Die Beeinflussung des Wachstums mit der Vorschubdoppelplatte im Vergleich zu anderen funktionskieferorthopädischen Geräten

Zusammenfassung Der dentale und skelettale Einfluß der Vorschubdoppelplatte konnte im Vergleich zu anderen funktionskieferorthopädischen Geräten gezeigt werden. Dabei ergaben sich folgende Besonderheiten: 1. Die Vorschubdoppelplatte übt einen skelettalen Einfluß auf den Oberkiefer aus. Dieser ist vergleichbar mit der Wirkung, die funktionskieferorthopädische Geräte in Kombination mit extraoralen Kräften zeigen (SNA-Winkel). 2. Der Einfluß auf den Unterkiefer (SNB-Winkel) entsprach in der Größenordnung dem elastisch offenen Aktivator nach Klammt und dem Teuscher-Aktivator. 3. Die Reduzierung des ANB-Winkels war bei der Vorschubdoppelplatte, verglichen mit den anderen Geräten, am größten. 4. Die Beeinflussung der Neigung der Spinaebene zur Nasion-Sella-Linie war nahezu Null. 5. Die Neigung der Unterkieferschneidezähne zur Gonion-Menton-Ebene wurde praktisch nicht beeinflußt. 6. Im Oberkiefer fand eine Retrusion der Schneidezähne statt. 7. Die Veränderung des Winkels UK zu NB im Vergleich zu UK zu GoMe zeigt, daß tatsächlich eine Vorverlagerung des Unterkiefers stattgefunden hat. Die besondere Wirkung der Vorschubdoppelplatte gegenüber anderen funktionskieferorthopädischen Geräten erklärt sich aus folgenden Aspekten: a) Durch die langen Stege ist auch bei einer größeren Mundöffnung eine sagittale Beeinflussung des Unterkiefers vorhanden [29]. b) Die Reibung zwischen den Stegen und der schiefen Ebene des Unterkiefers ist außerordentlich gering und nicht zu vergleichen mit der Reibung zwischen den Zähnen und dem Kunststoff bei sonstigen funktionskieferorthopädischen Geräten [28]. c) Patienten, die mit der Vorschubdoppelplatte im Munde sprechen, nehmen eine Position des Unterkiefers ein, die weiter sagittal liegt, als es der Konstruktionsbiß vorgibt [30].

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Summary The bite-jumping-appliance BJA is a special functional appliance which affects the upper jaw comparably to activator-headgear combinations (SNA angle). Concerning its influence on the lower jaw (SNB angle) the BJA can be compared with the Teuscher-activator and the Klammt-activator. The change in the inclination of the upper jaw (ANS-PNS to Nasion-Sella) proved to be negligible because the vector of the force passed through the center of resistance of the upper jaw. The extend of the dental influence was the largest with the activator, the smallest with the Fränkel II appliance. The inclination of the lower incisors ( to Gonion-Menton) was hardly affected. The upper incisors were retruded however not be the same extend as with the Teuscher-activator which even has torque springs (to avoid the retrusion). The treatment of all the patients ended in all cases excepting those that were treated with an activator in a nearly ideal IIW angle. Our findings encourage us to say that the BJA is an appliance with a far better working mechanism than the working mechanism of other functional appliances.

     

Length variation of a polyglutamine array in the gene encoding a small-conductance, calcium-activated potassium channel (hKCa3) and susceptibility to idiopathic generalized epilepsy

The present association study tested whether length variations of two adjacent polymorphic CAG repeats in the coding sequence of a small-conductance, calcium-activated potassium channel (hKCa3) confer susceptibility to common subtypes of idiopathic generalized epilepsy (IGE). We found no significant difference in the allelic length distribution of the CAG repeats between 290 healthy German controls and the entire sample of 126 German IGE patients (Wilcoxon rank-sum test, P = 0.44) or two subgroups, comprising either 78 patients with juvenile myoclonic epilepsy (Wilcoxon rank-sum test, P = 0.74) or 59 patients with idiopathic absence epilepsies (Wilcoxon rank-sum test, P = 0.44). Moreover, the allelic distribution in parents-child trios of 46 IGE offspring did not differ significantly between the transmitted and non-transmitted parental alleles (Wilcoxon rank-sum test, P = 0.48). Therefore, our association study provides no evidence that length variations of polyglutamine arrays in the N-terminus of the hKCa3 channel exert a frequent and relevant effect in the epileptogenesis of common subtypes of IGE.     

Progress in care and treatment of multiple trauma patients during the last twenty years

During the last 20 years, the increase in polytrauma has stimulated scientific development and brought about new activities in the field of patient can, Of these new activities, the early treatment of shock by first aid measures and intensive therapy are of greatest importance. In the operative approach, the atraumatic method of operation with the help of new technical devices, instruments, and implants has stood the test of time. A remarkable development arose in the operative treatment of fractures, which plays a decisive role in polytrauma on account of the high rate of bone injuries as well as for reasons of general patient support. The operative treatment of abdominal, craniocerebral, and thoracic injuries was improved not so much by changing operative technics, but rather by vigorous treatment of shock and intensive medical support which have decisively changed the magnitude and timing of the surgery that can be performed to aid the patient. By this means, as well as by newly developed diagnostic possibilities, the necessary conditions for an effective operative treatment have been greatly improved. Thus, at present, more complete primary care of the injured may be carried out successfully in a large percentage of trauma victims.     

The "Lower Saxony/Northern Rhine-Westphalia" Neuroblastoma Screening Project: on the need for epidemiologic comparison]

The proof for the general evolution of metastatic neuroblastoma from localized disease by a low-speed process is lacking. The epidemiological approach would require the decrease of neuroblastoma related mortality by reduction of the number of metastatic cases per population unit as a result of a screening program. During 1983 through 1990 the neuroblastoma incidence in the FRG was 0.85-1.09 cases per 100,000 children less than 15 years of age. The mortality rate ranged between 0.25 and 0.49 deaths per 100,000 children. The project "Niedersachsen/Nordrhein-Westfalen" started April 1st, 1992 and is investigating urinary catecholamine metabolite excretion in infants at the age of 10-12 months and for a second time in toddlers at 17-19 months. The target population includes 24.7 million inhabitants with 267,000 births per year. The urine sampled on filter paper is analyzed using thin layer chromatography. Positive and questionable positive results are confirmed by HPLC and GC-MS. The aim of the study is to demonstrate the feasibility of the chosen approach. Furthermore first epidemiological data will be obtained. Until a population-based study on neuroblastoma mortality in screened versus controlled populations has proven the usefulness of the screening it cannot be recommended as a general service to the public.     

Dreidimensionale computergestützte Modell- und Hologrammauswertung

Zusammenfassung Es wird ein selbstgebautes Vermessungsgerät für die dreidimensionale Vermessung von Modellen und Hologrammen vorgestellt. Folgende Besonderheiten weist dieses Meßsystem auf: 1. Alle Vermessungen erfolgen ohne Zuhilfenahme von optischen Instrumenten (Lupe, Mikroskop, Fernglas) und ermöglichen so ein ermüdungsfreies Messen. 2. Für die Vermessung der dreidimensional getrimmten Modelle ist lediglich das Einbohren von zwei Löchern mit 3 mm Durchmesser in die Modelle notwendig. 3. Die Benutzeroberfläche des Programmes ist menü- und fensterorientiert aufgebaut und läßt somit die Erstellung einer Datenbank zu. 4. Die mit diesem Gerät erzielte Genauigkeit übertrifft selbst bei der Hologrammauswertung die übliche Vermessung von Modellen um ein Vielfaches. 5. Hologramme stehen hinsichtlich ihrer Genauigkeit und ihres Informationsgehaltes den üblichen Modellen kaum nach. 6. Die Durchzeichnungen der Modelle und die Berechnungen der Strecken und Winkel erlauben dem Behandler einen schnellen Überblick über die zu behandelnde Problematik. 7. Durch die Transferierung der Modellanalyse in die seitlichen Fernröntgenaufnahmen sowie in die posterior-anterioren Aufnahmen entstehen neue diagnostische Möglichkeiten.

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Summary For the three-dimensional measurement of plaster casts and hologramms a self-fabricated measurement device will be introduced. This measurement device has the following specialities: 1. All measurements will be done without any subsidiary optical instruments like spectacles, microscope, binoculars or any thing else. Therefore a tire of measuring can be carried out. 2. Only two 3 mm deep wholes should be grinded in the base of the pflaster casts as preparatory measures for the three-dimensional measurements of the plaster casts. 3. The menue- and window orientated software gives the possibility for the collecting of datas in a data bank. 4. The precision of these measurement results, even in the case of measuring hologramms, are frequently better than the common way of measuring plasters casts. 5. The precision and information by the hologramms are nearly the same, compared with the common plaster casts. 6. The tracing and measuring of the angles and lines by this newly measurement device guaranties the doctor a quick overview concerning the therapeutic measures. 7. The transfer of these datas in the lateral-rays and in the posterior-anterior findings leads to a better diagnostic. That means the diagnostic horizont will be widened with this new method.

     

Evaluation of a child health associate program.

The staff of the University of Colorado Child Health Associate Program critically reviewed the effectiveness of the program's structure and content during an intensive two-day seminar. The review was conducted through workshops involving participants representing students, graduates, faculty, employers, funding agencies, university administrators, and educational consultants. The agenda for the evaluation included workshops on specific topics such as basic and clinical sciences, psychosocial skills, and proficiency testing. Information obtained provided extremely valuable data which were used to improve the program.     

Patient Capacity in Mental Health Care: Legal Overview

The discriminatory effects of categorizing psychiatric patients into competent and incompetent, have urged lawyers, philosophers and health care professionals to seek a functional approach to capacity assessment. Dutch and English law have produced some guidelines concerning this issue. So far, most legal systems under investigation have concentrated on alternatives for informed consent by the patient in case of mental incapacity, notably substitute decision-making, intervention of a judge and advance directives. It is hard to judge the way in which the law may further adapt to a more functional assessment of capacity, because the nature of law shows that legal reforms usually take place only when new methods have been accepted by the field. This is not yet the case today.     

Early risk factors for miscarriage: a prospective cohort study in pregnant women

Many pregnancies are lost during early gestation, but clinicians still lack tools to recognize risk factors for miscarriage. Thus, the identification of risk factors for miscarriage during the first trimester in women with no obvious risk for a pregnancy loss was the aim of this prospective cohort trial. A total of 1098 women between gestation weeks 4 and 12 in whom no apparent signs of a threatened pregnancy could be diagnosed were recruited. Demographic, anamnestic, psychometric and biological data were documented at recruitment and pregnancy outcomes were registered subsequently. Among the cases with sufficiently available data, 809 successfully progressing pregnancies and 55 subsequent miscarriages were reported. In this cohort, risk of miscarriage was significantly increased in women at higher age (>33 years), lower body mass index (< or =20 kg/ m(2)) and lower serum progesterone concentrations (< or =12 ng/ml) prior to the onset of the miscarriage. Women with subsequent miscarriage also perceived higher levels of stress/demands (supported by higher concentrations of corticotrophin-releasing hormone) and revealed reduced concentrations of progesterone-induced blocking factor. These risk factors were even more pronounced in the subcohort of women (n = 335) recruited between gestation weeks 4 and 7. The identification of these risk factors and development of an interaction model of these factors, as introduced in this article, will help clinicians to recognize pregnant women who require extra monitoring and who might benefit from therapeutic interventions such as progestogen supplementation, especially during the first weeks of pregnancy, to prevent a miscarriage.     

High Prevalence of Physical Frailty Among Community-Dwelling Malnourished Older Adults–A Systematic Review and Meta-Analysis

Background

Malnutrition and frailty are two geriatric syndromes that significantly affect independent living and health in community-dwelling older adults. Although the pathophysiology of malnutrition and physical frailty share common pathways, it is unknown to what extent these syndromes overlap and how they relate to each other.