrs; training: 65+/-20 km/wk over the last 20 yrs; means +/- SD) or are affected in elderly sedentary individuals (SED; n = 11; age: 69.1+/-2.6 yrs) by an aerobic training over 20 weeks (3 times/week, 30-60 min walking), respectively. The protocol included assessment of the hormone profile in basal non-suppressed state as well as evaluation of hormonal responses to dexamethasone (DEX, 1.5 mg) induced adrenal suppression, to post-DEX combined corticotrophin releasing hormone (CRH; 0.7 microg/kg) and luteinizing hormone releasing hormone (LHRH, 0.7 microg/kg) stimulation and to exercise challenge (30 min cycle ergometry at 65% VO2max). Mental functions influenced by HPAA and HPGA activity were also assessed in RUN and SED before (SED-PRE) and after (SED-POST) the training program. Basal and post-DEX plasma concentrations of adrenocorticotropic hormone (ACTH), cortisol (CSL), luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone (T) did not differ between RUN and SED-PRE. Basal plasma free T concentration was significantly lower in RUN (RUN: 10.23+/-2.41 pg x ml(-1) vs. SED-PRE: 16.6+/-5.59 pg x ml(-1)). During releasing hormone challenge test after DEX administration (DEX/RH), no differences were found between RUN and SED-PRE in plasma ACTH, LH, FSH and T response. During this stimulation test, plasma CSL was significantly higher in RUN than in SED-PRE after 90 min (RUN: 5.86+/-3.65 microg x dl(-1) vs. SED-PRE: 2.74+/-2.09 microg x dl(-1)). Differences in plasma CSL concentrations between groups were not induced by 30-min exercise challenge. Basal hormone profile was not altered by training in SED. During DEX/RH only plasma ACTH concentration was significantly higher in SED-POST compared to SED-PRE. Long and short-term memory function did not differ between RUN, SED-PRE and SED-POST. Our data suggest that following post-DEX CRH/LHRH challenge elderly endurance athletes reveal-in the absence of altered peak values-a pattern of prolonged secretion of glucocorticoids. However, the high interindividual variability of plasma ACTH and CSL concentrations shows that reduced corticotropic sensitivity to negative feedback is not always induced by chronic exercise stress. Lower plasma free T concentrations in RUN compared to SED are not caused by modified LH synthesis-secretion capacity.

[Improvement of physical performance and aerobic capacity mediated by a novel 4--week ambulatory cardiac rehabilitation program]. / Anderung der körperlichen Leistungsfähigkeit durch ein vierwöchiges kardiales Rehabilitationsprogramm der Phase II.

During a 4-week ambulatory cardiac rehabilitation program, 262 patients with coronary artery disease (CAD), 235 men and 27 women, 53.6 +/- 10.2 years, performed 30.5 +/- 2.9 exercise units. Before and after the rehabilitation program exercise, capacity was assessed by bicycle ergometry. There was a significant (p < 0.001) increase in the maximum exercise capacity at the end of the program (105.3 +/- 32.3 vs. 121.9 +/- 37.3 W). Physical work capacity on the 2.0 mmol lactate level improved (p < 0.001) from 72.2 +/- 23.5 to 86.4 +/- 25.8 W, on the 2.5 mmol/l level (p < 0.001) from 83.5 +/- 23.2 to 97.4 +/- 26.4 W, and on the 3.0 mmol/l level (p < 0.001) from 93.1 +/- 23.0 to 106.6 +/- 26.1 W. Despite enhanced performance, heart rate remained unaltered on the 2.0, 2.5, and 3.0 mmol/l lactate level. Furthermore, ergometric performance on predefined heart rate levels was significantly (p < 0.001) increased: 85/min: from 56.0 +/- 24.1 to 65.8 +/- 24.5 W, 90/min: from 62.0 +/- 27.3 to 71.2 +/- 26 W; 95/min: from 67.2 +/- 26.4 to 77.5 +/- 27.6 W; 100/min: from 71.1 +/- 29.6 to 80.6 +/- 28.1 W; 105/min: from 69.8 +/- 26.2 to 81.9 +/- 28.2 W and 110/min: from 73.6 +/- 28.9 to 90.4 +/- 29.4 W. The results demonstrate that physical performance in patients with CAD was improved by our novel ambulatory cardiac rehabilitation program. This improvement included an increase in maximum as well as endurance work capacity; furthermore, this increase was accompanied by a decrease in resting and exercise heart rates. The results demonstrate an absolute increase of physical performance, more importantly an increase of physical performance at defined lactate levels in the presence of unchanged heart rates mediated by the rehabilitation program. Thus, this increase was independent of motivational factors in the patients and/or the investigators during the re-exercise test. On the contrary, our data demonstrate that it is based on an improvement of aerobic endurance capacity associated with a therapeutically beneficial significant decrease of heart rate for a defined workload. The effects were independent of pharmacological influences (e.g., beta-receptor antagonists). These findings are of clinical importance with respect to reduction of myocardial oxygen consumption in patients with CAD.

Power of theta waves in the EEG of human subjects increases during recall of haptic information.

Several studies have reported a functional relationship between spectral power within the theta-band of the EEG (theta-power) and memory load while processing visual or semantic information. We investigated theta power during the processing of different complex haptic stimuli using a delayed recall design. The haptic explorations consisted of palpating the structure of twelve sunken reliefs with closed eyes. Subjects had to reproduce each relief by drawing it 10 s after the end of the exploration. The relationship between mean theta power and mean exploration time was analysed using a regression model. A linear relationship was found between the exploration time and theta power over fronto-central regions (Fp1, Fp2, F3, F7, F8, Fz, C3) directly before the recall of the relief. This result is interpreted in favour of the hypothesis that fronto-central theta power of the EEG correlates with the load of working memory independent of stimulus modality.

[Need for ambulatory cardiology after-care rehabilitation in the metropolitan area of a large city. Results of the Cologne model of ambulatory cardiologic rehabilitation--phase II]. / Der Bedarf an ambulanter kardiologischer Anschlussrehabilitation in einem grossstädtischen Ballungsgebiet. Ergebnisse des Kölner Modells der ambulanten kardiologischen Rehabilitation--Phase II.

Within the Cologne Model (CM) of outdoor cardiac rehabilitation (OCR), phase II investigations about the demand for this form of cardiac rehabilitation (CR) after acute cardiac diseases were carried out in three general hospitals, the cardiological and cardiosurgical university hospitals of Cologne. The subsequent questions were investigated: total number of coronary or cardiac operated patients, number of patients with indication for CR, and number of patients corresponding to the restricted indications of CM (age below 65, low risk patient, no cardiac operation). For these groups the acceptance or refusal of CR was checked. Subsequently a sample of patients corresponding to the criteria of CM or of operated patients were confronted with the additional offer of an OCR. The motivation for the acceptance of rehabilitation in specialized hospitals (ICR), OCR or refusal of each kind of CR was inquired. The acceptance of CR in the different groups varied widely. Whereas operated patients in Cologne accept CR in nearly 100% of cases, this is the case in patients after acute myocardial infarction (AMI) in only 50% and in patients after PTCA without AMI in only 5-6%. The analysis of predictors for acceptance brings about that younger patients prefer CR, and if they do, OCR. Patients with the more serious form of disease prefer ICR. Women accept CR more rarely than men, and if they do, they prefer the hospital form. However, this is less gender specific but consequence of the generally more serious form and later onset of CAD in females. Higher educational as well as occupational status favors acceptance of CR and specially OCR. The suspicions that unmarried people prefer OCR and foreigners ICR could not be generally confirmed. Crucial reasons for the form of CR which is accepted or refused are individual ones. ICR is favored by the wish for more safety and better recuperation. For OCR, the comfortable conditions at home with high social support and/or antipathy against hospitals after long clinical treatment are named. Analysis of demand for OCR demonstrates that between 40% in low risk patients (corresponding to CM criteria) and 20% in more serious cases (operated patients) prefer the outhospital form. From these data an estimation of demand for OCR in areas with high population was carried out.

[Haptic perception and EEG changes in anorexia nervosa]. / Haptische Wahrnehmung und EEG-Veränderungen bei Anorexia nervosa.

OBJECTIVES: We predicted that due to diminished somatosensory integrative ability, the anorectic patients would have problems reproducing haptic stimuli. In addition we sought to determine whether EEGs from anorectic patients (AN) and the healthy controls (CO) would show discrepancies between the two groups during haptic explorations in theta-power over the right parietal region. METHOD: EEG power (theta-power) data of AN (n = 13) and CO (n = 13) were analyzed during haptic exploration tasks and rest intervals. The haptic explorations consisted of palpating the structure of six sunken reliefs in sequence with both hands, eyes closed. After each exploration the structure was drawn on a piece of paper. RESULTS: The reproductions of haptic stimuli submitted by the anorectic patients were of notably poorer quality than those of the healthy controls. During rest intervals and haptic explorations, spectral power was generally lower in the AN group in comparison to the healthy controls. Significant theta-power differences between groups showed over the right parietal cortex during haptic explorations. The decrease in EEG power in the anorectic patients in the theta bands across the right parietal region during haptic exploration tasks could be interpreted as a minor activation of visuo-spatial regions. The results of the haptic explorations as well as the EEG-power changes indicate a cortical dysfunction and deficits in somatosensory integration processing in anorexia nervosa patients.

[Sports medicine aspects in children and adolescents]. / Sportmedizinische Aspekte bei Kindern und Jugendlichen.

In opposite to adults, exercise and sports are natural elements in the life of children and adolescents. However, they gain new aspects in the modern achievement-oriented society. The competitive sports are moving more and more towards the children's and adolescents's age. Additionally, sport should be done early during live for prevention of civilization diseases later on. Finally, physical therapy gains growing importance in the therapy and rehabilitation of children and adolescents. As to strength, children are not just 'small adults'. In children, the physical capacity in the aerobic range is larger and in the anaerobic range is smaller than in adults. The question of trainability and talent, respectively, plays an important role in the competitive sport as well as in the consultation of children for their sport career. The danger of the child during sport is discussed from the view of internal and orthopedic medicine. Concepts of sports medical preventions are derived from this discussion. The question of sports with pre-existing diseases in children and adolescents is only marginally discussed.