Validity of physical activity and cardiorespiratory fitness in the Danish cohort "Diet, Cancer and Health-Next Generations".

Valid assessments of physical activity (PA) and cardiorespiratory fitness (CRF) are essential in epidemiological studies to define dose-response relationship for formulating thorough recommendations of an appropriate pattern of PA to maintain good health. The aim of this study was to validate the Danish step test, the physical activity questionnaire Active-Q, and self-rated fitness against directly measured maximal oxygen uptake (VO2 max). A population-based subsample (n=125) was included from the "Diet, Cancer and Health-Next Generations" (DCH-NG) cohort which is under establishment. Validity coefficients, which express the correlation between measured and "true" exposure, were calculated, and misclassification across categories was evaluated. The validity of the Danish step test was moderate (women: r=.66, and men: r=.56); however, men were systematically underestimated (43% misclassification). When validating the questionnaire-derived measures of PA, leisure-time physical activity was not correlated with VO2 max. Positive correlations were found for sports overall, but these were only significant for men: total hours per week of sports (r=.26), MET-hours per week of sports (r=.28) and vigorous sports (0.28) alone were positively correlated with VO2 max. Finally, the percentage of misclassification was low for self-rated fitness (women: 9% and men: 13%). Thus, self-rated fitness was found to be a superior method to the Danish step test, as well as being less cost prohibitive and more practical than the VO2 max method. Finally, even if correlations were low, they support the potential for questionnaire outcomes, particularly sports, vigorous sports, and self-rated fitness to be used to estimate CRF.

Graft clonogenicity and intensity of pre-treatment: factors affecting outcome of autologous peripheral hematopoietic cell transplantation in patients with acute myeloid leukemia in first remission.

A total of 22 patients with acute myeloid leukemia (AML) in first complete remission receiving autologous blood stem cell transplantation (ABSCT) were investigated in order to determine factors affecting outcome. All but two patients had a normal karyotype and received the same high-dose chemotherapy followed by G-CSF-mobilized peripheral blood stem cells after the second (n=5) or third (n=17) course of induction and post-remission chemotherapy, respectively. With a median follow-up of 30 months, the median disease-free survival is 24.1 months. Univariate analysis showed that three chemotherapy cycles before ABSCT were associated with a significant better disease-free survival (P=0.0018) and overall survival (P=0.0033), whereas the presence of an FLT3-mutation (n=6) showed no impact. The number of megakaryocytic progenitors (CFU-MK) infused tended to correlate with primary platelet engraftment (P=0.07) and were predictive for neutrophil (P=0.011) and platelet counts (P=0.009) 180 days after transplantation. Patients receiving a higher amount of CFU-MK had a better event-free survival (P=0.02). Our data suggest that the content of CFU-MK within the graft predicts the quality of hematological recovery and long-term disease control. Additionally, a minimum of three chemotherapy cycles before ABSCT seems to be associated with an improved outcome.

Evidences of precession and obliquity orbital forcing in oxygen-18 isotope composition of Montalbano Jonico section (Basilicata, southern Italy)

Quantitative signal processing methods have been applied to a delta(18)O profile for a land-based stratigraphic section, extending from the upper part of lower Pleistocene to the lower part of middle Pleistocene. The section is well exposed with a continuous succession of muds and muddy silts, about 400 m thick, located in the southernmost part of Bradano Trough, near Montalbano Jonico in Basilicata (south Italy). The sampled part of the section is about 240 m thick, in which a foram benthic species (Cassidulina carinata) is continuously available for oxygen isotope ratio measurements. The aim of the data treatment is to discover how much of the Earth's orbital periodic movements, precession and obliquity, which represent the dominant periodicities in paleoclimatic variations from the base of the Pleistocene until 0.735 Myr BP, are responsible for the oscillations observed in the oxygen-18 record of the Montalbano Jonico section. A time framework of the section was constructed on the basis of calcareous nannofossil biostratigraphic analyses, preliminary magnetostratigraphic results and oxygen isotope correlation with the record from DSDP s607 (isotope data collected in the NOAA World Data Center). The resulting time-scale extends from 1.15 to 0.74 Myr. Power spectrum analysis was performed on the isotope data to illuminate the most important periodicity components of the Montalbano Jonico record. The periodic components of 41,000 and 21,000 yr are present in this record; the former associated with periodic changes in the tilt of Earth's axis and the latter with periodic changes with the precession of the equinoxes, as predicted by the astronomical theory of ice ages. They are, however, not the most important components of the power spectrum, in which a lower frequency component contains most of the variance. This low-frequency component is centered at a period around 208,000 yr. This periodicity seems not to be attributable to any known astronomical or paleoclimatic phenomenon. An attempt was made to verify if this periodicity was due to the composite effect of precession and obliquity signals together at different frequencies from their forcing frequencies. In order to investigate this effect, isotope data have been parameterized in terms of a sum of simple functions of precession and obliquity signals with unknown coefficients. The coefficients are estimated from the time series with the assumption that the best coefficients are those which minimize the 'noise' i.e. the difference between the data function and the precession and obliquity functions. Cross-spectra analyses were also performed on the data and the precession signal and on the data and the obliquity signal. The power spectrum of the residual 'noise' functions and the cross-spectra demonstrate that precession and obliquity signals are not in phase with the data at their forcing frequencies and so damp. The precession and obliquity signals were then shifted towards lower frequencies at equally spaced lags, the resultant 'noise' power spectra were plotted for every combination of lags of precession and obliquity. The results of this data processing demonstrate that it is possible to have a combination of precession and obliquity cyclicities that could be responsible for the signal with 208 kyr periodicity.

Intensified ESWL of gallstones: dissociation of pulverisation, pain relief and stone-clearance.

BACKGROUND/AIMS: Recently, intensified shock wave lithotripsy for gallstone pulverisation and subsequent clearance without bile salt medication has been advocated. We report our first 44 patients treated by this regime: Patients with intact gallbladder function and symptomatic gallstones of any size, number and composition. METHODOLOGY: Forty-four consecutive patients who received intensified shock wave lithotripsy for gallstone pulverisation and clearance were included in this study. The patients all had intact gallbladder function and presented with symptomatic gallstones of any size, number and composition. RESULTS: Pulverisation was achieved in 75% of all cases (12 months), but only 34% were stone free. The proportion of patients with stone pulverisation compared to subsequent complete clearance was 93% versus 60% in small (

[Gastrointestinal problems in elderly patients]. / Gastroenterologische Probleme des alten Patienten.

The following article contains a short review on gastrointestinal problems of the elderly. The diseases of the esophagus occurring in the elderly are not much different from those in younger patients. Clinically relevant in the stomach are above all bleeding ulcerations and the gastric carcinoma occurring more frequently in advanced age. The pyogenic liver abscess is diagnosed primarily in the elderly and is at a rule the consequence of an infection of the gall bladder and other abdominal sites. The hepatocellular carcinoma does not grow rapidly in the elderly, but its accompanying unfavourable survival rate at five years is also approximately 5 per cent. In the case of symptomatic cholelithiasis, older high risk patients do especially profit from minimally invasive laparoscopic surgical procedures. Today, bile duct calculi are preferably treated by endoscopic papillotomy and following extraction of the calculi. The pancreas is subjected to atrophy, lipomatosis and fibrosis at the advanced age. However, these changes are rarely of clinical relevance. A frequent problem in clinical practice is that of constipation, from which 35% of patients suffer above the age of 65 years. Another typical symptom of the elderly is the incontinence, the different causes are being discussed. In advanced age, gastrointestinal hemorrhages are mostly occurring above the Treitz's ligament. Hemorrhages of the lower gastrointestinal tract occur mostly in the form of diverticle bleedings and those of angiodysplasias in the elderly. The diverticulosis is also a disease observed in over 50 per cent of patients above 70 years, but it is symptomatic in only part of the patients. When suspecting an inflammatory bowel disease in the elderly, the possibility of a mesenterial ischemia must always be considered as differential diagnosis. The classical chronic inflammatory bowel diseases can, however, also occur at advanced age. The colon carcinoma is one of the most frequent lethal causes in the Western countries 90 per cent of the cases of colon carcinoma are found in patients older than 50 years of age. Intensive attention is therefore required in this age group.