The total amount of CRP within the first 72 h after STEMI is crucial for the outcome

Background

The CAMI-1 study dealt with the depletion of CRP by apheresis in patients with acute myocardial infarction (AMI). CRP, the prototype human acute phase protein, has been known as a marker of poor prognosis in AMI and independently predicts 30-day mortality.

Methods

66 STEMI patients were enrolled following complete coronary revascularization (2–12 h after AMI). 32 patients received CRP apheresis, whereas 34 patients treated by standard protocols served as controls. CRP apheresis started 24±12 h and 48±12 h after onset of symptoms. A specific CRP adsorber removed ≤79% of the original CRP. 6000 ml of plasma was treated via peripheral venous access. Primary endpoint was myocardial infarction size as determined by Cardiac Magnetic Resonance Imaging (CMR) 3–9 days after STEMI.

Results

Aphereses sessions were well tolerated with no relevant side effects. The expected peak CRP level after AMI can be calculated precisely with 2–3 CRP quantifications during the first 24h after the onset of symptoms (CRP gradient). The regression coefficient for this analysis is 0.91. This mathematical step allows for the comparison of the CRP-apheresis group and the controls on the basis of their individual CRP gradients. The mean CRP gradient does not differ between both groups, whereas the mean area under the curve (AUC) of CRP within the first 72 h after AMI does. Thus, there was no bias in CRP kinetics between the two groups. The AUC of CRP is a significant indicator for infarct size (p=0.002), LVEF (p<0.001), circumferential strain (p<0.001), longitudinal strain (p=0.021). Therefore, the aphereses patients performed significantly better at all endpoints than the controls. The CRP apheresis significantly reduced myocardial damage by a reduction of the AUC of CRP. To our surprise, two apheresis patients had an infarct size of 0%.

Conclusions

For the first time we find an unequivocal association between myocardial infarct size and the AUC of CRP. The results show a significant beneficial effect of CRP apheresis on myocardial infarction size and wall motion. Selective CRP apheresis is now being further evaluated as a therapeutic approach in the treatment of acute myocardial infarction in a registry (CAMI registry).

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Pentracor GmbH

C-reactive protein increases myocardial damage after STEMI

Background

The CAMI-1 study dealt with the depletion of CRP by apheresis in patients with acute myocardial infarction (AMI). CRP, the prototype human acute phase protein, has been known as a marker of poor prognosis in AMI and independently predicts 30-day mortality.

Methods

66 STEMI patients were enrolled in the study following complete coronary revascularization (2–12 h after the onset of symptoms). 32 patients received CRP apheresis, whereas 34 patients treated by standard protocols served as controls. CRP apheresis started 24±12 h and 48±12 h after onset of symptoms. In case of a rapid increase in CRP plasma levels following the 2nd session, a 3rd session was carried out another 24 h later. A specific CRP adsorber removed up to 79% of the original CRP. In each apheresis session, 6000 ml of plasma was treated via peripheral venous access. Primary study endpoint was myocardial infarction size as determined by Cardiac Magnetic Resonance Imaging (CMR) 2–9 days after STEMI.

Results

Aphereses sessions were well tolerated with no relevant side effects. Peak CRP plasma levels after STEMI ranged from 9 to 279 mg/l. The expected peak CRP level after AMI can be calculated precisely with 2–3 CRP quantifications during the first 24 h after the onset of symptoms. The regression coefficient for this analysis is 0.91. This mathematical step allows for the comparison of the CRP-apheresis group and the controls on the basis of their individual CRP peak levels. The statistical evaluation shows that the CRP concentration is significantly associated with the damage (infarct size, LVEF, circumferential strain) in the controls. This association was lost in the aphereses patients: they performed significantly better at all endpoints (infarct size, LVEF, circumferential strain) than the controls. The CRP apheresis significantly reduced myocardial damage. To our surprise, two apheresis patients had an infarct size of 0%.

Conclusions

For the first time we find an unequivocal association between myocardial infarct size and the CRP concentration. This is in some respects a surprise, since the basic assumption in AMI is that the vascular occlusion leads to primary damage and the reperfusion to secondary damage, which would not have led one to expect such a clear dose-response relationship as that observed here. In addition, our results show a significant beneficial effect of CRP apheresis on myocardial infarction size and wall motion. Selective CRP apheresis is now being further evaluated as a therapeutic approach in the treatment of acute myocardial infarction in a registry (CAMI registry).

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Pentracor GmbH

A simple ex vivo model of human renal allograft preservation using the gonadal vein

INTRODUCTION

Hypothermic machine perfusion, an organ preservation modality, involves flow of chilled preservation fluid through an allograft's vasculature. This study describes a simple, reproducible, human model that allows for interrogation of flow effects during ex vivo organ perfusion.

MATERIALS AND METHODS

Gonadal veins from deceased human renal allografts were subjected to either static cold storage or hypothermic machine perfusion for up to 24 hours. Caspase-3, Krüppel-like factor 2 expression and electron microscopic analysis were compared between 'flow' and 'no-flow' conditions, with living donor gonadal vein sections serving as negative controls.

RESULTS

The increase in caspase-3 expression was less pronounced for hypothermic machine-perfused veins compared with static cold storage (median-fold increase 1.2 vs 2.3; P < 0.05). Transmission electron microscopy provided ultrastructural corroboration of endothelial cell apoptosis in static cold storage conditions. For static cold storage preserved veins, Krüppel-like factor 2 expression diminished in a time-dependent manner between baseline and 12 hours (P < 0.05) but was abrogated and reversed by hypothermic machine perfusion (P < 0.05).

CONCLUSIONS

Our methodology is a simple, reproducible and successful model of ex vivo perfusion in the context of human organ preservation. To demonstrate the model's utility, we establish that two widely used markers of endothelial health (caspase-3 and Krüppel-like factor 2) differ between the flow and no-flow conditions of the two predominant kidney preservation modalities. These findings suggest that ex vivo perfusion may mediate the induction of a biochemically favourable endothelial niche which may contribute tohypothermic machine perfusion's association with improved renal transplantation outcomes.

[Diuretic resistance and mechanical ventilation in decompensated cor pulmonale: successful treatment by slow continuous ultrafiltration]

We report on a 53-year-old male patient who presented with severe dyspnea at rest and massive volume overload because of decompensated cor pulmonale. Furthermore he suffered from stage 3 chronic kidney disease. As there was diuretics resistance and carbon dioxide narcosis, he had to be intubated and ventilated. The massive volume overload could be successfully treated with slow continuous ultrafiltration (SCUF) with removal of a volume of 27.5 l within 3 days. The SCUF therapy is an effective and gentle method to treat even an excessive volume overload based on diuretics resistance.

Mesangial IgA deposition in minimal change nephrotic syndrome: coincidence of different entities or variant of minimal change disease?

BACKGROUND

Mesangial deposition of IgA (MCA) is a very rare finding in minimal change disease and has previously been considered a pure coincidence. In the U.S. and Europe only anecdotal case reports exist. To date, there has been no consensus on nomenclature and categorization of this entity. We describe 2 cases of MCA with analogue histological findings but relevant differences in clinical presentation, and we discuss the clinical implications of mesangial IgA deposition in minimal change nephrotic syndrome.

PATIENTS

A 47-year-old female was admitted to hospital with nephrotic syndrome, microscopic hematuria, arterial hypertension and slight impairment of renal function 3 weeks after an unspecific upper airway infection. A 42-year-old male presented with nephrotic syndrome, microscopic hematuria, normotension and normal renal function. Both of the nephrotic syndromes were steroid-responsive and steroid-dependent.

FINDINGS

The clinical presentation of the male patient was consistent with the features of minimal change glomerulopathy, whereas the female patient combined signs of minimal change disease and IgA nephropathy. Light microscopy revealed mesangial IgA immune deposits and slight mesangial hypercellularity. Electron microscopic studies of MCA patients disclose diffuse effacement of glomerular foot processes.

CONCLUSION

Our cases and a review of the literature indicate that the histological diagnosis of MCA may comprise different pathogenetic entities. From the clinical point of view, MCA has to be regarded as a minimal change nephrotic syndrome with symptomatic or asymptomatic mesangial IgA deposition. IgA deposition constitutes a risk factor for impairment of renal function and indicates a frequently relapsing course.

[Age dependence of laboratory parameters in a health study--attempt at calculating a laboratory index for assessing biological aging]

The laboratory analyses of 404 participants of the health study GUNDULA, 201 men and 203 women between 30 and 80 years old, were performed to evaluate the variables for the determination of biological age. From the more than 70 laboratory variables resulting from clinical-chemical and hematologic tests and from urinalysis, less than 40 are significantly age-dependent. About half of these variables were examined by regression analysis to evaluate whether they are useful for the estimation of biological age by a laboratory index. Considerable sex differences were observed. The laboratory indexes for the participants altogether (resulting from 13 parameters) and separated for women (10 parameters) and men (8 parameters) show more variations than the biological age estimated by non-invasive parameters. In men only, there exists a significant but inverse correlation between laboratory index and relative aging rate, the difference between biological and chronological age. The results of some striking variables (e.g. dehydroepiandrosterone sulfate and others) and the results of an explorative factor analysis with regard to possible interconnections between variables and chronological age will be discussed.

A new superoxide-generating oxidase in murine osteoclasts

Superoxide production contributes to osteoclastic bone resorption. Evidence strongly indicates that NADPH oxidase is an enzyme system responsible for superoxide generation in osteoclasts. A membrane-bound subunit, p91, is the catalytic domain of NADPH oxidase. However, osteoclasts from p91 knockout mice still produce superoxide at a rate similar to that observed in wild type mice. This unexpected phenomenon prompted us to examine the osteoclasts for an alternative to the p91-containing oxidase. In this study, the cloning of a NADPH oxidase subunit (Nox 4) with 578 amino acids is reported. Nox 4 has 58% similarity in amino acids with the known p91 subunit of NADPH oxidase. Nox 4 is present and active in osteoclasts. Antisense oligonucleotides of Nox 4 reduced osteoclastic superoxide generation as well as resorption pit formation by osteoclasts. This new oxidase complex was present and functional in osteoclasts from p91 knockout mice, explaining the normal resorptive activity seen in the osteoclasts where no p91 is present.

Evidence that the N-terminal part of the S-layer protein from Bacillus stearothermophilus PV72/p2 recognizes a secondary cell wall polymer

The S-layer of Bacillus stearothermophilus PV72/p2 shows oblique lattice symmetry and is composed of identical protein subunits with a molecular weight of 97,000. The isolated S-layer subunits could bind and recrystallize into the oblique lattice on native peptidoglycan-containing sacculi which consist of peptidoglycan of the A1gamma chemotype and a secondary cell wall polymer with an estimated molecular weight of 24,000. The secondary cell wall polymer could be completely extracted from peptidoglycan-containing sacculi with 48% HF, indicating the presence of phosphodiester linkages between the polymer chains and the peptidoglycan backbone. The cell wall polymer was composed mainly of GlcNAc and ManNAc in a molar ratio of 4:1, constituted about 20% of the peptidoglycan-containing sacculus dry weight, and was also detected in the fraction of the S-layer self-assembly products. Extraction experiments and recrystallization of the whole S-layer protein and proteolytic cleavage fragments confirmed that the secondary cell wall polymer is responsible for anchoring the S-layer subunits by the N-terminal part to the peptidoglycan-containing sacculi. In addition to this binding function, the cell wall polymer was found to influence the in vitro self-assembly of the guanidinium hydrochloride-extracted S-layer protein. Chemical modification studies further showed that the secondary cell wall polymer does not contribute significant free amino or carboxylate groups to the peptidoglycan-containing sacculi.

[Biological age in patients with progressive scleroderma]

In 25 patients (10 male, 15 female) with systemic sclerosis aged between 28 and 79 years the biological age was determined. Alterations in the sense of "premature aging" were observed in the mean and developed stronger in male patients. They have to be counted in a greater part on the real process of disease. Compared to a healthy reference group, the expected diminishing of hand grip strength and tendon extensibility, vital capacity and partial oxygen pressure in the arteries could be confirmed. The latter correlated to an increase in rest pulse. Auditory acuity and the condition of the teeth were also reduced. Beyond that, noteworthy differences in psychological and social parameters not presumed at the beginning point to a decrease in social activities and to psychic changes. They underline the necessity of psychological counseling of the patients.

The relationship between insulin binding, insulin activation of insulin-receptor tyrosine kinase, and insulin stimulation of glucose uptake in isolated rat adipocytes. Effects of isoprenaline

We have studied the relationship between insulin activation of insulin-receptor kinase and insulin stimulation of glucose uptake in isolated rat adipocytes. Glucose uptake was half-maximally or maximally stimulated, respectively, when only 4% or 14% of the maximal kinase activity had been reached. To investigate this relationship also under conditions where the insulin effect on activation of receptor kinase was decreased, the adipocytes were exposed to 10 microM-isoprenaline alone or with 5 micrograms of adenosine deaminase/ml. An approx. 30% (isoprenaline) or approx. 50% (isoprenaline + adenosine deaminase) decrease in the insulin effect on receptor kinase activity was found at insulin concentrations between 0.4 and 20 ng/ml, and this could not be explained by decreased insulin binding. The decreased insulin-effect on kinase activity was closely correlated with a loss of insulin-sensitivity of glucose uptake. Moreover, our data indicate that the relation between receptor kinase activity and glucose uptake (expressed as percentage of maximal uptake) remained unchanged. The following conclusions were drawn. (1) If activation of receptor kinase stimulates glucose uptake, only 14% of the maximal kinase activity is sufficient for maximal stimulation. (2) Isoprenaline decreases the coupling efficiency between insulin binding and receptor-kinase activation, this being accompanied by a corresponding decrease in sensitivity of glucose uptake. (3) Our data indicate that the signalling for glucose uptake is closely related to receptor-kinase activity, even when the coupling efficiency between insulin binding and kinase activation is altered. They thus support the hypothesis that receptor-kinase activity reflects the signal which originates from the receptor and which is transduced to the glucose-transport system.

[Motivations for determining biological aging]

Studies to determine the biological age of a person are a major concern of gerontological research today. The use of test batteries is now a proven method, and the procedure developed in Leipzig covers 47 parameters including physical, mental, and social data. It can be seen from the related findings that this approach is suitable for dealing with specific questions in gerontology. These include the detection of medical risk factors and environmental effects, and confirmation of intervention strategies. The prime motives behind these studies then seem to be in keeping with practical requirements.

[Clinical, biochemical and anthropometric studies and determination of biological age in relation to body mass in a longitudinal study]

On 46 adipose persons (25 males and 21 females) and 53 test persons with normal weight (35 males and 18 females) at the age of 25-40 years since 1976 clinical, biochemical and anthropometric investigations as well as the determination of the biological age have annually been performed. Several of the parameters established (e.g. cholesterol, triglycerides, fasting blood sugar, blood pressure among others) in the course of 9 years within the well-known normal regions draw towards the adequate valid limit value to the pathological entity. The results of the study distinctly show the central role of obesity for the development of risk factors. Despite the partly only with a certain tendency recognizable behaviour of single parameters after 9 years from our point of view the longitudinal method represents itself as a very well suitable method for establishing dynamic processes and risk factors of age.

[Bioergography of Max Bürger]

For the inquiry into changes during ageing apart from the usual methods of the cross-sectional and longitudinal research the biographical analysis is at our disposal. The establishment of statistics of works is called bioergography. This method is particularly suitable for the recognition of changes of creativity of productive persons, as it is shown at the instance of Ludwig van Beethoven. The bioergography of Max Bürger reveals how form and essence of his work have changed in the course of his life without speaking about a decline of his vigour.

[Effect of obesity and food restriction on health and aging]

Based on experiences in animal studies, an attempt is made to illustrate all those mechanisms influencing the ageing process of human beings. The experimental part especially investigates the influence of food restriction in obese on the cardiovascular system and biological age. In middle-aged obese patients a normalization of initially altered noninvasive cardiodynamic parameters was achieved by isocaloric reduction diet. The biological age was influenced by food restriction too. If there is a correlation of overweight, food restriction and expectation live with human beings should be subject of further investigations.

[Sex differences in biologic aging. Results of an experimental study]

The authors report on first experimentally verified findings concerning the sex-specific ageing dynamism of man. The study is based on reference values of biological age which could be gathered by employing a clinical complex technique. This technique is conspicuous for its high precision; the reference-value quality of the model curves likewise satisfying all test theoretical criteria. The reference values of biological age characterize the dynamism of ageing within a randomized population group, i.e. 197 male and 168 female citizens aged between 18 and 75 years who were living in urban Leipzig and mainly employed in the working process. Remarkably enough, there hardly appear to be any differences between the two sexes as far as the rate of ageing is concerned. This causes the authors to emphasize the great importance of sex-differentiated morbidity for an increased mortality among men in the industrialized countries. A genetically predetermined higher rate of ageing among men and a resulting lower life expectancy exclusively contingent on it does not seem to exist. These experimentally obtained results correspond in tendency to epidemiological data.

[Changes in noninvasive cardiovascular parameters by inpatient weight reduction]

36 normotensive obese and 23 hypertensive obese were treated with an isokaloric reduction diet of 800 kcal/a day under clinical conditions over a 4-week span. Blood pressure and cardiac performance were investigated by means of non-invasive techniques such as systolic time intervals (STI) and calculated indices. A significant decrease was established in systolic time intervals such as left ventricular ejection time and total electromechanical systole, systolic and diastolic blood pressure, myocardial oxygen consumption and cardiac output. Heart rate, preejection index and stroke volume were not diminished under dietary treatment. No decrease of all parameters was found in obese normotensives with a weight reduction greater than 5% after dietary treatment.

[12 years' analysis of serum fatty acids--final results of the Leipzig Longitudinal Gerontologic Study]

In the Leipzig longitudinal study performed from 1968 to 1980 in 383 test persons with healthy metabolism in 2-3 years time intervals gas-chromatographic analyses of the serum fatty acid pattern were carried out. In dependence upon age, sex, and body-weight the vasoprotective linoleic, linolenic and arachidonic acid increased and the vasoaggressive palmitic and eicosatrienic acid decreased. Influences of age as well as the change of the feeding habits are causally discussed for this purpose.

[Interpretation of a vitality model from the clinico-experimental viewpoint]

The vitality model conceived by Beier from a theoretical point of view is corroborated by clinical and experimental investigations of the authors. From a randomized study on the biological age of a statistically representative population group it can be concluded that the speed of ageing of this group is not linear in its course and hardly displays any differences between the sexes. Besides, distinct selection effects in advanced age suggest that the human population might consist of two sub-populations (the potentially long-lived and the potentially short-lived) who differ from one another with regard to the speed of ageing, morbidity and to the duration of life. Furthermore, similarities of the sex-specific change in vitality as occurs in the course of life, and the significance of this change for a possible reduction of male over-mortality are pointed out.

[Diseases of lipid metabolism in advanced age. Relation to environmentally-induced factors]

Obesity as well as hyperlipoproteinemia increase in old age. There are some differences between both diseases with regard to their activity as risk factors. Both diseases are caused by environmental phenomena as for instance overeating and immobility.

Chronological and biological age

Resuming the thread of previous studies, this paper reports a new method of assessing biological age with the inclusion of physical, psychical, and social parameters. The suitability of the method was tested on a total of three hundred and sixty-five subjects. The results obtained allowed a reference curve to be plotted which can be considered a basis for an assessment of biological age.

[Methods for the determination of psycho-social performance within the scope of a model for objectivizing biological age]

With the help of experimental findings of a randomized study concerning the dynamics of ageing of a reference population (365 persons of either sex between 18 and 73 years) the authors adopt a principal attitude to methodical questions in objectifying the biological ageing. It is above all demonstrated, if and in how far the psycho-sociometric methods used in a gerontological complex method developed for this purpose meet certain methodical requirements (objectifity, reliability, validity) and are effective from the practical and clinical point of view. On principle it is referred to the necessity of a sex-different interpretation of findings concerning the dynamics of ageing and to the possibilities and borderlines, to attract them for a total assessment of the performance. The clinical model demonstrated for objectifying the biological ageing of man opens a wide field of theoretical and practical possibilities to gain recognitions on dynamics and influencibility of human ageing.

[Systolic time interval, stress ergometry and 133-xenon clearance in obesity]

Systolic time intervals were measured with 55 middle aged healthy normal weight and 76 healthy overweight probands in two positions (standing and lying). In 39 adipose patients and 55 normal weight subjects an ergometric work was carried out. A significant difference between normal and extremely adipose subjects without cardiac diseases could not be noticed with regard to the preejection index. Preejection period and left ventricular ejection time showed significant differences in both positions between normal and overweight probands, independent of blood pressure. In overweight patients there was a significantly decreased heart work load. The preejection index of adipose patients with a work load below 76 watts amounted to a mean value of 1,04. A work load of 100 watts was reached by only half of the adipose patients. In 32 adipose subjects with a heart work load above 75 watts the regulation of heart-rate and blood-pressure was not different from that of normal weight persons. Muscle blood flow was measured by 133Xenon-Clearance after Lassen et al. The measurement of the 133Xenon-Clearance of the arm muscle at rest in 29 adipose patients resulted in significantly lower values compared with normal weight persons.

Selected metabolic results of the Leipzig gerontological longitudinal study

The results of the longitudinal study show a gradual development of the overweight of young obese women. The decrease of weight in middle aged obese women is likely to be influenced by additional therapeutic measures by the physicians. It is interesting to note that men and women of normal weight do not develop overweight over a ten-years-span. Serum cholesterol increased in all age and weight groups within a ten-years-interval. The changes of the shares of total fatty acids were especially characterized by the decrease of palmitic acid and the increase of linoleic acid in the ten-years-interval. However age, weight and sex differences were present. The increase of uric acid level occurred with all test persons independent of sex. With test persons above 45 years a significant sex difference was noticed.

[The influence of the body weight on the 133 xenon clearance of the brachial muscles (author's transl)]

Muscles blood flow (MBF) was determined by 133-Xenon-Clearance at rest in 78 persons free of vascular symptoms. Significant differences were found between males and females with normal body weight. Depending on the special composition of both groups (normal subjects and obese under 60 years) there was no significant decrease of MBF with increasing age.

[Behavior of serum lipid parameters--results of a longitudinal gerontologic study]

Within the Leipzig longitudinal study from 1968 to 1978 in 158 test persons (46 males, 112 females) cholesterol and the total fatty acid spectre were gas-chromatographically determined in regular intervals. Serum cholesterol as well as proportions of linoleic acid increased significantly. By the significant decrease of the palmitic acid the percentages of the saturated fatty acids altogether decreased despite increase of stearic acid. In these cases the differences between males and females as well as between persons with normal weight and overweight more and more evened up. Ascertained correlations existed between reduction of the relative weight and decrease or more insignificant increase of cholesterol on the one hand and increase of linoleic acid on the other. The latter phenomenon is above all to be traced back to the fat-reduced diet and to the diet rich in polyene fatty acids which was more and more applied mainly by older test persons in the course of the longitudinal study, which thus may lead to antiatherogenic constellations of serum fatty acids.

[Creativity and age in the arts and sciences (author's transl)]

Studies into the relations between aging and creativity are reported. After a brief review of statistics on works of medical scientists, the author deals with the age-dependent creativity of composers and, more specifically, symphonists. Using the method of differential analysis of works, he then analyzes and discusses the composing activities of Beethoven, Brahms, and Bruckner.

[Socioeconomic importance of obesity]

It is reported on the annual deficiency of work, the stay in the hospital and the sanatorium as well as on the expenditure for these criteria which were established on 346 males with normal weight and 1,041 males with overweight and females at the age of 18--59 years within the research project nutrition and effect. With growing overweight in women as well as in men the days of deficiency of work, the duration of the stay in the hospital and the cost for this increase. In these cases the dependence on age concerns persons with normal weight and obese persons. It is referred to the prevention and early treatment of obesity.

[Frequency of bacteriuria in the aged (author's transl)]

1125 inhabitants of 2 homes for aged people were tested for bacteriuria by dip slides. Increasing of age did not lead to higher frequency of bacteriuria, neither in women (n = 869), nor in men (n = 256). The persons were divided in the 4 decades of being 61--70, 71--80, 81--90, and 91--99 years old. The corresponding rates of bacteriuria (greater than or equal to 10(5) germs/ml) were 14.0, 15.0, 12.4, and 9.1%, respectively. The rate of reproducibility was 75.4%, indicating still smaller values in reality. The discrepancies to the much higher values reported in the literature may depend on the people tested: "normal persons" instead of hospital patients or patients' specimens having been sent to a microbiological laboratory.

[Epidermiologic studies on nutritional behavior of adipose subjects]

In 1,000 obese persons and 250 persons with normal weight detailed anamneses of nutrition concerning the average daily intake of calories, carbohydrates, protein, fats, cholesterol, saturated and manifold unsaturated fatty acids were made. Obese persons ingested less food than persons with normal weight, - findings which on the one hand are explained with the different habits of eating in the dynamic phase (the hyperalimentation takes place above all in this phase) and the stationary one of obesity, on the other hand a further differentiation in hypophages, normophages and hyperphages should be performed. Finally frequency and structure of the meals are of importance. Tendencies of age did not occur in females, whereas all nutrients in males, beginning with the fourth decade of life, were ingested in a smaller degree than in adolescence. Longitudinal studies on the behaviour concerning nutrition are desirable.

[Behavior of the body weight in 2261 maturity-onset diabetics under conditions of ambulatory care]

Of 2,261 maturity-onset-diabetics (970 males, 1,691 females) body weight, size and Broca-index were established at the beginning of the treatment, one year after the beginning of the treatment and at the date of analysis (x=5.7 years after the manifestation of diabetes). 72% of the females and 49% of the males had a Broca-index of more than 10 at the beginning of the treatment. The average loss of weight of the diabetics of adult type with overweight with a Broca-index of more than 5 was in the first year 7.6 kg in males and 5.2 kg in females. In the first year after beginning of the disease in the diet group and in the buformin group was achieved an average reduction of weight in males of about 7 kg and in females of about 6 kg. After the first year of treatment in the groups mentioned the body weight remained or rose to one kg. The patients treated with sulfonylureas--compared with the diet-biguanide group--showed in the first year of treatment, indeed, a loss of weight which was about 50% smaller, however, also in the following years (x=4.7) a further continuous reduction of weight could be recognized. The initial results and the late results in the treatment of elderly diabetics with overweight show that, compared with former years, partial success is to be achieved with reduction cures performed in outpatient departments. The importance of the reduction of weight in elderly diabetics for the improvement of the carbohydrate tolerance and the fat metabolism is emphasized.

[Primary hyperlipoproteinemia and cardiovascular diseases in relation to age]

The primary hyperlipoproteinaemia is a frequently appearing disease of the second half of life. Out of 188 patients with hyperliporpoteinaemia 19% were at an age of 40-49 years, 33% at an age of 50-59 years and 51% of 60-69 years. The type IV of hyperlipoproteinaemia was the most frequent one (19%), in the second place was type IIa (21%) and in the third place was type IIb (14%). In the 5th decade of life type IV prevailed in males and type IIa in females, in the 6th and 7th decade of life nearly the same percentage for these types was to be found in both sexes. In 60% of the patients with hyperlipoproteinaemia we found a hypertension, in males in 20% coronary insufficiency appeared already in the 4th decade of life, then it rose to 70%, in females these appearances occurred about 10 years later. 9% of the patients fell ill from myocardial infarction. A general arteriosclerosis appeared in 63% of the males and in 89% of the females beginning with the 5th decade of life, then it still increased. Therefore, adequate preventive and curative measures (diet and pharmaca) are necessary in time.

[Methodological problems in the determination of biological age]

It is reported on a new method of the establishment of the biological age. The test battery designed comprises 12 parameters, from which a so-called biological index can be calculated which on its part serves as basis for the establishment of biological age. The realisability of the methods is demonstrated by examinations carried out on 340 healthy persons. The method developed for the geriatric practice is regarded as supplementation of the general medical examination and for the clarification of certain, above all gerontologically orientated questions.

[The relations between aging and disease]

In a survey concerning the relations between ageing and disease the peculiarities of a nosology referred to old age are discussed. From the point of view of clinical gerontology the compilation contains problems of the determination of the normal value, the demarcation of orthological and pathological changes caused by ageing, of the morbidity, the symptomatology and the therapy. The paper sketches the modern state of knowledge and refers to the continuation of clinical gerontology, the special task of which should last not least consist of the formation of a diagnostic and therapeutic standard adequate to age.

[Problems of food absorption with reference to age and obesity]

In 1,000 obese persons and 250 persons with normal weight detailed nutrition anamneses concerning the average daily intake of calories, carbohydrates, protein, fats, cholesterol, saturated and repeatedly unsaturated fatty acids were made. Obese persons took less food than persons with normal weight--findings which are to be explained by the different habits of eating in the dynamic (the hyperalimentation takes place above all here) and in the static phase of obesity. There were no age tendencies in women, whereas in men, beginning with the 4th decade of life, all the nutrients were taken in a smaller quantity than in adolescence.

[Influence of overweight on the load-capacity of the supporting and locomotion system in women]

119 50-year-old women were examined with regard to connections between apparatus of locomotion and overweight. Middle-aged women with overweight compared with women with normal weight more frequently complain of podalgias and of by Schober's signs objectifyable sacrodynias. Compared with women with normal weight in them a more frequent hyperlordosis can be established. The percentage of the degenerative spondylopathies of 61% and of the densitometrically established osteoporosis of 25.4% in the total material corresponds with literary data. There are no differences between women with normal weight and overweight. In contrast to persons with normal weight persons with overweight have only somewhat more frequently the combination of hyperlordosis with degenerative processes of the lumbar vertebral column. The biconcavity index established at the lumbar vertebral bodies is in the lower region in persons with overweight as well as in persons with normal weight. Osteoporotic lumbar vertebral bodies show a decreased frequently of spondylosis. There is no correlation between the radiological parameters established at the lumbar vertebral column and the objectified by Schober's signs decrease of the function of the lumbar vertebral column. A decreased height of the plantar arch and a correlating with this bredth of the step plane of the foot in adipose persons compared with normal persons we regarded as an expression of the increased load of the foot, also in such cases where a connection with the more frequent foot-complaints could not be ascertained. Perhaps it corresponds with that fact that only the developing flat-foot causes complaints. In general a positive correlation is to be found between the frequency of sacrodynias and podalgias.