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To compare two different management approaches in prenatally diagnosed twin reversed arterial perfusion (TRAP) sequence.Retrospective analysis of all cases with TRAP sequence diagnosed in one center over a period of 10 years. Prior to 2010, all cases were managed expectantly until 19 weeks' gestation; thereafter, patients could choose either radiofrequency ablation (RFA) or expectant management (Group A). From 2010 onward all patients were offered interstitial laser at the time of diagnosis (12 weeks at the earliest) or expectant management (Group B).Forty cases were included in the study. In Group A, 23 cases were diagnosed at a mean gestational age of 19.9 ± 6.3 weeks. Sixteen patients were managed expectantly (13 survivors, 81%), while six underwent RFA at the time of diagnosis and one later in pregnancy (six survivors, 86%). In Group B, 17 cases were diagnosed at a mean gestational age of 16.4 ± 4.7 weeks. Six patients chose expectant management (five survivors, 83%) and 11 had interstitial laser therapy at the time of diagnosis (eight survivors, 73%). The loss rate of the pump twin was not significantly different between Group A and Group B (three of 23 vs four of 17; P = 0.3). In Group B the rates of preterm premature rupture of membranes (PPROM) and delivery34 weeks were significantly lower, and gestational age at birth as well as birth weight were significantly higher than in Group A.Despite the limitations resulting from its retrospective design, our study on management of TRAP sequence adds some evidence in favor of prophylactic intervention by intrafetal laser from 12 weeks onward.

The results of surface pressure measurements are presented in this paper to gain further insight into the lift changing influence of finite width micro-tabs, especially in adjacent airfoil sections. Micro-tabs are a promising concept for load control on wind turbines. Local pressure distributions were measured in several rows of pressure taps in the vicinity of the finite width micro-tab attached to a FX 63-137 profile at low Reynolds numbers. The investigation focuses on length dependency, chordwise position, and interaction between two micro-tabs. Additionally, stereo Particle-Image-Velocimetry measurements were conducted to study the structure, sense of rotation, and influence of tab-induced tip vortices, as well as the impact of a finite width micro-tab on the model’s near wake. Experiments reveal relative changes of more than 30 % in the pressure coefficient distribution upstream of several micro-tab configurations. Furthermore, increments of 20 % are recorded in neighbouring sections not directly controlled by micro-tabs. Even higher changes are obtained in the region between two tabs. These improvements are attained due to local and global changes in the effective camber.Copyright © 2013 by ASME

Wind turbines generally suffer from unsteady inflow caused by yaw misalignment, gusts, and turbulence which induce fatigue loads. Spanwise distributed active micro-tabs at the mid and outer blade regions are able to countervail these unsteady loads. However, during the actuation process of these devices, transient effects play an important role. This work aims to give a deeper insight in the process of the tab deployment and retraction to evaluate the effectiveness of active micro-tabs for load control on wind turbines. Wind tunnel experiments on a two-dimensional NACA 0018 airfoil with an active micro-tab were conducted. The tab deployment- and retraction time was varied for an application on the suction or the pressure side of the airfoil. Time resolved surface pressure measurements were performed at Reynolds numbers of Re = 7 · 105 and 1 · 106. Transient responses showed a significant delay and post deployment behavior of the lift which strongly depend on the actuation time.Copyright © 2013 by ASME

The purpose of the work was to study the influence of the oral health environment at age 10, of adolescent and adulthood dental behaviours and of social status on oral health of three birth-cohorts in 1983 and two of the three birth-cohorts in 2006 in Norway.The material comprised data from random samples of three birth-cohorts living in the counties of Sør- and Nord-Trøndelag in 1983. The birth-cohorts were 1929-1938, 1939-1948 and 1959-1960. In 2006 two samples were drawn from the 1929-1938 and 1959-1960 birth-cohort. The data collection comprised standard clinical measurements and self-administered questionnaires. The early oral health environment and social status and gender were related to oral health in 1983 by multiple regressions. The impact of social status was studied in combined datafiles from 1983 and 2006.The oral health environment in childhood was important for adults' oral health. The attention from parents and the local environment lead to a better oral health outcome in adulthood. Social status affected choices leading to better oral health. Regular dental visits were important especially for the eldest birth-cohort. Good oral health behaviours early and during adulthood were also important for oral health. Judged by number of tooth surfaces the difference between social status groups had not increased by 2006.A life-course perspective provides an opportunity to understand oral health over time. The present study supports the assumption that oral health is continuously exposed to environmental and behavioural risks that lead to accumulated diseases in the dental tissues.

The purpose of the present study was to describe the oral health environment in preschool children and to examine the extent to which paired twins experience the same oral health environment.In collaboration with The Medical Birth Registry of Norway (MBRN) 100 twin families who participated in the Norwegian Mother and Child Cohort, were invited to take part in ongoing studies on oral health. Participating twin families lived in Oslo and the surrounding counties of the capital. The age range of the participating twins was 1-8 years. A clinical examination took place at The Institute of Clinical Dentistry, University of Oslo in 2008. The oral health environment was measured in two ways: 1) Interview. Mothers were interviewed by trained interviewers about oral health related habits of each of the twins. 2) Weekend diet log. Parents listed 84 different deserts, ice cream, sweets, cakes, cookies, fruits, snacks, and biscuits for each twin that were consumed on during the weekend. The statistical analyses comprised frequency distributions of the environmental variables and correlations between the variables within the pair of twins.The results showed a parental involvement in early tooth brushing and also an indication of tooth brushing not always being easy. Use of fluoride toothpaste started early, and two thirds of the children also used fluoride tablets. Use of pacifier was prevalent; the duration of use of pacifier and feeding bottle was relatively long. Nearly 75% of the parents indicated that they had no problems relatively to the twins' meals, and 53% mentioned that the twin pairs were different with regard to meals. Nearly 70% of the kindergartens had a clear health profile. The correlations varied between r = 0.45 and 1.00.The children in the present work were young, and the detailed information in this paper therefore adds to the knowledge of parental involvement in children's oral health. Generally the findings indicate a high level of involvement from the parents in the oral health environment at home. Altogether the results showed that the assumption of identical oral health environment cannot be supported by these data.

The neural cell adhesion molecule (N-CAM), is expressed in definite spatiotemporal patterns during development. To identify factors that may influence place-dependent n-cam gene expression, we have studied the binding and activation of the n-cam promoter by Pax-8, a member of the Pax family of transcription factors. Pax-8 increased n-cam promoter activity 13.4-fold in cellular co-transfection experiments, and a short segment of the promoter (-143 to -15) mediated the response. This region of the n-cam promoter produced a DNA-protein complex when incubated with either extracts from COS-7 cells transfected with the Pax-8 expression vector or a Pax-8/GST fusion protein. Pax-8 bound to the n-cam promoter through two TGCTCC motifs (designated PBS-1 and PBS-2) that resemble paired domain binding sites. Mutation of PBS-1 and PBS-2 eliminated Pax-8 activation of the n-cam promoter. Transfection of N2A neuroblastoma cells with the Pax-8 expression vector resulted in a 5-fold increase in the transcription of the endogenous n-cam gene. The combined results suggest that Pax-8 activates transcription of the n-cam gene through binding of sequences resembling paired domain binding sites in the n-cam promoter. The data raise the possibility that the n-cam promoter may be regulated by other members of the Pax gene family.

Previous studies have shown that in vitro expression of the neural cell adhesion molecule (N-CAM) can be regulated by the products of homeobox genes HoxB9, -B8, and -C6. N-CAM is a Ca(2+)-independent immunoglobulin-related CAM that plays an important role in neural development. In the present study, we investigated whether the liver cell adhesion molecule (L-CAM) a member of the Ca(2+)-dependent CAM family (cadherins) is also regulated by homeobox-containing genes. In transient cotransfection experiments of NIH 3T3 cells, we observed that both HoxD9 and liver-enriched POU-homeodomain transcription factor, HNF-1, activated chloramphenicol acetyltransferase gene reporter constructs containing the L-CAM promoter and an enhancer present in the second intron of the chicken L-CAM gene. Using electrophoretic mobility-shift assays, we found that components of cell extracts from NIH 3T3 cells transfected with HoxD9 bound to a small region of the L-CAM enhancer having a consensus sequence that is a putative binding site for HNF-1. Components of extracts from the chicken hepatoma cell line LMH that had been transfected with an HNF-1 expression vector also bound to this same site. In nuclear run-on experiments with nuclei from LMH cells that were transfected with expression vectors for HoxD9 or HNF-1, L-CAM RNA levels were increased 33-fold and 4-fold respectively. Using the same run-on procedure, it was confirmed that nuclei prepared from normal embryonic chicken liver cells expressed the RNAs for HoxD9, HNF-1, and L-CAM. Taken together with previous observations, these data raise the possibility that homeobox-containing genes will have a widespread role in the place-dependent expression of CAMs belonging both to immunoglobulin-related and to cadherin families.

OBJECTIVE-The incretin glucagon-like peptide 1 (GLP-1) exerts insulinotropic activity in type 2 diabetic patients, whereas glucose-dependent insulinotropic polypeptide (GIP) no longer does. We studied whether GIP can alter the insulinotropic or glucagonostatic activity of GLP-1 in type 2 diabetic patients. RESEARCH DESIGN AND METHODS-Twelve patients with type 2 diabetes (nine men and three women; 61 +/- 10 years; BMI 30.0 +/- 3.7 kg/m(2); HbA(1c) 7.3 +/- 1.5%) were studied. In randomized order, intravenous infusions of GLP-1(7-36)-amide (1.2 pmol . kg(-1) . min(-1)), GIP (4 pmol . kg(-1) . min(-1)), GLP-1 plus GIP, and placebo were administered over 360 min after an overnight fast (>= 1 day wash-out period between experiments). Capillary blood glucose, plasma insulin, C-peptide, glucagon, GIP, GLP-1, and free fatty acids (FFA) were determined. RESULTS-Exogenous GLP-1 alone reduced glycemia from 10.3 to 5.1 +/- 0.2 mmol/L. Insulin secretion was stimulated (insulin, C-peptide, P < 0.0001), and glucagon was suppressed (P = 0.009). With GIP alone, glucose was lowered slightly (P = 0.0021); insulin and C-peptide were stimulated to a lesser degree than with GLP-1 (P < 0.001). Adding GIP to GLP-1 did not further enhance the insulinotropic activity of GLP-1 (insulin, P = 0.90; C-peptide, P = 0.85). Rather, the suppression of glucagon elicited by GLP-1 was antagonized by the addition of GIP (P = 0.008). FFA were suppressed by GLP-1 (P < 0.0001) and hardly affected by GIP (P = 0.07). CONCLUSIONS-GIP is unable to further amplify the insulinotropic and glucose-lowering effects of GLP-1 in type 2 diabetes. Rather, the suppression of glucagon by GLP-1 is antagonized by GIP. Diabetes 60:1270-1276, 2011

An interdisciplinary working group from the German Society of Hospital Hygiene (DGKH) and the German Society for Anesthesiology and Intensive Care (DGAI) worked out the following recommendations for infection prevention during anesthesia by using breathing system filters (BSF). The BSF shall be changed after each patient. The filter retention efficiency for airborne particles is recommended to be99% (II). The retention performance of BSF for liquids is recommended to be at pressures of at least 60 hPa (=60 mbar) or 20 hPa above the selected maximum ventilation pressure in the anesthetic system.The anesthesia breathing system may be used for a period of up to 7 days provided that the functional requirements of the system remain unchanged and the manufacturer states this in the instructions for use. The breathing system and the manual ventilation bag are changed immediately after the respective anesthesia if the following situation has occurred or it is suspected to have occurred: Notifiable infectious disease involving the risk of transmission via the breathing system and the manual bag, e.g. tuberculosis, acute viral hepatitis, measles, influenza virus, infection and/or colonization with a multi-resistant pathogen or upper or lower respiratory tract infections. In case of visible contamination e.g. by blood or in case of defect, it is required that the BSF and also the anesthesia breathing system is changed and the breathing gas conducting parts of the anesthesia ventilator are hygienically reprocessed.Observing of the appropriate hand disinfection is very important. All surfaces of the anesthesia equipment exposed to hand contact must be disinfected after each case.

Improved glucose tolerance to sequential glucose loading (Staub-Traugott effect) is an important determinant of day-to-day glycemic exposure. Its mechanisms have not been clearly established. We recruited 17 healthy volunteers to receive two sequential oral glucose tolerance tests (OGTTs), at time 0 min and 180 min ( Study I). The protocol was repeated on a separate day ( Study II) except that plasma glucose was clamped at 8.3 mmol/l between 60 and 180 min. β-Cell function was analyzed by mathematical modeling of C-peptide concentrations. In a subgroup, glucose kinetics were measured by a triple-tracer technique (infusion of [6,6-2H2]glucose and labeling of the 2 glucose loads with [1-2H]glucose and [U-13C]glucose). In both Studies I and II, the plasma glucose response to the second OGTT equaled 84 ± 2% ( P = 0.003) of the response to the first OGTT. Absolute insulin secretion was lower (37.8 ± 4.3 vs. 42.8 ± 5.1 nmol/m2, P = 0.02), but glucose potentiation (i.e., higher secretion at the same glycemia) was stronger (1.08 ± 0.02- vs. 0.92 ± 0.02-fold, P = 0.006), the increment being higher in Study II (+36 ± 5%) than Study I (+19 ± 6%, P < 0.05). In pooled data, a higher glucose area during the first OGTT was associated with a higher potentiation during the second OGTT (rho=0.60, P = 0.002). Neither insulin clearance nor glucose clearance differed between loads, and appearance of glucose over 3 h totalled 60 ± 6 g for the first load and 52 ± 5 g for the second load ( P = not significant). Fasting endogenous glucose production [13.3 ± 0.6 μmol·min−1·kg fat-free mass (FFM)−1] averaged 6.0 ± 3.8 μmol·min−1·kg FFM−1between 0 and 180 min and 1.7 ± 2.6 between 180 and 360 min ( P < 0.03). Glucose potentiation and stronger suppression of endogenous glucose release are the main mechanisms underlying the Staub-Traugott effect.

SK3 K(+) channels influence neuronal excitability and are present in 5-hydroxytryptamine (5-HT) and dopamine (DA) nuclei in the brain stem. We therefore hypothesized that SK3 channels affect 5-HT and DA neurotransmission and associated behaviors. To explore this, we used doxycycline-induced conditional SK3-deficient (T/T) mice. In microdialysis, T/T mice had elevated baseline levels of striatal extracellular DA and the metabolites dihydroxyphenylacetic acid and homovanillic acid. While baseline hippocampal extracellular 5-HT was unchanged in T/T mice, the 5-HT response to the 5-HT transporter inhibitor citalopram was enhanced. Furthermore, baseline levels of the 5-HT metabolite 5-hydroxyindoleacetic acid were elevated in T/T mice. T/T mice performed equally to wild type (WT) in most sensory and motor tests, indicating that SK3 deficiency does not lead to gross impairments. In the forced swim and tail suspension tests, the T/T mice displayed reduced immobility compared with WT, indicative of an antidepressant-like phenotype. Female T/T mice were more anxious in the zero maze. In contrast, anxiety-like behaviors in the open-field and four-plate tests were unchanged in T/T mice of both sexes. Home cage diurnal activity was also unchanged in T/T mice. However, SK3 deficiency had a complex effect on activity responses to novelty: T/T mice showed decreased, increased or unchanged activity responses to novelty, depending on sex and context. In summary, we report that SK3 deficiency leads to enhanced DA and 5-HT neurotransmission accompanied by distinct alterations in emotional behaviors.

The Lagrange method for numerical prediction of particulate two-phase flows is discussed and reviewed. The numerical models used in calculating the particle trajectories, wall collisions and turbulence based movement, are presented. A venturi test case with high particle loading is treated and numerical and experimental results are compared. A circulating fluidised bed pre-separator is analysed and flow-particle coupled results at particle loadings up to 10 kg particles per kg air are presented. Convergence difficulties are discussed and a source smoothing method is introduced. Numerical and experimental results are compared and the reasons for the differences treated.

The aim of the present study was to describe the inter-individual variation in the plaque formation rate of 38 young adults.The plaque formation rate was estimated by employing a quantitative plaque percent index (P% index). A substantial inter-individual variation in the plaque formation rate was observed. The possible contributions of stimulated salivary flow rate, buffer capacity, diet and smoking to the variation in plaque formation were estimated by regression analysis.The control variables explained only 2.5% of the variance in the plaque formation rate. Neither associations nor the total model were significant. The present method of measuring plaque presented as a simple and time-effective procedure.It is suggested that the observed variation in the plague formation rate between the young individuals can be regarded as a biological function which is possibly an inherent individual characteristic. Studies with larger sample sizes are required to confirm the findings of the present study.

In the present investigation we aimed to analyse causally the pattern of determinants leading to the maintenance of functional teeth in adults. Clinical and self-reported information was used. The hypothesis was that socio-economic conditions operate through psychosocial circumstances that influence lifestyle, and are thus related to oral hygiene and levels of remaining teeth. Testing of the patterns for adults residing in high- and low-fluoride areas did not reveal any principal differences in dental health, therefore further testing was combined for both fluoride areas. Further analysis also indicated that testing should be performed separately for each gender. Social structure and dental health-related lifestyle were important in an overall pattern of maintaining functional teeth, but general lifestyle and psychosocial conditions were not found to be part of the pattern influencing dental health. Gender-specific patterns were revealed. New hypotheses may be suggested for further research with regard to studying patterns of dental health in Lithuanian adults.

National Cancer Center Network (NCCN) and Society of Surgical Oncology (SSO) practice guidelines recommend chest computed tomography (CT) as part of the staging evaluation of patients with extremity soft tissue sarcoma (STS). In the current study, the authors evaluated the use and yield of chest roentgenography (CXR) and selective chest CT to screen for pulmonary metastases in patients with T1 STS.The utility of these staging studies was evaluated retrospectively in a cohort of 125 consecutive patients who presented to a tertiary care cancer center with T1 primary (nonrecurrent) extremity STS. Two diagnostic strategies (CXR alone vs. CXR plus chest CT) were evaluated using an incremental cost-effectiveness ratio.The majority of tumors (70%) were high grade. The median sarcoma size was 3.0 cm; 64 of the tumors (51%) were located deep to the investing fascia of the extremity. All patients underwent staging CXR; 1 CXR (1%) was suspicious for metastatic disease. Fifty-one patients (41%) also underwent chest CT; 1 chest CT, performed in the patient with a suspicious CXR, revealed metastatic disease. With a median follow-up of 76 months, 19 patients (15%) developed metachronous pulmonary metastases. The relatively low yield resulted in an incremental cost-effectiveness ratio of $59,772 per case of synchronous pulmonary metastasis detected by CXR plus chest CT.Less than 1% of patients with T1 primary extremity STS were found to have pulmonary metastases that were detectable using a staging algorithm that employs routine CXR with the selective use of chest CT. The findings of the current study do not support current NCCN or SSO practice guidelines for patients with high-grade T1 STS.

The focus of this paper is caries in populations. Caries is assessed as a phenomenon and as it occurs in populations. It is observed that in recent literature the notion of causation of caries is restricted to the biological process on the tooth surface. This may be sufficient to explain caries as a phenomenon, but it is argued that a biological causation is insufficient in order to understand caries and its variation in populations. The understanding of the determinants of a population's oral health has been seriously impeded by the absence of a theoretical framework. A framework would be useful to the extent that it would bridge relevant categories for portraying complex causal patterns of caries in populations. An approach to a framework has therefore been outlined, and the idea of such a framework has been confronted with three critical comments. The framework is as yet pragmatic, incomplete, uncertain and fragmented. Yet, even such an approach may invite greater precision in epidemiological concepts about causes of caries than presently prevails. The framework directs attention to health effects of collective phenomena that cannot be reduced to individual attributes. The image proposed in this paper is intended to spur discussion about important aspects of the epidemiology of caries in populations.

Oral status in a population has traditionally been described by the DMFT index (decayed, filled, and missing teeth). There seems to be contradicting and confusing evidence in the literature with regard to the usefulness of different indices. Limitations of the DMFT are recognised, and attempts have been made to develop other indices. Two indices, DMFT and FS-T (filled and sound teeth) have been selected for analysis in the present paper. The purpose of this paper is to examine the relationship between DMFT and FS-T in different populations, and to show consequences of choice of index exemplified in analytical analysis. Data stem from the Trondelag-83 and -94 studies that were follow-up studies of the Norwegian portion of the 1973 International Collaborative Study. Sunflower scatter plots and regression analyses were used to describe the variation in DMFT and FS-T in different populations. DMFT was more suitable for describing variation in populations with low levels of disease than FS-T, while FS-T was more suitable for describing variation in populations with high levels of disease. It may be concluded that both DMFT and FS-T should be presented when describing oral status in a population. However, choice of index depends first of all on the purpose of the investigation. If there are theoretical reasons to prefer one index instead of the other, the superiority of the alternative index in terms of variation must be disregarded.

Based on a questionnaire of the General Hospital of Hamburg-Altona, we asked 738 patients about postoperative complaints such as nausea, vomiting, pain in the operating field and feeling of coldness in order to record the quality of the results of operation and anaesthesia in 1997 and 1998. The incidence of nausea and vomiting amounted to only 29% on average. One of our earlier studies of postoperative vomiting from 1995-1997 and the results gained from a control group of non-treated patients in our ondansetron study from 1995, which was conducted using information drawn from the routinely-used anaesthesia protocol and was therefore limited to data from the immediate pre- and postoperative period up to discharge of the patients from the recovery ward, showed much higher frequencies of nausea and vomiting (44 and even 66% on average, respectively). We cannot definitely evaluate whether the reduction in the average rates of nausea and vomiting in our present study is due to the additional preoperative application of 150 mg vomex supp. and 1.0-2.5 mg dehydrobenzperidol and/or 20-30 mg metoclopramid given i.v. shortly before the end of anaesthesia or to more intensive observation of non-medicinal prophylactic possibilities. But when we look at the frequency of nausea and vomiting in special groups of our present study, we can still find unacceptably high rates of nausea and vomiting, for instance 40% after cholecystectomies and abruptios and even 50% after struma operations. This shows that a satisfactory solution to this problem has not yet been found--partly due, unfortunately, to financial restrictions. Nevertheless, for 15% of the patients postoperative nausea and vomiting were of only minor importance for general satisfaction with the treatment given them. This was probably due to good premedication of amnestic after-effects of narcosis.

Data summarising caries levels differ between countries and often conceal large variations. These differences may reflect variations at individual, group, social and other levels. Caries and treatment experience differences are found to be significantly related to a variety of clinical and non-clinical factors. Variation in caries within Lithuanian children has been reported and related to background-, behavior-, dental care- and other factors. Variation in general or related to any factors in adult Lithuanian population has not been studied. The aim of the present study was to estimate variation in caries and treatment experience and relate them to biological-, psychosocial-, health-related, behavioral- and dental care related aspects. The existing knowledge from other oral health studies was used to select the factors found of importance in relation to variations in caries scores. The study consisted of clinical and self-reported data collected from a stratified random sample of 382 individuals (attendance rate 50%). Two statistical approaches, a bivariate and a multivariate, were applied. The two dependent variables DMFT and DS were tested with a set of independent variables. The bivariate analysis revealed significant associations for approximately one half of all variables studied. For multivariate testing, a backward linear multiple regression was used. Forty-one percent of the variation in DS was explained and 48% in DMFT scores. Differences in scores were related to various factors in the two analyses. The strength and significance of a few relationships differed in both of the analyses. The multivariate testing revealed some strong and significant associations with independent variables which were found to be weak and non-significant (P0.05) when tested bivariately and vice versa. Less than half of the variation could be explained in dental caries scores in 35-44-year-olds and not only dental care related factors were important. In both of the analyses, the varying degrees of strength (significance levels) give rise to a hypothesis that this incomplete explanation of the variation can be due to interrelated effects of different estimates.

The purpose of this analysis was to study temporal variation in oral health in an adult population. The cohort analysis comprised 1) estimation of longitudinal, cross-sectional, and time-lag differences in caries and treatment experience of the adult population in Trøndelag from 1973 to 1983 and to 1994; 2) assessment of which of the effects of age, period and cohort was the most plausible explanation for the observed differences and 3) discussion of causal and other factors underlying the effects of age, period and cohort.Cohort analysis was used to study changes in oral health over time. Study participants were selected by random sampling in 1973, 1983, and 1994 (n = 1959, n = 3195, n = 2341 respectively). The methods of data collection comprised standardised clinical measurements and a self-administered questionnaire. Cohort tables were established to analyse changes in DFT from 1973 to 1983 and DFT and DFS from 1983 to 1994.Four patterns of changes in oral health were identified from adolescence to older adulthood. They point in different directions which indicate that complex processes are present. There were two and three significant changes in the subsets of analysis. Assumptions and conditions that allow identification of separate cohort, period, and age effects appeared not to be present. The pattern of changes was consistent with main effects of both age, period, and cohort. The effects were discussed from the perspective of the chosen frame of explanatory factors.The changes in oral health between populations in 1973, 1983 and 1994 were the combined consequences of simultaneously occurring factors that account for both age, period and cohort effects.

Our current concept of stationary workplaces results in an interruption in patient monitoring and treatment. Because transfers are invariably associated with a reduction or interruption in the monitoring and treatment chain, an endangerment to critically-ill patients, as well as a significant increase in the mortality rates, can result.In the new construction of the Cardiac Clinic, the previous concept of immobile anesthesia and intensive care workstations has been completely abandoned. The complete treatment workstation, including monitoring and fluid management, is set up on a bedside cart which accompanies the patients uninterruptedly--from anesthesia administration, to the operating room, to the ICU or recovery room, as well as during elective or emergency interventions outside the ICU. Transport times and complications from 995 transports (ASA III and IV) were analysed and compared with 880 transports with the conventional system.During all intrahospital transfers with the mobile workplace, there were no complications resulting from faulty operation or accidental adjustment of the perfusors, or from disconnecting the monitoring,-, respiration-, or infusion lines. On the whole, there were fewer cases of circulatory instability during transport, since infusion treatment and medication could be administered without interruption. All hemodynamic parameters were recorded during transport, as were cardiac minute output and right- and left-atrial filling pressures. The mobile workplace system allows for the shortest possible transport and exchange times--13.5 min, as compared to 42.5 min with the conventional system. The reconnection of monitoring equipment with zeroing, adjustment of the alarm limits, as well as exchanging perfusors and infusomats before and after transport is eliminated entirely.This mobile workplace, in which all components of the anesthesiological and intensive care workstations are integrated, guarantees the highest possible level of patient safety, since nothing has to be disconnected until the patient is transferred to a normal-care ward. In addition to the improved ergonomic design of the nurse's and doctor's workplace, substantial savings can also be made.

107 Swedish subjects, all 20 years old, were studied for the first three years (1990-1992) after they had left the organised dental care for children and adolescents (which is free of charge for all youth through the age of 19). They were registered in four different risk-grouping systems in order to estimate the amount of their future dental care. Three of the systems used registrations from the Public Dental Service records and in the fourth one a dentist made a subjective estimation. The follow-up used dental insurance claims to study performed treatments, courses of treatments and cost. The risk group system that used subjective estimations appeared to be the one that most accurately predicted the actual dental care consumption. Approximately 70% of the subjects received some kind of dental care during the three years. The distribution was not confined to any particular risk group. Ten per cent had received complete dental care annually. Twenty-five per cent went to a private dentist and 75% continued to go to the Public Dental Service. Those who went to a private dentist received substantially more treatment and the annual cost was a little more than twice as much as in the Public Dental Service.

To describe the dental care consumption in a random sample of the population of a Swedish county 1990-1992 and to compare this with results from other Swedish studies, especially those using different self-reporting methods.One sixtieth of all adult inhabitants in the County of Göteborgs and Bohus län (all individuals born on the 17th day of an odd month) formed the sample.All insurance claims sent from both public and private dentists to the local insurance offices were registered in a data base. Thus every treatment registration was collected into this data base, independently, whether it was made in a private clinic or in the Public Dental Service and whether or not by a dental hygienist or other grade. Since almost all dental care in Sweden was performed within the dental insurance system, these registrations could be regarded as very near to the total dental care consumption of this group. The registrations were related to the age of the patient, the type of care (acute/regular), regularity, dental hygienist treatment and other factors.It was found that the youngest and the oldest patients visited a dentist less often, that approximately a quarter received hygienist care, that many received emergency treatment sometime during the observation period but that a majority also had regular dental care. Studies using a self-reporting technique reported a systematically higher level of consumption than those using insurance claim registration.Dental care consumption studies using self-reporting methods will probably overestimate the actual consumption. Emergency treatment is frequent even among patients who go to a dentist regularly.

BACKGROUND Gas exchange is impaired during general anaesthesia due to development of shunt and ventilation-perfusion mismatching. Thoracic epidural anaesthesia (TEA) may affect the mechanics of the respiratory system, intrathoracic blood volume and possibly ventilation-perfusion (VA/Q) distribution during general anaesthesia. METHODS VA/Q relationships were analyzed in 24 patients undergoing major abdominal surgery. Intrapulmonary shunt (Qs/QT), perfusion of "low" VA/Q areas, ventilation of "high" VA/Q regions, dead space ventilation and mean distribution of ventilation and perfusion were calculated from the retention/excretion data of six inert gases. Intrathoracic blood volume (ITBV) and pulmonary blood volume (PBV) were determined with a double indicator technique. Recordings were made before and after administration of 8.5 +/- 1.5 ml bupivacaine 0.5% (n = 12) or 8.3 +/- 1.8 ml placebo (n = 12) into a thoracic epidural catheter and after induction of general anaesthesia. RESULTS Before TEA, Qs/QT was normal in the bupivacaine group (2 +/- 2%) and the placebo group (2 +/- 3%). TEA covering the dermatomal segments T 12 to T 4 had no effect on VA/Q relationships, ITBV and PBV. After induction of general anaesthesia Qs/QT increased to 8 +/- 4% (bupivacaine group, P < 0.05 and to 7 +/- 2% (placebo group, P < 0.05). ITBV and PBV decreased significantly to the same extent in the bupivacaine group and the placebo group. CONCLUSIONS TEA has no effect on VA/Q distribution, gas exchange and intrathoracic blood volume in the awake state and does not influence development of Qs/QT and VA/Q inequality after induction of general anaesthesia.

Recurrent cough and asthma are common problems in children. In the evaluation of children with recurrent cough, the sequential measurements of airway responsiveness (AR) and capsaicin cough receptor sensitivity may be useful. However, the effect of capsaicin on AR induced by an indirect stimulus such as hypertonic saline (HS) is not known. Current evidence suggests that a common pathway is involved in both capsaicin and HS challenges. This study was designed to determine whether inhalation of capsaicin for the cough receptor sensitivity test before HS challenge will alter AR of asthmatic and non-asthmatic children to that challenge. Twenty-one children (12 asthmatics, 9 non-asthmatics; mean age, 11.3 years) performed the HS challenge alone or 2 min after capsaicin inhalation on 2 different days in random order. The end point of the capsaicin inhalation was whenor = 5 coughs were stimulated from a single inhalation. The power of the study was90% at a significance level of 0.05. Capsaicin inhalation prior to HS challenge did not alter the AR of normal children. In the asthmatic group, the PD15 (provocation dose causing a fall in forced expiratory volume in 1 s ofor = 15% from the baseline) without prior inhalation of capsaicin (mean, 2.44 +/- SEM 1.21 ml) was not significantly different from that when HS challenge was performed after capsaicin inhalation (mean, 2.19 +/- SEM 0.83 ml). The mean of the difference in log PD15 of the HS challenge with and without capsaicin was -0.02 (95% CI, -0.16, 0.12), i.e. within the equivalence range of the HS challenge in children with asthma. We conclude that in normal and asthmatic children, capsaicin inhalation does not alter AR to HS; consequently the capsaicin cough sensitivity test can be performed validly before an HS challenge.

Homeobox genes are regulators of place-dependent morphogenesis and play important roles in controlling the expression patterns of cell adhesion molecules (CAMs). To identify proteins that bind to a regulatory element common to the genes for two neural CAMs, Ng–CAM and L1, we screened a mouse cDNA expression library with a concatamer of the sequence CCATTAGPyGA and found a new homeobox gene, which we have called Barx2 . The homeodomain encoded by Barx2 is 87% identical to that of Barx1 , and both genes are related to genes at the Bar locus of Drosophila melanogaster . Barx1 and Barx2 also encode an identical stretch of 17 residues downstream of the homeobox; otherwise, they share no appreciable homology. In vitro , Barx2 stimulated activity of an L1 promoter construct containing the CCATTAGPyGA motif but repressed activity when this sequence was deleted. Localization studies showed that expression of Barx1 and Barx2 overlap in the nervous system, particularly in the telencephalon, spinal cord, and dorsal root ganglia. Barx2 was also prominently expressed in the floor plate and in Rathke’s pouch. During craniofacial development, Barx1 and Barx2 showed complementary patterns of expression: whereas Barx1 appeared in the mesenchyme of the mandibular and maxillary processes, Barx2 was observed in the ectodermal lining of these tissues. Intense expression of Barx2 was observed in small groups of cells undergoing tissue remodeling, such as ectodermal cells within indentations surrounding the eye and maxillo-nasal groove and in the first branchial pouch, lung buds, precartilagenous condensations, and mesenchyme of the limb. The localization data, combined with Barx2 ’s dual function as activator and repressor, suggest that Barx2 may differentially control the expression of L1 and other target genes during embryonic development.

In the wild, tree shrews (Tupaia belangeri) live in pairs in territories which they defend vigorously against strange conspecifics. The paper gives an overview on some of our laboratory studies with tree shrews, which demonstrate the great relevance the concepts of Jim Henry have in understanding the biological relevance of mammalian social behavior. A basic result of these studies is that the physiological consequences of social relations between mammals depend on the appraisal of the situation by the animals and their coping behavior. Appraisal of a stimulus or a situation, as well as the resulting coping behavior, are basically psychological processes. There are, therefore, no simple relationships between stimuli imposed on individuals and their physiological responses; rather the behavioral, psychological and, thus, the physiological responses of individuals to stimuli differ depending on their genetics, prenatal influences and postnatal learning processes. This means, to understand the consequences of social relations between individuals, an integrated approach is required to assess which factors, including social rank and bonds to conspecifics, interact to affect an individual's fertility and health, as has been so clearly demonstrated in the work of Jim Henry.

Life-threatening cardiovascular complications are a serious risk even for healthy patients during spinal/epidural anaesthesia. The incidence of fatal cardiovascular complications for epidural anaesthesia is 1:10000, for spinal anaesthesia 1:7000. In contrast, general anaesthesia has an overall mortality of only 1:28000. Administration of IV fluids to minimise the haemodynaemic reactions of beginning sympatholysis is not always sufficient. In this study, we examined whether fractionated application of local anaesthetics via a spinal catheter would provide better haemodynamic stability.In a prospective study, we examined the haemodynaemic reactions of 300 patients during single-dose (n = 150) versus continuous spinal anaesthesia (CSA) (n = 150). Isobaric bupivacaine 0.5% was given through a 29 G Quincke needle (3.5 ml) or a 28 G spinal catheter (1.5 ml as a bolus, followed by 1 ml/10 min until an anaesthetic level of T12 was reached).The sensory and motor effects of both methods were comparable. The T12 level of anaesthesia was achieved with the single-dose method after 10.5 min and with the continuous method after 19.1 min. After single-dose anaesthesia, the blood pressure dropped by 16.5% and the heart rate by 12% compared to the control values. During CSA no significant blood pressure changes were recorded; the heart rate decreased by 8%. In 15 cases vasoconstrictors had to be given to stabilise the lowered blood pressure after single-dose anaesthesia.With the use of CSA, the haemodynamic effects of sympatholysis can be minimised. This method thus has advantages, especially for high-risk cardiovascular patients.

Although continuous spinal anesthesia with microcatheters has a number of advantages, there are also some drawbacks: technical problems in advancing the catheter, the possibility of traumatizing neural structures, the development of cauda equina syndrome, and maldistribution of the local anesthetic.Spinaloscopy was performed with a 2-mm-diameter endoscope in fresh cadavers to visualize the fate of the catheters, as well as the distribution of the local anesthetic administered through these fine-bore catheters. Midline and paramedian approach achieved an easy insertion of the 28-gauge catheter as long as the 22-gauge needle was not advanced too far into the subarachnoid space, thereby making it impossible for the catheter to bend at the anterior wall of the dura mater.Injection of methylene blue-colored hyperbaric local anesthetic through the catheter revealed an inhomogenous distribution with pooling in the caudal segments. After the catheter tip leaves the needle, the catheter should be advanced only 2-3 cm to avoid coiling, possible damage of the nerve roots, or malpositioning in preformed pouches.To take advantage of continuous spinal anesthesia, a meticulous technique is required.

Scores of homeobox gene-encoded transcription factors are expressed in a definite spatiotemporal pattern during embryogenesis and regulate a series of as yet unidentified target genes to help coordinate the morphogenetic process. We have suggested that homeobox gene products modulate the expression of adhesion molecule genes and have shown in cotransfection experiments that the promoters for the neural cell adhesion molecule (N-CAM) and cytotactin/tenascin genes respond to cues from different homeobox-containing genes. In this study, we show that the HoxC6 (Hox-3.3)-encoded homeoprotein binds to a DNA sequence in the N-CAM promoter CCTAATTATTAA, designated homeodomain binding site I (HBS-I). To test whether HoxC6 regulated N-CAM promoter activity, we cotransfected the Long and Short reading frame variants of Xenopus HoxC6 (CMV-HoxC6-L and CMV-HoxC6-S) driven by the human cytomegalovirus (CMV) promoter together with a chloramphenicol acetyltransferase (CAT) reporter gene driven by the mouse N-CAM promoter (N-CAM-Pro-CAT). Cotransfection of NIH 3T3 cells with either of the CMV-HoxC6 expression vectors stimulated N-CAM promoter-driven CAT expression. A 47-bp region from the N-CAM promoter that included HBS-I and an adjacent potential HBS, HBS-II, conferred HoxC6 regulation on a simian virus 40 minimal promoter. HBS-I was sufficient for transactivation of the minimal promoter by CMV-HoxC6-S. However, transcriptional activation by CMV-HoxC6-L required both HBS-I and HBS-II, inasmuch as mutation of either HBS-I, HBS-II, or both motifs abolished the response. These studies suggest that HBS-I is a target site for binding and transcriptional control of the N-CAM promoter by homeoproteins, although accessory DNA sequences (such as HBS-II) may also be required. Together with previous studies, these results support the notion that N-CAM gene expression may be controlled by different combinations of homeoproteins that appear in a place-dependent manner during embryogenesis.

To establish precise correlations between high-resolution computed tomography (CT) and normal pulmonary anatomy and pulmonary pathology, 49 lungs affected by different diseases were analysed. Post-mortem high-resolution CT scans were compared with the corresponding macroscopic and microscopic pathological findings. For scanning, lungs were inflated and fixed, which avoided any decrease in the structural resolution of pulmonary parenchyma and allowed a topographically exact correlation between CT appearances and morphological changes. After demonstration of the structural details relevant for CT in normal pulmonary parenchyma, an attempt is made to establish the morphological basis of the following CT phenomena: thickening of interlobular septae, increase in pulmonary translucency, consolidation of the non-nodular alveolar and of the nodular type, and changes in the pleural region. Although CT findings in pulmonary lesions are mainly non-specific, knowledge of the corresponding morphological basis is helpful in diagnostic evaluation.

The aim of the present study was a comparison of the intraoperative sympathoadrenergic response and the postoperative vigilance of a propofol/alfentanil anaesthesia to a conventional isoflurane anaesthesia. 25 patients were admitted to the study undergoing septorhino surgery. Patients with continuous intravenous anaesthesia with propofol/alfentanil combined with nitrous oxide showed better haemodynamic conditions without an increase of blood pressure and catecholamines under laryngoscopy, intubation and surgical stimulation. In contrast to that the patients with isoflurane anesthesia showed a significant increase in haemodynamic parameters and capillary bloodflow. The measured plasma adrenalin levels showed wide intraindividual fluctuation but no significant difference between the groups. The suppression of plasma noradrenaline was more pronounced under intravenous anaesthesia. Recovery was significantly faster and vigilance significantly better in the patients undergoing intravenous anaesthesia. After 30 min patients with i.v. anaesthesia fulfilled all the conditions to be transferred to the regular ward; the other group needed more than one hour. It can be concluded that continuous i.v. anaesthesia with propofol/alfentanil is superior in suppressing the stress response to invasive stimuli and provides faster recovery and better postoperative analgesia.

The technique of combined spinal epidural anaesthesia (CSE) combines the versatility of spinal with the variability of epidural anaesthesia. Spinal application of the local anaesthetic achieves a fast response, reliable sensorial and motor block at a low dose with little toxicity. The epidural catheter allows for the duration of surgical anaesthesia to be extended and provides analgesia for the postoperative period. As the incidence of post dural puncture headache (PDPH) is inversely related to the size of the spinal needle, PDPH rarely or never occurs when 29 gauge needles are used. In 1775 parturients receiving spinal anaesthesia for caesarean section, Dittmann et al. [4] reported an incidence of PDPH of 1.37% with 29 gauge needles. The 29 gauge needle produced by Becton-Dickinson is the one now most frequently used for this technique. It is recommended that these needles be reused after resterilization. The objective of this study was to examine how clean 29 gauge spinal needles really are after resterilization. MATERIALS AND METHODS. Fifteen needles (29 gauge; Becton-Dickinson) were routinely used for combined spinal epidural anaesthesia. After identification of the epidural space at the L3-4 spinal segment with the 18 gauge Tuohy needle, the 29 gauge needle was advanced through the Tuohy needle. Immediately after use the needles were cleaned, rinsed with 20 ml distilled water, dried with pressurized air and subsequently resterilized in gas. Preparation of the used needles was in accordance with the manufacturer's recommendations ("wash, rinse, dry, sterilize before initial and each subsequent use") and with generally accepted principles [6]. Two needles were additionally cleaned in an ultrasonic bath for 15 min. The needles were examined using a scanning electron microscope. After this analyses, eight needles were sterilized again and then taken for hygienic examination. They were incubated with trypticase soy broth and checked for bacterial growth. RESULTS. Scanning electron microscopy (ScEM) showed organic impurities on all needles. These impurities were equally distributed among all needles. Even the two cleaned in the ultrasonic bath were not free of organic particles. However, no material defects or damage could be seen. Hygienic evaluation proved sterility as no bacterial growth could be detected. CONCLUSION. Owing to the possibility of medico-legal consequences, which sometimes occur a long time after anaesthesia has been given, we think it is unwise to reuse such needles. We hope that disposable and cheap 29 gauge needles will soon become available.

Accidental subdural injections and catheterisations are a complication of epidural and spinal anaesthesia. The incidence of subdural spread in myelographies is estimated to be over 10% by the spinal technique. With spinaloscopy in an anatomic human model, we analysed the puncture process and the influence of different needle types on the incidence of subdural injection. We compared 22-gauge Sprotte, Quincke, and 18-gauge Tuohy needles in median and paramedian approaches with various bevel orientations. METHOD. The studies were performed in a preserved and recently expired cadaver donated to the Institut für Anatomie, Westfälische Wilhelms-Universität, Münster. The spinal column from T12 to S1, together with the back musculature (in order to preserve the normal curvature of the spine), were removed from the cadaver. Spinaloscopy was performed with a 4-mm endoscope with a 0 degree optic (Storz, Tuttlingen, Germany). All observations were made in the lumbosacral region of the dissected preparation. The endoscope was inserted from the caudal end of the spinal canal and, depending on the observations being made, the spinal canal was filled with air or artificial cerebrospinal fluid (CSF). To obtain information on the distribution of local anaesthetics injected into the subarachnoid space, 0.5% bupivacaine was coloured with a small amount of 1% methylene blue. The distribution of the coloured anaesthetic was clearly visible during and after injection. RESULTS. Needle insertion: Multiple observations were made using median or paramedian advancement of the needle into the spinal canal. With all needles, including the pencil-point, we saw an unexpected inward movement of the dura to the epidural space before penetration. This dural movement was independent of the direction of the dural fibres in the lumbar area. Distribution of local anaesthetics: Our observations indicate that difficulty with injecting drugs occurred when needle insertion was stopped too close to the dura, especially with the Sprotte needle. After manually registered penetration of the dura, the lateral opening of the needle only partially penetrates the dura. This allows CSF to appear in the needle hub, and injection into the vertical subdural space is possible. In all cases with the Sprotte needle, we could reproduce deposition of methylene-blue-coloured local anaesthetics into the subdural space. With the Quincke and Thuohy needles, it was not possible to deposit local anaesthetics into the subdural space in this model. CONCLUSION. Spinaloscopy was done in a non-fixated anatomic preparation of a spinal column with a 4-mm, 0 degree endoscope. From these observations we conclude that both manually registered penetration of the dural and the appearance of CSF in the needle hub can mimic correct needle position. Especially with the lateral opening of the Sprotte needle, deposition of local anaesthetics in the subdural space is possible.

Continuous spinal anaesthesia has a number of advantages, but there are a number of drawbacks as well: difficulties in threading the catheter, distribution of the local anaesthetics and the development of cauda equina syndrome. Spinaloscopy was done to visualize the fate of catheters during and after their insertion, as well as the distribution of local anaesthetics injected through these fine-bore catheters. METHOD. The studies were conducted in preserved and fresh cadavers donated to the Anatomic Institute for Medical Studies. The spinal column from T12 to S1, together with the back musculature (in order to preserve the normal curvature of the spine) were removed from the cadaver. Spinaloscopy was done with a 4 mm endoscope with a 0 degree optic (Storz, Tutlingen, FRG). All observations were made from the lumbosacral region of the dissected preparation. In this fashion, it was possible to observe the insertion of the spinal needle used to introduce the catheter into the subdural space. The distribution of local anaesthetics injected through a 22-gauge spinal needle or a 28-gauge catheter was shown by injecting 0.5% hyperbaric bupivacaine colored with a small amount of 1% methylene blue. Pictures were taken 15, 30 and 45 s after beginning the injection. RESULTS. Difficulty in threading the catheter: our observations indicate that the difficulty in inserting microbore catheters is most likely due to inserting the needle too far. It is impossible for the catheter to bend and be inserted into the subarachnoid space. In many cases the catheter encountered the anterior wall of the spinal canal and would slide along various structures. Distribution of the drug: the injection is better dispersed with a 22-gauge needle and it completely fills the subarachnoid space. The local anaesthetics injected through the 28-gauge nylon catheter (Kendall Healthcare, Mansfield, Mass.) are distributed in the dependent portions of the spinal canal. If high doses and a high concentration are injected, the distribution pattern may result in an overconcentration in some parts of the subarachnoid space. Possibility of trauma: the catheter stretches around the roots, the potential for trauma is that untoward stress may be applied to the root, either during full insertion of the catheter or during its withdrawal. CONCLUSION. Spinaloscopy was done in a non-fixated anatomic spinal column preparation with a 4 mm 0 degree endoscope (Storz, Tuttlingen, FRG). Based on our observations, we conclude: The catheter should only be inserted 2 cm into the subarachnoid space. This may decrease the risk of malpositioning. After the tip of the catheter has reached the subarachnoid space, the stylet should be with drawn 2 or 3 cm to minimize the risk of nerve injury and/or bleeding.

The aim of the present study was to describe the Norwegian adult population according to: 1. number of teeth present, 2. demand and utilization of dental services, 3. travel time from home to the dentist, 4. dental health behaviour, 5. fear for dental treatment. The analyses were performed on a set of national data collected in 1989, which was representative of the non-institutionalized Norwegian population 20 years and above. The sample size was 1260 individuals. About 75% of the people had 20 teeth or more present. Nine percent were edentulous. Seventy-seven percent who had demanded dental services during the last year. The average expenditure for dental treatment for those who had demanded the services during the last year was NOK 826. Fifty-three percent travelled 15 minutes or less from home to the dentist. Eighteen percent travelled 30 minutes or more. Almost everybody with their own teeth present brushed their teeth regularly once a day. Thirty-three percent of all dentate people used woodsticks regularly once a day, while 20% used toothfloss regularly. Seventy-five percent had no to mild fear of the dentist, while 7% had a strong fear. Fear of the dentist was higher among women than among men. Fear of the dentist decreased by increasing age. Few people, less than 4%, had cancelled a dental appointment because of dental anxiety. There has been an improvement in dental health and dental health behaviour in Norway during the 1970's and 1980's. These improvements are discussed with special attention paid to the findings from the present study.

The National Health Insurance covers a minor part of the expenditures for adults' dental care in Norway. This paper describes the present principles for charging patients for health care services. The paper has 3 aims, 1) to describe patient charges assessed as personal expenditures for dental treatment, 2) to relate patient charges for dental treatment to patient charges for other health services, and thirdly 3) to compare the level of spending for dental care to other household-consumption. Patient charges are higher for dental care than for other non-institutionalized health services. There is an upper limit to patient charges for health services (dental services are not included). The upper limit was approximately 90 in 1987. Above that limit health services are free. Altogether 137,000 persons reached that level of personal expenditures for health services in 1987. The price per unit of dental services is considered rather low in Norway. However, approximately 600,000 adults had expenditures for dental services which exceeded 90. The inconsistency in the present level of patient charges is discussed.