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For the guided regeneration of periimplant hard and soft tissues, human adipose-derived stromal cells (hADSC) seem to be a promising source for mesenchymal stromal cells. For this, the proliferation and differentiation of hADSC were evaluated on titanium and zirconia dental implants with different surface treatments. Results were compared to edaphic cells as human osteoblasts (hOB) and human gingival fibroblasts (HGF). Primary cells were cultured on (1) titanium implants with a polished surface (Ti-PT), (2) sandblasted and acid-etched titanium (Ti-SLA), (3) sandblasted and alkaline etched zirconia (ZrO2-ZLA) and (4) machined zirconia (ZrO2-M). The cell proliferation and differentiation on osteogenic lineage were assessed after 1, 7 and 14 days. Statistical analysis was performed by one-way ANOVA and a modified Levene test with a statistical significance at p = 0.05. PostHoc tests were performed by Bonferroni-Holm. Zirconia dental implants with rough surface (ZrO2-ZLA) showed the highest proliferation rates (p = 0.048). The osteogenic differentiation occurred early for zirconia and later for titanium implants, and it was enhanced for rough surfaces in comparison to polished/machined surfaces. Zirconia was more effective to promote the proliferation and differentiation of hADSCs in comparison to titanium. Rough surfaces were able to improve the biological response for both zirconia and titanium.

The incidence of obesity is on the rise in most western countries and represents major risks to health. Obesity causes complex metabolic dysfunctions and can be associated with a large number of secondary diseases. To investigate causal mechanisms of obesity and develop better options for treatment, researchers study the condition in animal models. In addition to genetically engineered animal models, diet-induced obesity is often used because it occurs similarly in animals as it does in humans. For several types of investigations that use obesity models, investigators must carry out surgical interventions and they frequently encounter severe perioperative complications induced by anesthesia. In an example of this problem, we observed 100% mortality in obese BALB/c mice after ovariectomy, despite no obvious surgical complications. We supposed that a failure to recover from surgery was the primary cause of this increased mortality. Therefore, to support their recovery from surgery we administered atropine to obese mice in order to facilitate blood circulation, and we also increased the oxygen content of the ambient air. With this specific support before and after surgery, we increased the survival rate of obese ovariectomized mice up to 83%. These results confirm the assumption that obesity is a risk factor for the recovery of obese animal models after ovariectomy, and they highlight the need to provide additional interventions for such experimental animals.

Background Ewing sarcoma (EWS) of the head and neck is rare. Multimodal treatment consists of chemotherapy and local treatment; however, local treatment for EWS of the head and neck is challenging. The first objective was to describe local treatment administered to the patients with localized EWS of the head and neck according to the EURO-E.W.I.N.G.99-trial, and to assess the impact on survival. The second objective was to systematically review the scientific literature available for this topic. Procedure Fifty-one patients were included. Local control consisted of surgery and/or radiotherapy (RT). Event-free survival (EFS) and overall survival (OS) were determined. Outcome was analyzed by comparing local treatment approaches. A Medline search was performed for EWS of the head and neck. Results Eighty-six percent of patients had localized disease. Most common primary sites included the skull (45%), maxilla (14%), and mandible (12%). Three-year EFS was 74% and 3-year OS was 87% for patients with localized disease. EFS was 40% for patients >15 years compared to 81% for patients

Three-dimensional (3D) mini plate systems are used in the treatment of mandibular fractures. The system is advantageous in comparison to conventional plates due to the stabilization of tension and compression areas, improved initial stability, and biomechanical behavior. The aim of this retrospective study was to evaluate the use of a 3D miniplate system for the treatment of patients with mandibular fractures. Patients with mandibular fractures treated with a 3D plate system at the Department of Oral and Maxillofacial Surgery, University Hospital M&uuml, nster, during a period of 5 years, were included in this study. Mandibular fracture conditions and minor and major post-operative complications were reported. In total, 336 patients and 391 mandibular fractures were assessed. The most common fracture site was anterior mandible, and 155 cases involved a tooth-bearing area. Minor complications were seen in 8.03% of cases, whereas only 1.49% of patients suffered from major complications. The treatment of mandible fractures using 3D miniplates resulted in fracture reduction with a low complication rate.

Background and Objective: The oral health-related quality of life (OHRQoL) of patients with achalasia has not been evaluated to date. Therefore, the aim of this study was to assess the OHRQoL of patients with achalasia and to get information about the time taken for diagnosis and oral symptoms. Materials and Methods: The study was conceived of as an anonymous epidemiological survey study in people with achalasia in order to assess their OHRQoL in each case. For this, a questionnaire was developed consisting of free-text questions and of the standardized German version of the OHIP-14 questionnaire. Results: In total, forty-four questionnaires were analyzed including 31 female and 13 male participants. Regardless of gender, the mean age was 50.57 years (range: 17&ndash, 78). Of the surveyed individuals, seventy-nine-point-five-five percent had been diagnosed between 25 and 60 years of age. The period from the first signs of the disease to diagnosis was 6.15 years, irrespective of gender. The overall OHIP-14 score without gender differentiation was 8.72 points (range 0&ndash, 48), the mean score of female participants was 11.13 (range: 0&ndash, 48), and the OHIP score of male participants was 3.15 on average. Two participants reported oral symptoms. Conclusions: The already known problem of the delayed diagnosis of rare diseases was also confirmed in the case of achalasia. Females with achalasia seemed to be significantly affected by lower OHRQoL than males with achalasia and women of the general population. Demineralization of the tooth structure was described in two participants.

Background: Combination of insulin with oral antidiabetic drugs is a valid option, but oral combination therapy emerged as an alternative treatment in type 2 diabetes (T2DM). However, the effects on blood pressure (BP) and vascular function of such combination therapies is less clear. Methods: In this study 101 patients with T2DM were randomized to receive either empagliflozin 10 mg and linagliptin 5 mg (E+L group) orally or metformin and insulin glargine (M+I group, with dose adjustments according to glucose levels), for 3 months. Patients underwent BP and vascular examination at baseline and after 12 weeks of treatment, including measurement of office and ambulatory BP and vascular function under clinical and ambulatory conditions by validated systems. Results: In comparison to baseline, office, 24-hour ambulatory BP and central blood and pulse pressure (PP) values decreased significantly after 12 weeks of treatment with E+L, whereas there was no significant change in vascular parameters in the M+I group (Table 1). Comparing the 2 groups, there were significant decreases in 24-h ambulatory peripheral systolic (mean difference between the 2 groups: −5.2 ± 1.5 mmHg, p = 0.004), diastolic BP (−1.9 ± 1.0 mmHg, p = 0.036) and PP (−3.3 ± 1.0 mmHg, p = 0.007) in favour of E+L. Central systolic BP (−5.56 ± 1.9 mmHg, p = 0.009), forward pressure pulse height (−2.0 ± 0.9 mmHg, p = 0.028) and 24-h ambulatory central systolic (−3.6 ± 1.4 mmHg, p = 0.045), diastolic BP (−1.95 ± 1.1 mmHg, p = 0.041) and 24-h pulse wave velocity (−0.14 ± 0.05 m/s, p = 0.043) were reduced to a greater extent in the E+L group than in the M+I group. Table 1 E + L M + I Baseline 12 weeks p-value Baseline 12 weeks p-value Peripheral (brachial) BP values 24-h ambulatory SBP [mmHg] 131 ± 10.9 127 ± 8.8

Background: The aim of this study was to analyze data on oral health-related quality of life (OHRQoL) in people with Marfan syndrome and to obtain information on the diagnosis period, orthodontic treatment, and oral symptoms. Methods: A questionnaire was developed consisting of open questions and the standardized German version of the OHIP-14 (Oral Health Impact Profile) questionnaire for the evaluation of OHRQoL. The age of diagnosis, time period from the first signs of the disease to diagnosis, and OHIP-values were compared between male and female participants. Additionally, the OHIP-values between participants who were orthodontically treated and those who were not treated were assessed. The statistical analysis was performed using the Mann&ndash, Whitney test with a significance level at p = 0.05. Results: A total of 51 questionnaires were evaluated, which included 34 female and 17 male participants. Overall, 84% of respondents reported oral symptoms. Male respondents tended to diagnose the disease earlier (p = 0.00), with a smaller period between the first symptom and the diagnosis (p = 0.04). The OHIP-14 score was gender-neutral at 13.65 &plusmn, 13.53 points. Conclusion: In Marfan syndrome, many years (12.01 &plusmn, 11.61) elapse between the onset of first symptoms and correct diagnosis of the disease. People with Marfan syndrome have a worse OHRQoL than do the general population.

Background Adult stem cells appear to be a promising subject for tissue engineering, representing an individual material for regeneration of aged and damaged cells. Especially adipose derived stromal cells (ADSC), which are easily to achieve, allow an encouraging perspective due to their capability of differentiating into miscellaneous cell types. Here we describe the in vitro formation of human subcutaneous, visceral and omental ADSC micromasses and compare their histological attributes while being cultivated on collagen membranes. Methods Subcutaneous, visceral and omental fat tissue derived cells were isolated and processed according to standard protocols. Positively stained cells for CD13, CD44 and CD90 were cultivated on agarose in order to study micromass formation using a special method of cell tracking. Stained paraffin-embedded micromasses were analysed morphologically before and after being plated on collagen membranes. Results The micromass formation process was similar in all three tissue types. Subcutaneous fat tissue derived micromasses turned out to develop a more homogeneous and compact shape than visceral and omental tissue. Nevertheless all micromasses adhered to collagen membranes with visible spreading of cells. The immune histochemical (IHC) staining of subcutaneous, visceral and omental ADSC micromasses shows a constant expression of CD13 and a decrease of CD44 and CD 90 expression within 28 days. After that period, omental fat cells don’t show any expression of CD44. Conclusion In conclusion micromass formation and cultivation of all analysed fat tissues can be achieved, subcutaneous cells appearing to be the best material for regenerative concepts.

Objective: In patients with resistant hypertension, percutaneous placement of an iliac arteriovenous coupler device leads to a reduction of blood pressure (BP) via decreased total vascular resistance and improved arterial compliance. However, long-term efficacy and safety need to be further explored. We report on the first case of 3.5-year follow-up in a patient who underwent implantation of an iliac arteriovenous coupler device. Results: A patient with resistant hypertension was admitted to hospital. Despite treatment with six anti-hypertensive drugs, his BP was poorly controlled. Previously, he had undergone renal denervation, which did not cause a significant BP decrease. Therefore, an arteriovenous coupler device was implanted, leading to an immediate and significant BP decrease. The patient was discharged with an office BP of 122/71 mmHg. After 3 months, there was a sustained BP decrease (−14/9 mmHg), whereas later, it was fluctuant (office BP: 147–173/85–95 mmHg, ABPM: 153–166/81–94 mmHg) probably due to medication non-adherence confirmed by a urinary toxicological screening test. Follow-up right heart catheterization showed changes in hemodynamic parameters related to volume congestion, which were accompanied by progressive dyspnea and weight gain. This was controlled by an optimized diuretic therapy. Additionally, an invasive closure maneuver was performed, leading to an immediate BP increase after closure and a similar decrease after re-opening of the anastomosis, verifying its proper long-term function. Conclusion: The implantation of an iliac arteriovenous coupler device appears to be a promising and effective method to decrease BP and therefore reduce cardiovascular risk in patients with severe, treatment-resistant hypertension.

Background: The aim of this study was to examine the current dental care situation in Germany from the perspective of those affected by a rare disease, especially concerning their satisfaction with the German dental health care system, and thus assess the relationship between their perspective and their oral health-related quality of life (OHRQoL). Methods: A questionnaire regarding their experiences with the dental assistance and the health care system, such as the OHIP-14, was sent to the member associations of the organization of self-help groups for rare diseases ACHSE e.V. The correlation between OHIP-14 values and patient&rsquo, s perspective was statistically analyzed by the non-parametric Tau de Kendall test (p &lt, 0.05). Results: There was a statistically significant correlation between the OHIP score and the patient&rsquo, s perspective regarding dental assistance and health care system (p &lt, 0.05). For those surveyed who were satisfied with the support of the health care system, an average OHIP score of 8.54 &plusmn, 10.45 points (range: 0&ndash, 48) was determined. The group that did not feel sufficiently supported by the health care system had an average OHIP score of 16.07 &plusmn, 13.43 points (range: 0&ndash, 56). Discussion: The majority of respondents with rare diseases are dissatisfied with the German health care system and its support with regard to dental care.

In 2013, a national action plan for people with rare diseases (Nationaler Aktionsplan für Menschen mit Seltenen Erkrankungen, NAMSE) was adopted in the Federal Republic of Germany which is currently in the implementation phase. People with rare diseases are often confronted with huge difficulties in the diagnosis and therapy, and being repeatedly misdiagnosed also leads to psychological stress for those affected and their families. Of the up to 8000 rare diseases, about 15% can manifest in the orofacial region and thus give an indication of the underlying disease. A look in the oral cavity or consultative support to determine the cause of symptoms in the oral and maxillofacial region can possibly help the specialists in internal medicine to find the appropriate diagnosis.

Background The Interdisciplinary Tumor Board (ITB) of the Cooperative Ewing Sarcoma Study (CESS) Group was investigated to assess its impact on the overall survival (OAS) of Ewing sarcoma (EwS) patients. The ITB functions as a reference center for the international institutions participating in the clinical trials of the CESS group, but is also available internationally to patients who have not been treated within an appropriate clinical trial. The value of tumor boards in terms of benefit for the patients and the health care system in general is not well documented and is also the subject of controversial discussions. A review of the representative literature is included. Methods Data were analyzed from 481 patients who had been registered into the European Ewing Tumor Working Initiative of National Groups (EURO E.W.I.N.G.-99) clinical trial via the CESS data center between 2006 and 2009; this included 331 patients with localized disease and another 150 individuals with metastases at diagnosis. Median follow-up time was 3.2 years. Results Improved OAS was observed for patients with metastases who had received recommendations from the ITB compared with those who had not received recommendations. In patients with localized disease, a recommendation from the ITB had no influence on OAS. Conclusion As a reference center for a rare disease, recommendations from our ITB impacted local therapy and led to higher OAS in patients with metastatic disease. To our knowledge, this is the first analysis that examines the value of a reference tumor board on a rare disease.

The aim of this study was to evaluate the biocompatibility of two comparatively new calcium silicate containing sealers (MTA-Fillapex and BioRoot-RCS) with that of two established sealers (AH-Plus, epoxy resin-based; Pulp-Canal-Sealer, zinc oxide eugenol containing). Human periodontal ligament cells (PDL-cells) were brought in contact with eluates from freshly mixed and set sealer. The sealers were mixed strictly according to the manufacturers’ instructions and identically samples were produced. 1:1, 1:2, and 1:10 dilutions of sealers extract were used. Extracts from freshly mixed sealer were added to the PDL-cells on day one to simulate a clinical scenario. Subsequently, at 24 h, 7, 14, and 21 days extracts form set sealers were used for PDL-cell culturing. PDL-cell viability was analyzed by living-cell-count, MTT-assay, and living/dead-staining, cytotoxicity by LDH-assay, and changes by Richardson-staining. All data were statistically evaluated by one way ANOVA and a posthoc analysis with Bonferroni-Holm testing (p

Isolation and cultivation of human peridontale ligement cells from surgical removed wisdom teeth.

In 2013 the German Ministry of Health initiated a "National Plan of Action for People with Rare Diseases" (NAMSE), in order to improve medical treatment for people with rare diseases. The aim of NAMSE is to set up appropriate medical care for those affected, as well as to obtain information on the current state of care for these patients. The aim of this study was to obtain information on the oral health-related quality of life (OHRQoL) of people with rare diseases with oral involvement.In the context of the NAMSE plan, special consultation times were introduced for people with rare diseases with oral involvement. Using the standardized OHIP 14 questionnaire, specific information was acquired on OHRQoL, as was as general information on the disease in question.During consultation hours, 50 people were treated who, on average, travelled 143 km each way. On average, patients had to wait 5 years before the final diagnosis of their rare disease was reached. The mean OHIP 14 overall score achieved was 26.4.The long distances travelled show the effort involved for patients, especially for those who come for a series of sessions. This has led to a call for a nationwide system of special consultation sessions for rare diseases with oral involvement - something NAMSE has also called for. There seems to be a markedly worse OHRQoL among all our patients. Overall, rare diseases with oral involvement appear to benefit more from an earlier diagnosis of the disease than do rare diseases without any oral involvement.Um die medizinische Versorgung von Menschen mit Seltenen Erkrankungen (SE) zu verbessern wurde 2013 durch das Bundesministerium für Gesundheit ein „Nationaler Aktionsplan für Menschen mit Seltenen Erkrankungen“ (NAMSE) ins Leben gerufen. Ziel des NAMSE ist dabei, eine medizinisch adäquate Versorgung für die Betroffenen aufzubauen sowie Informationen über die aktuelle Versorgungssituation von SE zu gewinnen. Vor diesem Hintergrund sollen Informationen zur die mundgesundheitsbezogenen Lebensqualität (OHRQoL) bei Menschen mit SE und oraler Beteiligung gewonnen werden.Unter dem Hintergrund des NAMSE wurde eine Spezialsprechstunde für SE mit oraler Beteiligung eingerichtet. Mittels dem standardisiertem OHIP-14 Fragebogen wurden Informationen zur OHRQoL sowie allgemeine Informationen zur Erkrankung gewonnen.Insgesamt wurden 50 Patienten in der Sprechstunde behandelt. Diese nahmen durchschnittlich eine einfache Anfahrtsstrecke von 143 km auf sich. Im Mittel mussten die Betroffenen 5 Jahre auf die finale Diagnose ihrer SE warten. Die Betroffenen weisen einen durchschnittlichen OHIP-14 Gesamt-Score von 26,4 auf. SCHLUßFOLGERUNG: Der lange Anfahrtsweg zeigt, welchen Aufwand Patienten insbesondere bei mehrfachen Vorstellungen auf sich nehmen müssen. Hieraus entsteht die Forderung, künftig flächendeckend Spezialsprechstunden für SE mit oraler Beteiligung aufzubauen, wie dies auch im NAMSE gefordert wird. Der Vergleich mit den wenigen vorhandenen Daten lässt auf eine deutlich schlechtere OHRQoL in unserem Patientenkollektiv schließen. Seltene Erkrankungen mit oraler Beteiligung scheinen insgesamt von einer früheren Diagnose der Erkrankung zu profitieren, als SE ohne orale Beteiligung.

On November 25, the first national congress for rare diseases in dentistry and oral medicine under the auspices of ACHSE e. V. and Orphanet was held in Muenster. With speakers from the field of medicine, dentistry, politics, patient advocacy groups, self-help groups and persons concerned, a platform for exchange between physicians and patients on an equal footing was offered to the participants. At the end of each of the 12 lectures, more than 300 national and international guests discussed the various issues and perspectives related to the topic of rare diseases in dentistry and oral medicine. Besides the different presentations focusing on dentistry, neuropediatrics, and human genetics, the existing centers for rare diseases, sources of information, European reference networks, and the national action plan for people with rare diseases were the subjects of intensive discussion. The patient perspective was also considered. From now on the congress shall be held in Muenster biennially.

Isolation and cultivation of human mandibular osteoblasts.

One aim of cranio-maxillo-facial surgery is to strive for an esthetical appearance. Do facial symmetry and attractiveness correlate? How are they affected by surgery? Within this study faces of patients with orthognathic surgery were captured and analyzed regarding their symmetry. A total of 25 faces of patients were measured three-dimensionally by an optical sensor using the fringe projection technique before and after orthognathic surgery. Based upon this data an asymmetry index was calculated for each case. In order to gather subjective ratings each face was presented to 100 independent test subjects in a 3D rotation sequence. Those were asked to rate the symmetry and the attractiveness of the faces. It was analyzed to what extend the ratings correlate with the measured asymmetry indices and whether pre- and post-surgical data differ. The measured asymmetry indices correlate significantly with the subjective ratings of both items. The measured symmetry as well as the rated symmetry and attractiveness increased on average after surgery. The increase of the ratings was even statistically significant. A larger enhancement of symmetry is achieved in pre-surgical strongly asymmetric faces than in rather symmetric faces.

In Germany there are more than 70 million bicycles. Because of technical progress, over 200,000 electro-assisted bikes were sold in Germany in 2010 alone. In 2013, the number increased to 410,000. Currently more than 1.6 million electric bicycles are used here. One of the largest user groups are seniors. Accident researchers fear an increased risk of accidents/injuries.For one year, all cycling accidents involving electric bicycles and senior citizens were collected and analysed in 23 hospitals of the TraumaNetwork NorthWest and by the local police authorities.A comparison of the senior and younger electro-assisted cyclists showed a higher risk of injury for seniors in the initial analysis. A further comparative analysis of severely injured seniors who were riding an electro-assisted bike with those who used a conventional bicycle contradicted this. There was no statistical significance. The risk of an accident increased with age, but not with bicycle type.To reduce accidents, driving training and medical precautionary examinations could be used to detect losses of performance, cognitive processing and balance. In the future, they should become an integral part of the health care system and the services of practicing physicians.Deutschland ist eine Radfahrnation mit über 70 Mill. Fahrrädern. Bedingt durch die technische Weiterentwicklung wurden im Jahr 2010 deutschlandweit bereits 200 000 E-Bikes (Oberbegriff für elektrobetriebene Fahrräder, beinhaltet auch Pedelecs) verkauft, 2013 waren dies bereits 410 000. Aktuell werden deutschlandweit mehr als 1,6 Mill. Elektrofahrräder genutzt. Eine der größten Nutzergruppen sind Senioren. Unfallforscher befürchten ein erhöhtes Unfall-/Verletzungsrisiko.Ein Jahr lang wurden alle Radverkehrsunfälle, speziell die Elektrofahrradunfälle unter Beteiligung von Senioren, in 23 Krankenhäusern des TraumaNetzwerks NordWest und der örtlich zuständigen Polizeibehörden erhoben und analysiert.Ein Vergleich der Elektrofahrrad fahrenden Senioren mit der Gruppe der ebenfalls elektrounterstützt Rad fahrenden Jüngeren ergab im ersten Ansatz ein höheres Verletzungsrisiko. Die weitere vergleichende Analyse der schwerverletzten Senioren, die ein elektrounterstütztes Fahrrad fuhren, mit denen, die ein konventionelles Fahrrad nutzten, widersprach dem jedoch. Eine statistische Signifikanz blieb aus. Die Unfallwahrscheinlichkeit erhöhte sich mit dem Alter, nicht jedoch mit dem Fahrradtyp.Unfallvermeidend könnten, neben einem spezifischen Fahrtraining, medizinische Vorsorgeuntersuchungen zur Früherkennung von Leistungseinbußen, speziell im Bereich kognitiver Verarbeitungsprozesse und des Gleichgewichts, wirken. Sie sollten zukünftig selbstverständlicher Bestandteil der Gesundheitsvorsorge und damit der Beratungsleistung der niedergelassenen Ärzte sein.

In orthognathic surgery aesthetic issues and facial symmetry are vital parameters in surgical planning. Aim of this investigation was to document and analyze the results of orthognathic surgery on the base of a three-dimensional photogrammetric assessment, to assess the soft tissue response related to the skeletal shift and the alterations in facial symmetry after orthognathic surgery.In this prospective clinical trial from January 2010 to June 2011, 104 patients were examined who underwent orthognathic surgery due to mono- or bimaxillary dysgnathia. The standardized measurements, based on optical 3D face scans, took place one day before orthognathic surgery (T1) and one day before removal of osteosynthesis material (T2).Soft tissue changes after procedures involving the mandible showed significant positive correlations and strong soft tissue response (p 0.05). The midfacial soft tissue response after maxillary advancement was only of minor extent (p 0.05). The facial surfaces became more symmetric and harmonic with the exception of surgical maxillary expansion, but improvement of facial symmetry revealed no statistical significance.Soft tissue response after orthognathic surgery and symmetry are only partially predictable, especially in the maxillary and midfacial region. Computer programs predicting soft tissue changes are not currently safely reliable and should not be used or with caution to demonstrate a patient potential outcome of surgery.

Velopharyngeal insufficiency (VPI) can be caused by a variety of disorders. The most common cause of VPI is the association with cleft palate. The aim of this study was to evaluate the effectiveness of different surgical techniques for cleft palate patients with VPI: (1) velopharyngoplasty with an inferiorly based posterior pharyngeal flap (VPP posterior, Schönborn-Rosenthal), and (2) combination of VPP posterior and push-back operation (Dorrance).41 subjects (26 females, 15 males) with VPI were analysed. Hypernasality was judged subjectively and nasalance data were assessed objectively using the NasalView system preoperative and 6 months postoperative.Subjective analysis showed improved speech results regarding hypernasality for all OP-techniques with good results for VPP posterior and VPP posterior combined with push-back with success rates of 94.4% and 87.7%, respectively. Objective analysis showed a statistically significant reduction of nasalance for both VPP posterior and VPP posterior combined with push-back (p0.01). However, there were no statistically significant differences concerning measured nasalance values postoperatively between the VPP posterior and VPP posterior combined with push-back.Based on our findings, both VPP posterior and VPP posterior combined with push-back showed good results in correction of hypernasality in cleft patients with velopharyngeal insufficiency.

Objective:Flow-mediated vasodilation (FMD) has become one of the most widely assessed parameter to analyze endothelial function. However, some techniques used to measure FMD have limitations. Recently, finger plethysmography (EndoPAT) failed to show any kind of reproducibility. A semi-automatic devi

Objective:Retinal microvascular structural abnormalities mirror cerebrovascular structural changes and are related to an increased risk of cerebrovascular morbidity. Endothelial dysfunction is described as a key pathological condition associated with established cardiovascular disease. Endothelial d

Objective:Detailed analysis of retinal capillary flow (RCF) and vascular parameters in the retinal circulation allows us to differentiate between eutrophic and hypertrophic remodeling. In previous studies, we found that hypertensive patients with type 2 diabetes mellitus (T2DM) mostly suffer from hy

Objective:Epidemiological evidence suggests a link between noise exposure and increased incidence of arterial hypertension and cardiovascular disease. The kidney as long-term regulator of blood pressure might play a role in the underlying pathophysiological mechanism. The aim of this study is to inv

Objective:The tetrahydrobiopterin-analogue VAS203, an in vivo inhibitor of predominantly the inducible nitric oxide synthase (iNOS), was developed to reduce secondary damage in patients with severe traumatic brain injury. However, its effect on micro- and macrocirculation is less well established. T

Objective:Spectral-domain optical coherence tomography (SD-OCT) of the eye has become a valuable high-resolution imaging technique for the evaluation of retinal layer volumes in a variety of diseases such as glaucoma and age-related macular degeneration, but also neurodegenerative diseases such as m

This article addresses the interdependency between child-rearing goals and values, emotionally arousing child-rearing practices, and the socialization and development of so-called socializing emotions. The latter are assigned a general psychological control function that enables children to adjust their behavior and emotions to the normative prescriptions of their culture. It is assumed that they are inculcated by means of emotionally arousing strategies such as frightening, corporal punishment, mocking, shaming but also praising, encouraging, or cherishing (Quinn, 2005) and that—in line with Vygotsky's genetic law of development—they become internalized so effectively that they can exert their control function already without prior disciplining.

Orthognathic surgery in general addresses young patients and aims to improve their bite function and to harmonize their facial aesthetics. Secure surgical standards and a defined post-surgical protocol of after-care are indispensable to reduce surgical as well as anaesthesiological risks in this area of complex elective surgery. The development of pneumomediastinum is a rare incident but threatens the patients’ physical integrity. The case of a young healthy male who underwent Le Fort I osteotomy in combination with bilateral mandibular sagittal split osteotomy and postoperatively developed pneumomediastinum is presented, together with a discussion of the possible reasons for this rare complication of orthognathic surgery. The avoidance of life-threatening coincidences must be one main focus in the preparation and aftercare in elective orthognathic surgery.

In subtotally nephrectomized rats, we studied to what extent high-dose calcitriol-induced cardiovascular disease can be modulated by almost complete suppression of parathyroid hormone (PTH), mediated by either cinacalcet (CINA) or parathyroidectomy (PTX).Five groups were studied: sham-operated controls, uremic (U), uremic with calcitriol (U+1,25D), uremic and calcitriol with CINA (U+1,25D+CINA) and uremic and calcitriol with PTX (U+1,25D+PTX). Treatments lasted 14 weeks.Compared with U group animals, PTH was significantly lower with calcitriol treatment and almost completely suppressed in animals treated with either PTX or CINA. Serum calcium and phosphorus levels were similarly elevated in all groups receiving calcitriol. Renal function in uremic animals was significantly more impaired in the U+1,25D group. Aortic calcifications were pronounced in U+1,25D animals and reduced by more than 50% by concomittant treatment with CINA or PTX. Chondrocytes were observed near areas of calcification (90%) and endochondral bone formation was confirmed by positive immunofluorescence for chondrocytic transcription factor sox9 and matrix protein collagen X. Altered arterial (aneurysmatic) geometry with a significant increase in wall/lumen and lumen/body weight ratio was found only in the U+1,25D group. Myocardial fibrosis was present in all uremic groups with a significant increase in the U+1,25D group. Connective tissue growth factor messenger RNA was significantly upregulated only in the U+1,25D group.Submaximal suppression of PTH by either CINA or PTX reduced vascular calcifications, arterial remodeling and myocardial fibrosis to a similar degree and independent of the serum calcium and phosphorus levels. These data do not indicate vasculotropic effects of calcimimetics independent of PTH suppression.

Introduction. The aim of this paper was to evaluate cephalometrically the nasopharyngeal development of patients with complete unilateral cleft lip and palate. Influencing factors were evaluated and cleft to noncleft subjects were compared to each other.Material and Methods. The lateral cephalograms of 66 patients with complete cleft lip and palate were measured and compared retrospectively to the cephalograms of 123 healthy probands. Measurements were derived from a standardized analysis of 56 landmarks.Results. We observed significant differences between cleft and control group: the cleft patients showed amaxillary retroposition and a reduced maxillary length; the inclination of the maxilla was significantly more posterior and cranial; the anterior nasopharyngeal height was reduced; the nasopharyngeal growth followed a vertical tendency with reduced sagittal dimensions concerning hard and soft tissue. The velum length was reduced. In the cleft group, an accumulation of mandibular retrognathia and an anterior position of the hyoid were observed. Skeletal configuration and type of growth were predominantly vertical.Conclusions. Our data provides a fundamental radiological analysis of the nasopharyngeal development in cleft patients. It confirms the lateral cephalogram as a basic diagnostic device in the analysis of nasopharyngeal and skeletal growth in cleft patients.

The prognostic relevance of additional cytogenetic findings at diagnosis of chronic myeloid leukemia (CML) is unclear. The impact of additional cytogenetic findings at diagnosis on time to complete cytogenetic (CCR) and major molecular remission (MMR) and progression-free (PFS) and overall survival (OS) was analyzed using data from 1151 Philadelphia chromosome–positive (Ph+) CML patients randomized to the German CML Study IV. At diagnosis, 1003 of 1151 patients (87%) had standard t(9;22)(q34;q11) only, 69 patients (6.0%) had variant t(v;22), and 79 (6.9%) additional cytogenetic aberrations (ACAs). Of these, 38 patients (3.3%) lacked the Y chromosome (−Y) and 41 patients (3.6%) had ACAs except −Y; 16 of these (1.4%) were major route (second Philadelphia [Ph] chromosome, trisomy 8, isochromosome 17q, or trisomy 19) and 25 minor route (all other) ACAs. After a median observation time of 5.3 years for patients with t(9;22), t(v;22), −Y, minor- and major-route ACAs, the 5-year PFS was 90%, 81%, 88%, 96%, and 50%, and the 5-year OS was 92%, 87%, 91%, 96%, and 53%, respectively. In patients with major-route ACAs, the times to CCR and MMR were longer and PFS and OS were shorter (P < .001) than in patients with standard t(9;22). We conclude that major-route ACAs at diagnosis are associated with a negative impact on survival and signify progression to the accelerated phase and blast crisis.

Purpose Treatment of chronic-phase (CP) chronic myeloid leukemia (CML) with imatinib 400 mg/d can be unsatisfactory. Optimization of treatment is warranted. Patients and Methods In all, 1,014 newly diagnosed CP-CML patients were randomly assigned to imatinib 800 mg/d (n = 338), imatinib 400 mg/d (n = 325), or imatinib 400 mg/d plus interferon alfa (IFN-α; n = 351). Dose adaptation to avoid higher-grade toxicity was recommended. First primary end point was major molecular remission (MMR) at 12 months. Results A higher rate of MMR at 12 months occurred with tolerability-adapted imatinib 800 mg/d than with imatinib 400 mg/d (59% [95% CI, 53% to 65%] v 44% [95% CI, 37% to 50%]; P < .001) or imatinib 400 mg/d plus IFN-α (59% v 46% [95% CI, 40% to 52%]; P = .002). Median dose in the 800-mg/d arm was 628 mg/d with a maximum dose of 737 mg/d during months 4 to 6 and a maintenance dose of 600 mg/d. All three treatment approaches were well tolerated with similar grade 3 and 4 adverse events. Independent of treatment approach, MMR at 12 months showed better progression-free survival (99% v 94%; P = .0023) and overall survival (99% v 93%; P = .0011) at 3 years when compared with > 1% on the international scale or no MMR but showed no difference in 0.1% to < 1% on the international scale, which closely correlates with complete cytogenetic remission. Conclusion Treatment of early-phase CML with imatinib can be optimized. Early high-dose therapy followed by rapid adaptation to good tolerability increases the rate of MMR at 12 months. Achievement of MMR by month 12 is directly associated with improved survival.

Geschildert wird der Fall eines 58-jahrigen Patienten mit progredienter Hypasthesie im Bereich von N. lingualis und N. alveolaris inferior links. Diagnostik und Bildgebung ergaben ein monophasisches Synovialsarkom des pterygomandibularen und infratemporalen Raums mit Destruktion von Unterkiefer und Schadelbasis. Einer neoadjuvanten Radiatio folgte die Resektion des Tumors in sano. Trotzdem erlag der Patient aufgrund intrakranieller und pulmonaler Metastasierung letztendlich seinem Leiden. Prognose und Therapieoptionen fur diese seltene Tumorentitat werden dargestellt.