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Performance of restorations in primary molars over a seven-year period
Get PDFObjective
The aim of this study was to evaluate the use and reintervention rate of fillings compared to preformed metal crowns in the everyday clinical practice of German dentists.
Methods
In this retrospective, longitudinal analysis, fee codes from the Kassenzahnärztliche Vereinigung Westfalen-Lippe for restorations placed in primary molars between 2012 and 2015 in children until 7 years of age followed for a 7-year period (latest until December 2022) were filtered and analyzed with the Fine and Gray competing risk regression and Cox proportional hazards regression to calculate the risk of reintervention divided into the main outcomes “Successful”, “Minor Failure/Repair” and “Major Failure/Endodontic Treatment/Extraction”. 367,139 primary molars (one-surface fillings: n = 117,721; two-surface fillings n = 198,815; three-surface fillings n = 36,695; more than three-surface fillings n = 8,267 and preformed metal crowns n = 5,641 were included in this study.
Results
Teeth treated with preformed crowns needed significantly less re-interventions. Subdistribution hazard ratio for minor events was 0.117 (95 %-CI: 0.097 to 0.141) and hazard ratio of major events (HR=0.786; 95 %-CI: 0.695 to 0.890) when compared to one-surface fillings in multivariable adjusted analysis. Within 7-year follow-up preformed crowns required less repairs (80.6 % success rate, minor failure 4.4 %, major failure 16.3 %) than the teeth treated with composite fillings (46.2 %–52.6 % success rate, minor failure 27.0 %–39.5 %, major failure 15.5 %–28.4 %, p < 0.001).
Conclusion
Within the German healthcare system fillings are the first choice for treating primary molars despite considerably higher reintervention rates. This encourages a discussion on the indication of fillings and the more durable preformed metal crowns to reduce unnecessary reintervention in young children.
Clinical significance
This study gives an unprecedented insight into the German healthcare system regarding the reintervention rates of the most relevant treatment techniques for caries in primary molars
Einfluss präoperativer, prozeduraler Edukationsinterventionen auf die perioperative Stressverarbeitung bei Patienten mit elektiven chirurgischen Eingriffen in Allgemeinanästhesie und stationärem Aufenthalt
Get PDFBackground: Patients awaiting ENT surgery typically experience
significant physical and psychological stress. However, although there
is evidence that preoperative education interventions can lead to
positive perioperative outcomes for surgical patients, less is known
about the effectiveness among patients undergoing ENT surgery.
▪ Objective: This study investigated whether, preoperative procedural
patient education designed for ENT surgery patients, as a time- and
cost-efficient intervention, can reduce patient stress and anxietyHintergrund: Patienten, die auf eine HNO-Operation warten, erleben häufig erheblichen physischen und psychischen Stress. Obwohl es Hinweise darauf gibt, dass präoperative Aufklärungsmaßnahmen zu positiven perioperativen Ergebnissen bei chirurgischen Patienten führen können, ist die Evidenzlage zur Wirksamkeit dieser Maßnahmen speziell bei HNO-Patienten begrenzt.
Zielsetzung: Diese Studie untersuchte, ob eine speziell für HNO-Patienten entwickelte präoperative Aufklärung als zeit- und kosteneffiziente Maßnahme dazu beitragen kann, den Stress und die Angst der Patienten zu reduzieren
Follow-up mit Vergleich der funktionellen Untersuchungsergebnisse bei Patienten ohne und mit dorsaler subkutaner Fettlappenplastik nach Implantateinbringung am distalen dorsalen Radius
Get PDFEine Ursache der hohen Komplikationsraten dorsaler Plattensysteme ist das durch die Implantate veränderte Strecksehnengleitlager, das zu mechanischem Abrieb und in Folge zu Strecksehnenrupturen führen kann. Ein Versuch, das Risiko von Strecksehnenirritationen zu vermindern, ist das Platzieren einer subkutanen Fettlappenplastik zwischen den dorsalen Osteosyntheseplatten und den Strecksehnen. In der vorliegenden Studie wurden die von 2020 bis 2022 erhobenen funktionellen postoperativen Ergebnisse von 29 Patienten mit subkutaner Fettlappenplastik und 26 Patienten ohne subkutane Fettlappenplastik bei Implantaten am distalen dorsalen Radius in Berliner Krankenhäusern (Vivantes Klinikum Neukölln, Vivantes Klinikum am Urban, Charité - Campus Benjamin Franklin, Unfallkrankenhaus Berlin) erhoben und diskutiert. Hierzu wurden ein für die Studie erstellter Untersuchungsbogen sowie der DASH-Fragebogen herangezogen.
Die Ergebnisse von 55 Fällen wurden statistisch ausgewertet und diskutiert.
Bei den 29 Patienten mit subkutaner Fettlappenplastik ereigneten sich keine Strecksehnenrupturen. Bei 10,3 Prozent der Patienten kam es zu Strecksehnenirritationen, in 28 Prozent zu Materialentfernungen, in 24,1 Prozent zu Verletzungen im Bereich des R. superficialis n. radialis, in 17,2 Prozent zu Verletzungen im Bereich des N. cutaneus antebrachii lateralis und zu durchschnittlichen DASH-Werten von 31,4 Punkten.
Bei den 26 Patienten ohne subkutane Fettlappenplastik ereigneten sich ebenfalls keine Strecksehnenrupturen. In 15,4 Prozent der Fälle kam es zu Strecksehnenirritationen, in 54 Prozent zu Materialentfernungen, in 11,5 Prozent zu Verletzungen des R. superficialis n. radialis, in 3,8 Prozent zu Verletzungen des N. cutaneus antebrachii lateralis und zu durchschnittlichen DASH-Werten von 27,7 Punkten.
Das Ausmaß der Supination war bei Patienten mit subkutaner Fettlappenplastik auf der operierten Seite um 11,2 Grad größer im Vergleich zu den Patienten ohne subkutane Fettlappenplastik. Diese Differenz ist signifikant. Alle weiteren Untersuchungen zeigten keine stärkeren Bewegungseinschränkungen der Funktionalität von Kraft und Bewegungsausmaß, keine größere Zunahme des Handgelenkumfanges und keine längere Arbeitsunfähigkeit als bei den Patienten ohne subkutane Fettlappenplastik
New insights into the hypothalamic–pituitary–thyroid axis: a transcriptome- and proteome-wide association study
Get PDFIntroduction
Thyroid hormones have systemic effects on the human body and play a key role in the development and function of virtually all tissues. They are regulated via the hypothalamic–pituitary–thyroid (HPT) axis and have a heritable component. Using genetic information, we applied tissue-specific transcriptome-wide association studies (TWAS) and plasma proteome-wide association studies (PWAS) to elucidate gene products related to thyrotropin (TSH) and free thyroxine (FT4) levels.
Results
TWAS identified 297 and 113 transcripts associated with TSH and FT4 levels, respectively (25 shared), including transcripts not identified by genome-wide association studies (GWAS) of these traits, demonstrating the increased power of this approach. Testing for genetic colocalization revealed a shared genetic basis of 158 transcripts with TSH and 45 transcripts with FT4, including independent, FT4-associated genetic signals within the CAPZB locus that were differentially associated with CAPZB expression in different tissues. PWAS identified 18 and ten proteins associated with TSH and FT4, respectively (HEXIM1 and QSOX2 with both). Among these, the cognate genes of five TSH- and 7 FT4-associated proteins mapped outside significant GWAS loci. Colocalization was observed for five plasma proteins each with TSH and FT4. There were ten TSH and one FT4-related gene(s) significant in both TWAS and PWAS. Of these, ANXA5 expression and plasma annexin A5 levels were inversely associated with TSH (PWAS: P = 1.18 × 10−13, TWAS: P = 7.61 × 10−12 (whole blood), P = 6.40 × 10−13 (hypothalamus), P = 1.57 × 10−15 (pituitary), P = 4.27 × 10−15 (thyroid)), supported by colocalizations.
Conclusion
Our analyses revealed new thyroid function-associated genes and prioritized candidates in known GWAS loci, contributing to a better understanding of transcriptional regulation and protein levels relevant to thyroid function
Die Effekte von kaltem physikalischem Plasma auf die Membranpermeabilität von humanen Chondro- und Ewingsarkomzellen
Get PDFKnochensarkome sind mit einer erheblichen Morbidität und Mortalität assoziiert. Die Möglichkeiten der Therapie des Chondrosarkoms (CS) sind aufgrund der Strahlen- sowie Chemotherapeutika-Resistenz vor allem auf eine operative Strategie begrenzt. Auch die Versorgung des Ewingsarkoms (ES) weist – durch das oft junge Alter der Betroffenen und das lebenslang erhöhte, Therapie-assoziierte Risiko für Mortalität sowie Morbidität – Defizite auf. Hieraus folgt die Notwendigkeit neuer Therapien, welche nicht nur die Mortalität senken, sondern durch eine effektive antitumorale Wirkung und geringere kurz- sowie langzeitige Nebenwirkungen auch die Morbidität reduzieren.
Bisherige Untersuchungen konnten bereits einen antitumoralen Effekt des kalten physikalischen Plasmas (englisch Cold Physical Plasma, CPP) auf verschiedene Tumorentitäten feststellen. Auch wurde ein antiproliferativer Effekt des CPP auf Osteosarkome beobachtet. Bei CS und ES Zellen erfolgte dies bisher nicht.
Im Rahmen dieser Arbeit konnte erstmalig ein antiproliferativer Einfluss des CPP auf CS und ES Zellen gezeigt werden. Weiterhin führte CPP zu einer Veränderung der Zellmembran. Infolge dessen konnte eine erhöhte Membranpermeabilität für exogene Moleküle niedrigen Molekulargewichts (FDA) sowie von Makromolekülen (FITC-Dextran) nachgewiesen werden. Zudem wurde ein ATP-Efflux durch die Anwendung des CPP detektiert. Der Verlust eines für den Zellmetabolismus essentiellen, endogen synthetisierten Moleküls kurz nach der Behandlung deutet auf eine Veränderung der Membranintegrität durch CPP hin. Daher resultiert aus der erhöhten Membranpermeabilität der CS und ES Zellen eine verminderte Zellzahl sowie ein reduziertes Zellwachstum. CPP wirkt somit durch die veränderte biochemische Funktionalität der Tumorzellmembran antitumoral
What drives growth responses of nitrogen and phosphorus (co-)limited primary producer communities?
Get PDFThe growth of autotroph communities is frequently (co-)limited by essential nutrients such as nitrogen (N) and phosphorus (P). Several mechanisms have been proposed to explain the observed co-limitation patterns at different levels of biological organization, especially at the biochemical level for individual species. When considering communities, the presence of different species and functional groups with contrasting physiologies and nutrient requirements leads to a more difficult understanding of the mechanisms involved in nutrient (co-)limitation. To investigate what drives co-limitation patterns and possible underlying mechanisms based on biomass responses in autotroph communities, we grew phytoplankton communities differing in species composition in experimental microcosms on three N:P ratios to impose different limiting conditions. Afterwards, N, P, both, or none were factorially supplied to the communities to test which nutrients were limiting growth. We measured the biovolume of single species in the communities to assess how they responded to nutrient additions and compared it to the response of the overall community biovolume. The types of nutrient (co-)limitation identified, i.e. the factorial limitation scenarios for community biomass were single N limitation or simultaneous co-limitation by N and P, and were strongly driven by the dominant species. The phytoplankton species in the communities responded differently to the nutrient addition treatments, i.e. they showed contrasting limitation outcomes and therefore likely different nutrient requirements. Our experiment indicates that phylogenetically distantly-related phytoplankton species grown in a community can have different resource use efficiencies and thus can be limited by different nutrients. We suggest that the dominance of species or groups with similar traits in nutrient requirements and acquisition is one of the leading mechanisms that determines the biomass pattern of nutrient (co-)limitation observed at the community level. This work also highlights the potential of predicting community growth limitation outcomes based on knowledge of nutrient use efficiencies of one or few dominant species, which can be a suitable tool for lake restoration and oligotrophication efforts
Combined Application of Cold Physical Plasma and Chemotherapeutics against Chondrosarcoma Cells
Get PDFChondrosarcoma (CS) is a rare malignant bone sarcoma that primarily affects cartilage cells in the femur and pelvis. While most subtypes exhibit slow growth with a very good prognosis, some aggressive subtypes have a poorer overall survival. CS is known for its resistance to chemotherapy and radiotherapy, leaving surgery as the sole effective therapeutic option. Cold physical plasma (CPP) has been explored in vitro as a potential therapy, demonstrating positive anti-tumor effects on CS cells. This study investigated the synergistic effects of combining CPP with cytostatics on CS cells. The chemotherapeutic agents cisplatin, doxorubicin, and vincristine were applied to two CS cell lines (CAL-78 and SW1353). After determining their IC20 and IC50, they were combined with CPP in both cell lines to assess their impact on the cell proliferation, viability, metabolism, and apoptosis. This combined approach significantly reduced the cell proliferation and viability while increasing the apoptosis signals compared to cytostatic therapy alone. The combination of CPP and chemotherapeutic drugs shows promise in targeting chemoresistant CS cells, potentially improving the prognosis for patients in clinical settings
Clinical Manifestations of Infections with the Omicron Sub-Lineages BA.1, BA.2, and BA.5: A Retrospective Follow-Up Analysis of Public Health Data from Mecklenburg-Western Pomerania, Germany
Get PDFThe Omicron variants BA.1, BA.2, and BA.5 caused several waves of SARS-CoV-2 in Germany in 2022. In this comparative study, public health data on SARS-CoV-2 infections from Mecklenburg-Western Pomerania, Germany, between January and October 2022 were examined retrospectively using Pearson’s chi-squared tests and Fisher’s exact tests for testing for statistical significance. Compared to BA.5 infections, BA.1 and BA.2 infections affected younger individuals aged up to 19 years significantly more often, whereas BA.5 infections occurred significantly more frequently in patients between 40 and 59 years of age when compared to BA.1 and BA.2. Infections with all three variants predominantly caused flu-like symptoms; nevertheless, there were significant differences between the reported symptoms of BA.1, BA.2, and BA.5 infections. Especially, the symptoms of ‘fever’, ‘severe feeling of sickness’, ‘loss of taste’, and ‘loss of smell’ were significantly more often present in patients with BA.5 infections compared to BA.1 and BA.2 cases. Additionally, BA.2 and BA.5 cases reported significantly more often the symptoms of ‘runny nose’ and ‘cough’ than BA.1-infected cases. Our findings indicate remarkable differences in the clinical presentations among the sub-lineages, especially in BA.5 infections. Furthermore, the study demonstrates a powerful tool to link epidemiological data with genetic data in order to investigate their potential impact on public health
Durchs Feuer. Schauspiel in fünf Aufzügen
Get PDFAuf Gut Allay ist Zofe Christine ins heiratsfähige Alter gekommen. Ihr Herz hängt an Edgar, der ein einfacher Gutsarbeiter ist und einen cholerischen Charakter hat. Außerdem hat er ein Alkoholproblem. Deswegen neigen Christines Verstand und ihre Mutter Herrn Steincken zu, einem anständigen Gutsbauern mit Besitz, der Christine mag. Doch leider ist Christine nicht in ihrer Entscheidung frei, weil illustre Figuren des Guts eine Intrige gegen sie spinnen
Cognitive training and brain stimulation in patients with cognitive impairment: a randomized controlled trial
Get PDFBackground
Repeated sessions of training and non-invasive brain stimulation have the potential to enhance cognition in patients with cognitive impairment. We hypothesized that combining cognitive training with anodal transcranial direct current stimulation (tDCS) will lead to performance improvement in the trained task and yield transfer to non-trained tasks.
Methods
In our randomized, sham-controlled, double-blind study, 46 patients with cognitive impairment (60–80 years) were randomly assigned to one of two interventional groups. We administered a 9-session cognitive training (consisting of a letter updating and a Markov decision-making task) over 3 weeks with concurrent 1-mA anodal tDCS over the left dorsolateral prefrontal cortex (20 min in tDCS, 30 s in sham group). Primary outcome was trained task performance (letter updating task) immediately after training. Secondary outcomes included performance in tasks testing working memory (N-back task), decision-making (Wiener Matrices test) and verbal memory (verbal learning and memory test), and resting-state functional connectivity (FC). Tasks were administered at baseline, at post-assessment, and at 1- and 7-month follow-ups (FU). MRI was conducted at baseline and 7-month FU. Thirty-nine participants (85%) successfully completed the intervention. Data analyses are reported on the intention-to-treat (ITT) and the per-protocol (PP) sample.
Results
For the primary outcome, no difference was observed in the ITT (β = 0.1, 95%-CI [− 1.2, 1.3, p = 0.93] or PP sample (β = − 0.2, 95%-CI [− 1.6, 1.2], p = 0.77). However, secondary analyses in the N-back working memory task showed that, only in the PP sample, the tDCS outperformed the sham group (PP: % correct, β = 5.0, 95%-CI [− 0.1, 10.2], p = 0.06, d-prime β = 0.2, 95%-CI [0.0, 0.4], p = 0.02; ITT: % correct, β = 3.0, 95%-CI [− 3.9, 9.9], p = 0.39, d-prime β = 0.1, 95%-CI [− 0.1, 0.3], p = 0.5). Frontoparietal network FC was increased from baseline to 7-month FU in the tDCS compared to the sham group (pFDR < 0.05). Exploratory analyses showed a correlation between individual memory improvements and higher electric field magnitudes induced by tDCS (ρtDCS = 0.59, p = 0.02). Adverse events did not differ between groups, questionnaires indicated successful blinding (incidence rate ratio, 1.1, 95%-CI [0.5, 2.2]).
Conclusions
In sum, cognitive training with concurrent brain stimulation, compared to cognitive training with sham stimulation, did not lead to superior performance enhancements in patients with cognitive impairment. However, we observed transferred working memory benefits in patients who underwent the full 3-week intervention. MRI data pointed toward a potential intervention-induced modulation of neural network dynamics. A link between individual performance gains and electric fields suggested dosage-dependent effects of brain stimulation. Together, our findings do not support the immediate benefit of the combined intervention on the trained function, but provide exploratory evidence for transfer effects on working memory in patients with cognitive impairment. Future research needs to explore whether individualized protocols for both training and stimulation parameters might further enhance treatment gains.
Trial registration
The study is registered on ClinicalTrials.gov (NCT04265378). Registered on 7 February 2020. Retrospectively registered