Use of Very Low-Calorie Diet in Preoperative Weight Loss: Efficacy and Safety

PEKKARINEN, TUULA, PERTTI MUSTAJOKI. Use of very low-calorie diet in preoperative weight loss: Efficacy and Safety. We report the efficacy of a very low-calorie diet (VLCD)-based weight reduction program in patients with morbid obesity whose elective surgery had been postponed because of being overweight. The safety of weight loss on the immune system will also be evaluated. Thirty patients (mean age, 50 years; weight, 125 kg; BMI, 44 kg/m2) were treated. The program consisted of a 7-week to 24-week VLCD period, supported by individual sessions with a therapist, and of a refeeding period of 1 month before surgery. Two patients discontinued, and the mean weight loss of the remaining 28 patients was 19. 6 kg (15% of initial weight). In 23 patients, weight loss was 10% or more of the initial weight. After weight loss, 15 patients underwent surgery, 4 patients did not need an operation, and the remaining 9 patients were not operated on for various reasons. The numbers of circulating leukocytes, neutrophils, basophils, monocytes, CD3+, CD4+, CD8+, and natural killer cells did not change significantly by the ninth week on VLCD or by the end of the program. However, there was a significant (p<0. 05) decrease in the immunoglobulinM serum concentration during the program. In conclusion, a VLCD program is suitable for preoperative weight reduction in morbid obesity and seems not to compromise the immune system.     

Markers for the gene ob and serum leptin levels in human morbid obesity

Leptin, the product of the ob gene, reduces body fat in genetically obese animals and circulates in elevated concentrations in the blood of obese patients. Polymorphic markers situated in the proximity of the human ob gene have recently been suggested to be linked to morbid obesity. We have studied the possible association between the microsatellite markers near the ob gene and morbid obesity in 252 morbidly obese patients with a mean body mass index (BMI) of 43 ± 7 kg/m², and 151 lean controls with a mean BMI of 22 ± 2 kg/m², and searched for linkage of these gene markers to obesity in 76 affected sib-pairs (BMI ≥ 32). No significant association was observed between any of the eight microsatellite markers and morbid obesity, and affected-sib-pair analysis failed to show linkage of three selected ob gene markers to obesity in the sibships. There was a strong positive correlation between serum leptin levels and BMI in morbidly obese patients; a carrier status for either of the two most prevalent alleles of the microsatellite marker D7S530 in the vicinity of the ob gene was associated with serum leptin levels in the obese subjects. Two of the markers (D7S2519, D7S649) showed a significant relation to the weight-losing response to a 16-week very-low-calorie dietary intervention. We have thus been able to confirm a tight relationship between serum leptin and body mass but have found no evidence for genetic linkage of the ob gene markers to morbid obesity in a population considered to represent a genetic isolate and to be an ideal model for studies of complex disorders. Received: 25 October 1996 / Revised: 4 December 1996     

Studying Knowledge, Culture, and Behavior in Applied Medical Anthropology

In this article we argue that the concept of knowledge, as utilized by public health professionals, is best regarded as cultural belief as defined in anthropology. The implications of this position are explored, particularly as it relates to the development of a decision-making approach to the understanding and analysis of health care behavior. The methodological challenges posed by the new theoretical perspective that has emerged from the emphasis on decision making is discussed from the perspective of applied research. The role of focused ethnographic studies is examined and contrasted with ethnomedicine and survey approaches. Some main features of focused ethnographic methods are described and illustrated with a case example of acute respiratory infection (ARI) in Gambia. [knowledge and cultural beliefs, decision-making approaches, health behavior, focused ethnographic studies]     

Paleolimnological reflections of fiber-plant retting in the sediment of a small clear-water lake

Likolampi is a small groundwater kettle-hole lake in Ilomantsi, Eastern Finland. At 11 m water depth the uppermost 51 cm of sediment contains about 390 varves. A thin layer of chrysophyte statospores is the main structural unit in these; in some varves it is followed by a layer of cf. Drepanocladus fluitans moss spores. Below the laminated sequence, two layers of moss detritus (110–87 cm, 81–51 cm) alternate with greyish brown fine detritus. Pollen analysis reveals that the start of the deposition of varved sediment coincides with the beginning of intensive fiber plant retting with large quantities of Cannabis/Humulus -type pollen and even regular occurrence of the insect-pollinated Linum usitatissimum. The cf. Drepanocladus spores are almost absent during the retting period (c. 1590–1900 by the varves), but very common before and after it. Drepanocladus fluitans is capable of assimilating dissolved CO₂ in water, so it thrives at low pH and is typical for oligotrophic clear-water lakes. We conclude that the stratigraphy of Drepanocladus fragments and spores is a true negative indicator of cultural influence in Likolampi.     

Rapid classification of bacterial strains by SDS-polyacrylamide gel electrophoresis: population dynamics of the dominant dispersed phase bacteria of activated sludge

Summary Sodium dodecyl sulphate-polyacrylamide gel electrophoresis of total cellular proteins has been used to classify bacterial strains of the dispersed phase of activated sludge. The dominant bacterial populations are shown to be in dynamic change at species level while higher order taxons are more stable.     

Choroideremia: linkage analysis with physically mapped close DNA-markers

Summary We report linkage studies in 18 choroideremia (TCD) families using four closely linked polymorphic markers. Probe pZ11, which is known to be deleted in several unrelated patients with TCD, showed no recombinations (z _max 15.63 at = 0.00). In contrast, one recombination was observed with DXS367, which is also physically very close to TCD. Loci DXS95 and DXYS69 each showed more than one recombination with TCD. Moreover, these analyses revealed a double crossover between TCD and DXYS1, changing the previously reported very close linkage to a recombination fraction of 0.04 with a lod score of 9.93. Multipoint linkage analysis placed TCD proximal to DXS95-DXYS69 and very close to DXS367-pZ11 with almost identical multipoint lod score maxima either proximal to DXS367 (z _max= 23.43) or proximal to pZ11 (z _max=23.36). These results provide a refined linkage map around TCD and will also be useful in DNA diagnostics of the disease.     

Phytoplankton primary production in a eutrophic cooling water pond

The seasonal variation of phytoplankton photosynthesis was measured with ¹⁴C-method in a warmed ice-free pond in central Finland. Simultaneously with in situ measurements the photosynthesis was also measured in an incubator with different water temperatures and constant light (ca. 16 W m^–2). The total annual photosynthesis was 57.2 C m^–2 a^–1. The portion of the winter and spring production of the annual photosynthesis was 18.4%, that of the autumn production ws 17.4%. Thus 64.3% of the total annual phytoplankton photosynthesis occurred in the three summer months. The range of the daily integrated photosynthesis per unit area was 1.9—563 mg C m^–2d^–1. The photosynthetic rate per unit chlorophyll a varied in situ from 0.94 to 33.1 mg C (mg chl. a)^–1 d^–1. The highest value was measured in the beginning of July and the lowest in mid-January. The photosynthetic rate increased in situ exponentially with increasing water temperature. In the incubator the highest photosynthetic rate values were also found in July and August (at+20 °C) when the phytoplankton population was increasing and the minimum values occurred after every diatom maximum both in spring and autumn. Light was a limiting factor for photosynthesis from September to Mid-January, low water temperature was a limiting factor from late January through May. The efficiency of the photosynthesis varied between 0.1 and 0.7% of P.A.R. According to the incubator experiments the Q₁₀ values for the photosynthesis were 2.45 and 2.44 for the winter population between 1 and 10° C and for the summer population between 5 and 15° C, respectively, but the Q₁₀ values decrease at the higher temperatures. The main effect of the warm effluents on the yearly photosynthesis was the increase of production in spring months due to the lack of ice cover. However, the increase of total annual phytoplankton photosynthesis was only ca. 10–15%, because the water temperature was during the spring months below 10° C.     

Greenhouse gas fluxes from the eutrophic Temmesjoki River and its Estuary in the Liminganlahti Bay (the Baltic Sea)

We studied concentrations of carbon dioxide (CO₂), methane (CH₄) and nitrous oxide (N₂O) in the eutrophic Temmesjoki River and Estuary in the Liminganlahti Bay in 2003–2004 and evaluated the atmospheric fluxes of the gases based on measured concentrations, wind speeds and water current velocities. The Temmesjoki River was a source of CO₂, CH₄ and N₂O to the atmosphere, whereas the Liminganlahti Bay was a minor source of CH₄ and a minor source or a sink of CO₂ and N₂O. The results show that the fluxes of greenhouse gases in river ecosystems are highly related to the land use in its catchment areas. The most upstream river site, surrounded by forests and drained peatlands, released significant amounts of CO₂ and CH₄, with average fluxes of 5,400 mg CO₂–C m⁻² d⁻¹ and 66 mg CH₄–C m⁻² d⁻¹, and concentrations of 210 μM and 345 nM, respectively, but N₂O concentrations, at an average of 17 nM, were close to the atmospheric equilibrium concentration. The downstream river sites surrounded by agricultural soils released significant amounts of N₂O (with an average emission of 650 μg N₂O–N m⁻² d⁻¹ and concentration of 22 nM), whereas the CO₂ and CH₄ concentrations were low compared to the upstream site (55 μM and 350 nM). In boreal regions, rivers are partly ice-covered in wintertime (approximately 5 months). A large part of the gases, i.e. 58% of CO₂, 55% of CH₄ and 36% of N₂O emissions, were found to be released during wintertime from unfrozen parts of the river.     

Effects of temperature and oxygenavailability on greenhouse gas and nutrient dynamics in sediment of a eutrophic mid-boreal lake

The effects of oxygen conditions and temperature on dynamics of greenhousegases (CH₄, CO₂, N₂O) and nutrients(NH₄ ⁺, NO₂ ^–+NO₃ ^–, tot-P) were studied in sediment of hyper-eutrophic LakeKevätön, Finland. Undisturbed sediment cores were incubated at 6, 11,16, and 23 °C in a laboratory microcosm using a continuouswater flowtechnique with an oxic or anoxic water flow. The production of CO₂increased with increasing temperature in both oxic (Q₁₀ 3.2 ±0.6) and anoxic (Q₁₀ 2.3 ± 0.4) flows. The release ofCH₄ increased with temperature in anoxic conditions (Q₁₀2.3 ± 0.2), but was negligible with the oxic flow at all temperatures.The release of NH₄ ⁺ increased with temperature with the oxic and anoxic flows(Q₁₀ 2.4 ± 0.1). There was a net production of NO₂ ^–, NO₃ ^– and N₂O with the oxic flow at temperatures below16 °C. The release of phosphorus was greater from the anoxicsediments and increased with temperature with both the anoxic (Q₁₀2.9 ± 0.5) and oxic (Q₁₀ 1.9 ± 0.1) flows. It isprobable that the temperature of boreal lakes and the associated oxygendeficiency will increase as the climate becomes warmer. Our experiments showedthat this change would increase the global warming potential of greenhousegasesreleased from sediments of eutrophic lakes predominately attributable to theincrease in the CH₄ production. Furthermore, warming would alsoaccelerate the eutrophication of lakes by increasing release of phosphorus andmineral nitrogen from sediments, which further enhance CH₄productionin sediments.